Med-Certification.com Expects Industry "Hiccups" with New Models for Patient Care and Reimbursement

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Medical Career Certification

Aug 28, 2014, 08:00 ET


Salt Lake City, UT (PRWEB) August 28, 2014 -- CMMI (Center for Medicare and Medicaid Innovation) is suggesting more attention to coordination and integration of care to address patient needs. What does it all mean? The idea is to improve the quality of care outcomes (with more provider accountability) and reduce the cost of care.

Bundled payments are anticipated where all the people involved in the care of a patient get a single payment from the payer and have to figure out how to distribute it. If it sounds complicated, that's because it is. To complicate things further, there's a smorgasbord of acronyms involved throughout the entire process.

  • ACO (Accountable Care Organization)
  • The Affordable Care Act, the ACA, or, sometimes "Obamacare." The first version was called the Patient Protection and Affordable Care Act (PPACA). After the law was amended, this ungainly name was then shortened to the "Affordable Care Act" (ACA).
  • PCMH (Patient Centered Medical Homes)
  • CMACA (Centers for Medicare and Medicaid Affordable Care Act)
  • and on and on

Incentives of the process include prevention and "cost shifting" where - according to CMS - providers may increase rates from non-Medicare patients to avoid losing money which is definitely predicted with the coming changes in Medicare-Medicaid reimbursement models. Private insurers hint at limiting payments for problems acquired in hospitals, e.g., infections, bed sores, etc., and for better control of hospital readmissions which might have been preventable.

CMS advisories state that payments would be based on value, not volume, meaning that physicians will see payments related to better reimbursement for those who provide higher quality care and lower payments to those who provide lower quality. Penalties will be also be forthcoming based on 2013 performance.

What body will govern how to improve the quality of care for Medicare beneficiaries while containing cost growth? Why, another acronym, of course. The Independent Payment Advisory Board (IPAB) was established with the ACA and began its work in 2012. This board monitors the fiscal health of the Medicare program and makes annual recommendations to Congress regarding how to improve quality of care for Medicare beneficiaries while containing cost growth. That is a daunting task.

With such a complicated process being rolled out, Med-Certification anticipates an increase in demand for medical billing and coding training to fulfill opening career slots. For those confused about the entire process of patient care, they're not alone. To learn more about the healthcare industry, visit med-certification.com for news, training, and more.

Jari Davis, Medical Career Certification, http://www.med-certification.com, +1 (801) 774-9999, [email protected]