Accountable Care Organizations

Also in the news for Nov. 5, 2014 . . .

Supreme Court hears arguments over whether Omnicare misled investors ... Hospice medical director faces up to 20 years in prison for improper patient certifications ... Lack of interoperability is hindering accountable care organizations, ONC report says

For long-term operators, a growing list of 'frenemies'

For long-term operators, a growing list of 'frenemies'

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Most of us are all too aware of our professional friends and enemies. But not so much when it comes to our "frenemies." Given the many changes taking place in healthcare today, the frenemy list for many long-term care operators is expanding as never before.

Latest ACO dropout blames issues with payment system

Latest ACO dropout blames issues with payment system

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A California healthcare system recently became the latest dropout from the Pioneer Accountable Care Organization program, citing the fact that payments are not adjusted by region. Sharp HealthCare announced the move in its third-quarter financial report.

No ACOs have reliable interoperability with external organizations, survey finds

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A widespread lack of interoperable technology threatens the Accountable Care Organization model, according to recently released survey results.

Report: Complex care management can succeed, reduced Medicare SNF expenditures 64% in one instance

Report: Complex care management can succeed, reduced Medicare SNF expenditures 64% in one instance

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Well-designed programs to coordinate care for patients with complex needs can reduce Medicare expenditures, including skilled nursing facility costs, according to an issue brief released Thursday by The Commonwealth Fund.

Skilled nursing facility trends contribute to improved Medicare outlook, Congressional report says

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The Medicare trust fund is on track to remain solvent until 2030, trustees of the program stated in a Congressional report released Monday. This improved outlook is due in part to revised expectations about the case mix in skilled nursing facilities.

 Skilled nursing facility readmissions should be an ACO quality measure, government proposes in payment rule

Skilled nursing facility readmissions should be an ACO quality measure, government proposes in payment rule

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Accountable care organizations should be assessed on the number of people who return to a member hospital within 30 days of being discharged to a skilled nursing facility, the Centers for Medicare & Medicaid Services has stated in a proposed rule.

Managed care will completely replace today's healthcare payment system by 2025, former White House adviser says

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Healthcare providers should expect that they will be paid exclusively through managed care systems by 2025, a former White House adviser said Tuesday.

All ACOs should be allowed to waive 3-midnight requirement for Medicare skilled nursing coverage, MedPAC says

All ACOs should be allowed to waive 3-midnight requirement for Medicare skilled nursing coverage, MedPAC says

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Accountable care organizations should be able to place patients in skilled nursing facilities more quickly and communicate which SNFs are preferred providers, the Medicare Payment Advisory Commission stated in a letter to a top government health official.

Jonathan Blum, who oversaw long-term care reforms, resigns as head of Medicare

The nation's top Medicare official, Jonathan Blum, is leaving his post next month, news outlets reported Tuesday. Blum became a familiar figure to long-term care providers through Open Door Forum calls and other outreach efforts during his five-year tenure, as he guided implementation of Medicare reforms under the Affordable Care Act.

Long-term care providers are participating in 'most ambitious test' of bundled payments, CMS announces

Long-term care providers are participating in 'most ambitious test' of bundled payments, CMS announces

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Skilled nursing facilities and home health agencies are among 232 healthcare providers that have entered into agreements to take part in the Bundled Payments for Care Improvement initiative, the Centers for Medicare & Medicaid Services announced Thursday.

Transition from facility to home- and community-based care greatly increases dual eligibles' risk of hospitalization, study shows

Transition from facility to home- and community-based care greatly increases dual eligibles' risk of hospitalization, study shows

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Dual eligibles who moved from a long-term care facility to home- and community-based services had a 40% increased risk of a potentially preventable hospital stay, according to recently published research.

Table talk: You have to listen to the right people

Table talk: You have to listen to the right people

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When we at McKnight's host a special roundtable discussion, I look forward to getting to know the esteemed participants. Captains of the profession, they typically have evolved from nurses, business managers and doctors into C-suite inhabitants — extremely observant top executives, in fact.

