Judy Rich, President & CEO, Tucson Medical CenterIn this guest post, Judy Rich, president and CEO of Tucson Medical Center, shares the innovative ways her teams are leveraging technology to support improvements in care transitions. Tucson Medical Center is also part of Arizona Connected Care, which was recently selected to participate in the Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organization (ACO), sponsored by the Centers for Medicare and Medicaid Services (CMS).

Every hospital executive and clinician today is working to effectively manage what we call the “white space” – the place where patients exist between episodes of care, after a doctor’s appointment, surgery or procedure and before their next touch point or follow up. While it’s challenging to connect with patients once they leave the hospital and are out of our control, doing so is critical to both increasing quality of care and controlling healthcare costs. Mastering the “white space” plays a key role in helping patients stay on the road to recovery and ultimately reduce hospital readmissions.

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In this post from Mark Morsch, vice president of technology at OptumInsight, and Brian Potter, manager of NLP innovation at OptumInsight, explain how making the jump from ICD-9 to ICD-10 can be less intimidating to coding professionals.

Whenever the regulation goes into effect – currently proposed for October 1, 2014 – the expectation is that ICD-10 will be overwhelmingly complex for coding professionals. The sheer increase in the number of new codes in the system – a five time increase in diagnosis codes and a 19 time increase in procedure codes – may be daunting to even the best of coders. However, most do not realize that the code explosion comes from a handful of additional attributes that are being applied to codes they already know. Hospitals and health networks increasingly rely on computer-assisted coding (CAC) systems driven by natural language processing (NLP) technology, but not all NLP engines are created equal.

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It’s no secret that the transformation of U.S. healthcare will take a considerable amount of time (measured in terms of generations of people) and resources (both financial and human) to accomplish. But what we need to understand as an industry is that the best way to work toward accomplishing this goal is by transforming the health of individual communities one by one, learning from our successes and failures to make improvements for our neighbors. From there, we can allow the “snowball effect” to help us reach our ultimate goal: improved health for the entire country. Quite frankly the timeline is irrelevant – we must begin making changes now, beginning with the local healthcare delivery system.

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Rich Rogers is vice president of information technology and chief information officer at Health First in Rockledge Florida. In his guest post here on Healthcare-Exchange he discusses some of the lesser known impacts ICD-10 will have on healthcare organizations.

While we’re all trying to demonstrate meaningful use and achieve financial incentives, ICD-10 is still a major regulatory issue that hospitals and health systems have to prepare to support. For providers, ICD-10 is the equivalent of switching the entire U.S. to the metric system, impacting every part of our lives from footwear to the gas pump to baking ingredients. ICD-10 will change healthcare organizations not only in how they will secure revenue, but also in how they operate across every aspect of their business.

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Last week Todd Cozzens outlined some of the shifts he sees happening over the next year in health care, and this week we’re turning it over to you, our readers. In this, our latest poll, we want to know what your health care IT plans are.

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In 2011, the health care industry went through some interesting changes – from Meaningful Use attestations and delays to ICD-10 – but one of the less publicized milestones was one that may have a deeper and longer lasting effect on how we care for patients and that was the CMS final rule on the Medicare Shared Savings Program (MSSP). I believe that this rule, and the types of new provider risk-bearing models it encourages, will spawn a whole new generation of health information technology. A generation that focuses not just on patients currently seeing doctors and being admitted to hospitals and appearing on a census, but on a much broader spectrum of analytics, clinical transformation tools, wellness/prevention solutions and automated care management systems for comprehensive management of patient populations.

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Provider organizations have always focused on the importance of accurate documentation of health care services, and as an industry we all know that documentation accuracy is key to ensuring the appropriate reimbursement. But as my colleague Dean Farley pointed out in his recent post, the shift to accountable care and new payment models is inevitable. With these new payment models, along with the greater specificity and increased scope for both diagnosis and procedure coding that ICD-10 will bring next year, physicians are going to need to pay even closer attention to care documentation.

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For an MSSP ACO to succeed, it must deliver care to its attributed Medicare fee-for-service population for less than it costs CMS. Comparing an ACO’s actual cost of care to CMS’ pre-determined value of what it is expected to cost them ─ or the ACO’s “hurdle rate” ─ determines if an MSSP ACO will be able to participate in gain. But as of now, CMS hasn’t released these hurdle rates ─ making it very difficult for an MSSP ACO to ascertain whether success is possible under these parameters, and therefore to decide with any confidence whether or not to proceed to contract with CMS.

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This week’s guest post comes from Dean Farley PhD, Vice President at OptumInsight. An advocate for collaboration across all constituencies for better patient care, here he explains how payers and providers can make bundled payments a reality.

The idea of implementing bundled payments can be intimidating for any hospital CFO. But, as a way of paying providers that combines all the services needed to treat a patient, bundled payments are an inevitable step for both payers and providers as the industry heads toward accountable care.

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In this week’s guest post Dr. Miles Snowden, chief medical officer at OptumHealth, offers tips for stimulating patient accountability in the age of accountable care.

While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability. More and more frequently patients are selecting doctors with the best outcomes, asking proactive questions, and taking an active role in their lifestyle and behaviors. Empowering patients with the support and tools to be responsible for and more involved in their own health is critical to improving outcomes and reducing costs as part of any accountable care environment.  In fact, Optum found that when given more information about a planned elective surgery, 1 of every 15 patients change course – either deferring, choosing a less intensive option, or changing facility or proceduralist.

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