This week’s Medicare updates include the release of the End-Stage Renal Disease Prospective Payment System final rule, an announcement of the next round of Medicare Recovery Audit Contractors, the Hospital Outpatient Prospective Payment Changes for 2017 final rule, CY 2017 Home Health Prospective Payment System, a Hospital Appeals Settlement Update, and more!
Medicare beneficiaries sometimes have information about discharge planning from CMS. What questions might they ask as a result of having this information?
Opening the lines of communication between clinicians and specialists to make care more efficient can be a sizable challenge.
At many facilities, hospitalists shuttle from floor to floor to see patients, each time trying to track down the nurse and other professionals working on each case. Information is typically transferred through an inefficient system of pages and phone calls, sometimes taking hours at a time to deliver crucial pieces of information.
Enter the accountable care unit, a new way of configuring care systems that can help to uncoil tangled communication wires between clinicians and support staff to provide care that is more efficient and streamlined.
In this model, hospitalists work with patients in a specified geographical area of the hospital in conjunction with interdisciplinary teams.
Having patients in one area helps make care more efficient, and as one hospital system in New Mexico learned, can also reduce length of stay and increase cost-efficiency.
Regionalization of hospitalist patients is becoming more common today, because of the benefits it's been shown to bring, says Stefani Daniels, RN, MSNA, ACM, CMAC, founder and managing partner of Phoenix Medical Management in Pompano Beach, Florida. Those benefits include:
Improved teamwork, care coordination, and communication
Fewer readmissions
Improved resource management to lower cost of care
Improvements in patient satisfaction
Reduction in inefficiencies
"I'm pushing accountable care units at all my hospital clients," says Daniels. But while the will is there in many cases to make the change, it's not always an easy conversion.
Sometimes these initiatives face pushback from physicians concerned about personnel or scheduling issues.
Other challenges include:
The lack of diagnostic diversity that results from having set teams on a unit
The challenge of deciding whether teams should be flexible or static
Hammering out logistical issues, such as how patients should be triaged and how beds are managed
Hospitals got a last-minute reprieve from the Medicare Outpatient Observation Notice (MOON) notification requirement, which was set to go into effect August 6. Citing the need for additional time to revise the standardized notification form that hospitals will need to use to notify patients about the financial implications of being assigned to observation services, CMS moved back the start date for the requirement in the 2017 IPPS final rule to 'no later than 90 days,' after the final version of the form is approved (www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/...).
If your hospital resides in one of the 67 metropolitan statistical areas (MSA) required to participate in the Comprehensive Joint Replacement Model (CJR), you will also be required to participate in a new orthopedic payment model called 'SHFFT' (surgical hip and femur fracture treatment) if an August 2 proposed rule is finalized. The impact? The following assigned MS-DRGs will no longer define hospital reimbursement:
Major Joint Replacement or Reattachment of Lower Extremity (MS-DRGs 469, 470)
Hip and Femur Procedures Except Major Joint (MS-DRGs 480, 481, 482)
