Health Care’s Latest Buzz

By Jackie Middleton, Vice President, Human Resources Operations


With changes to the Medicare payment system on the horizon, many new acronyms have surfaced. They’re quickly becoming part of our daily vocabulary, but more important, the meaning behind the letters will drive how hospitals and clinicians provide care. Every health care employee has a stake in these changes, how they’re implemented, and in the success of the organization for which they work.


To help you understand and navigate the changing health care landscape, here’s a brief overview of the latest lingo.


Accountable Care Organization (ACO)



  • Includes a network of physicians and hospitals that share responsibilities for providing care to patients

  • Manages health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years

  • Receives financial incentives to decrease growth of spending while meeting specific performance standards

  • Charged with coordinating care across the health care spectrum including physician offices, hospitals, and long-term care facilities

  • Accessed through voluntary participation for providers and patients



HAI – Hospital Acquired Infections



  • Represents a portion of the health care delivery system reforms that address patient safety by lowering hospital readmissions and reducing HAIs

  • Estimates reducing Medicare spending by $10 billion through 2013 if goals are met

  • Ensures goals are met through the Centers for Medicaid and Medicare Services (CMS) investment of $1 billion in funding from the Affordable Care Act through the Partnership for Patients Initiative

  • Targets 40 percent reduction in preventable HAIs, which translates to preventing 1.8 million injuries and 60,000 deaths for inpatients over the next three years

  • Targets 20 percent reduction in readmissions, or 1.6 million instances of readmissions



ICD-10-CM



  • Means the International Classification of Diseases, 10th Revision, Clinical Modification

  • Revised from ICD-9-CM

  • Classifies and codes all diagnoses, symptoms, and procedures

  • Includes more than 68,000 diagnostic codes, compared to 13,000 in ICD-9-CM

  • Uses alphanumeric category classifications for the first time



Meaningful Use of Compliance



  • Represents a reimbursement incentive for physician and hospital providers who become meaningful users of an electronic health record (EHR)

  • Includes incentive payments that begin this year and phase down gradually over the next several years

  • Incentivizes providers to adopt and actively utilize EHR in compliance with “meaningful use” definition by 2015, or subject to financial penalties


Value-Based Purchasing



  • Represents historic change in how Medicare pays health care providers and facilities

  • Means hospital inpatient acute care reimbursement will be based on quality, not quantity, of services they provide

  • Based on set of quality measures shown to improve clinical processes of care and patient satisfaction

  • Correlates higher quality measures with greater financial reward from Medicare



At Methodist Health System, a well-informed employee is an enlightened employee. To work where your light can grow brighter every day, visit Jobs.MethodistHealthSystem.org.


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