McKnight's Roundtable: Changes ahead

McKnight's Roundtable: Changes ahead

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Top long-term care officers tackled some of the field's main challenges, exchanged perspectives on new opportunities and shared ideas on what the future might hold.

Heard around the table: Provider execs listening to the right people

Heard around the table: Provider execs listening to the right people

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Captains of the long-term care profession get to their lofty positions by using their intellect and superior vision skills, as a gathering of minds recently re-emphasized.

Providers to learn: never enough friends in play

Providers to learn: never enough friends in play

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Sometimes long-term care providers struggle to find meaning in the signs that are strewn in their path. Whether it's legalese, regulatory gobbledy-gook or some form of bureaucracy, uncertain messages confront providers seemingly every day.

Research organizations team up for large-scale senior fall prevention study

Research organizations team up for large-scale senior fall prevention study

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Two research organizations are teaming up for a major study to reduce the number of fall-related injuries among seniors. Provider input is requested.

Time is limited for ACO deals

Time is limited for ACO deals

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By negotiating now, a nursing home can have a strong voice in an Accountable Care Organization. Otherwise, ACOs will come to nursing homes in two or three years with a "take it or leave it" proposition, according to John Durso, a partner at the law firm of Ungaretti & Harris LLP and a McKnight's Expert columnist.

Engaging ER physicians the way to go for long-term care

Engaging ER physicians the way to go for long-term care

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Healthcare journalists may have fallen inadvertently into triggering a Pavlovian response in our readers: We write "hospital readmissions" and you click.

Nursing homes' strong negotiating position with ACOs will not last long, legal expert says

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Skilled nursing facilities that delay joining an Accountable Care Organization will likely be losers in the healthcare marketplace, according to John Durso, a partner at the law firm of Ungaretti & Harris LLP. Durso recently offered tips for nursing homes that are negotiating to join an integrated care network.

Medicare reform proposed in new report

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Medicare beneficiaries should be allowed to enroll in a network that would "incentivize higher quality" and more cost-effective and coordinated care, according to a new report whose authors include three former Senators.

Updated palliative care guidelines: Providers should increase coordination, embrace QAPI

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Palliative care should follow care coordination and quality improvement processes called for by the Affordable Care Act, according to updated guidelines from the National Consensus Project for Quality Palliative Care.

Medicare accepting new codes for transition care

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As part of an effort to improve coordination among different care settings and reduce rehospitalizations, the Centers for Medicare and Medicaid Services is now accepting two new codes related to transitional care.

Number of Medicare ACOs could top 300 in January, official says

Number of Medicare ACOs could top 300 in January, official says

Accountable care organizations contracting with Medicare might double in January, according to the head of the Center for Medicare & Medicaid Innovation.

ACOs making progress in improving care transition, survey finds

ACOs making progress in improving care transition, survey finds

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A snapshot of hospitals involved in accountable care organizations finds that they are making progress in improving the coordination of care.

Accessibility is key to success of ACOs, report says

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Those most likely to benefit from participation in accountable care organizations may face the biggest barriers to enrollment, a new report suggests.

Health info expert: Time for long-term care providers to raise their hands for inclusion

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Long-term care providers must collaborate and create partnerships with their acute care counterparts in order to make efficient use of new technology, a health information management expert told listeners at a special McKnight's webcast Tuesday.

CMS frees up $275 million for state coordinated care initiatives

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States eager to test payment reform models for federal health programs can apply for awards totaling $275 million, courtesy of the Centers for Medicare & Medicaid Services.

In wake of Supreme Court ruling, states weighing Medicaid options

In wake of Supreme Court ruling, states weighing Medicaid options

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Many states are considering their options in the wake of a seemingly favorable Supreme Court ruling. The nation's highest court ruled that Congress exceeded its reach when it threatened states with a total Medicaid funding cutoff if they failed to participate in an expanded Medicaid program.

ACOs could thrive even if healthcare law is overturned, experts say

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Accountable care organizations are expected to thrive even if the Supreme Court throws out the Affordable Care Act, healthcare law experts said Tuesday.

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