The Fall 2012/Winter 2013 issue of The Florida Home Care Connection, HCAF’s official magazine, is now available online! This issue focuses on how health care reform is impacting the home care industry, and features articles from leading industry professionals.
Check out what’s inside:
ACOs and Independence at Home: Will They Flourish or Fail?: Reducing cost while improving the quality of care…sounds like a dream combination but are these models sustainable? This article will look at two aspects of the Act that have promised just this: 1) accountable care organizations can share in the cost savings they achieve for the Medicare program, provided they voluntarily meet quality thresholds; and 2) under the Independent at Home Demonstration, the effectiveness of delivery of primary care services at home will be tested, to see if this improves care for patients with multiple chronic conditions. The goal is to reward health care providers who provide high quality care while reducing costs, but with such a complicated network of providers, can this really transpire and where does it leave the rest of us?
Meeting the New Needs of Hospitals Should Be Our Goal: Value-based purchasing rules now tie acute care Medicare reimbursement to a hospital’s quality performance. This includes the Hospital Readmission Reduction Program, which lowers payment rates for all Medicare discharges if acute care hospitals experience higher-than-average readmission rates for certain “applicable conditions.” The program has begun with three applicable conditions: acute myocardial infarction (AMI), heart failure, and pneumonia. 2) Also, one percent of Medicare payments to hospitals will be withheld during FY 2013, amounting to about $850 million to be awarded to hospitals that meet a set of quality performance measures. This article seeks to explore what home care can do to become part of the solution that hospitals desperately need us to be.
The Latest Payment Mix or Mess: One in four enrollees in Medicare receive their benefits through private “Medicare Advantage” health plans. However, Medicare Advantage plans cost the federal government about 10 percent more than the traditional Medicare fee-for-service program. Rebates have been reduced for Medicare Advantage plans while providing a bonus payment to high-quality plans. Payment changes have also come into effect, adding a productivity adjustment for certain providers, which is expected to result in lower rates than otherwise would have been paid. Are these latest tweaks to the neverending payment changes achieving what they set out to do?
Clearing and Leveling the Playing Field: The Affordable Care Act seeks to take historic steps toward combating health care fraud and abuse by providing new tools to crack down on entities and individuals attempting to defraud Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and private insurance plans. This article will look at the effectiveness of the fraud and abuse prevention aspects of the Act, as well as the whether or not the enhanced data collection and reporting requirements aimed at ensuring underserved populations, are getting the care they need.
Reform on Florida’s Home Front: CMS conducts and sponsors many demonstration projects to test and measure the effect of potential program changes. The latest demonstration projects in Medicaid pay bundled payments for episodes of care that include hospitalizations and allow pediatric medical providers to share in cost-savings. This article will discuss Florida’s progress as well as Health Insurance Exchanges (HIX), which help insurers comply with consumer protections, compete in cost-efficient ways and facilitate the expansion of insurance coverage to more people.
In addition to these informative articles you’ll find details about upcoming HCAF events and more!