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  • Tom Boyd

Don’t Cross the Line

Care Continuum Alliance Releases Free ACO Toolkit

 Guidance for healthcare providers preparing for Medicare’s payment system from fee-for-service and episodic care to Accountable Care Organizations has been both scattered and expensive to date.  That changes this week with the release of a free, 60-page toolkit from the research and education group, Care Continuum Alliance, an advocacy organization for reducing preventable costs and improving quality of life for individuals with and at risk of chronic conditions.

Study finds infection violations at 15 percent of nursing homes

Healthcare Finance NewsDay, May 3, 2011

Fifteen percent of U.S. nursing homes receive deficiency citations for infection control per year, according to a new study.

Study: Employer sponsored healthcare coverage costs up

Healthcare Finance NewsDay, May 3, 2011

The Thomson Reuters Healthcare Spending index for Private Insurance showed that costs to people covered under employer-sponsored health insurance rose at a rate of 5.8 percent last year…

ACO Proposed Rule Draws Tough Questions, Highlights System’s Shortcomings

Kaiser Health News, May 3, 2011

CQ HealthBeat reports that federal officials are considering the public criticism and comments they are receiving in response to the proposed rule issued regarding the health law’s accountable care organizations.  One expert, for instance, tells Politico Pro that data collection challenges could impede the formation of ACOs.

CQ HealthBeat Medicare Officials Acknowledge Criticism of ACO Proposal

Top Medicare official Jon Blum said Monday that federal officials are taking seriously the many tough questions raised by the public about the proposed rule for accountable care organizations released March 31.  “Some of the reaction is, “You guys made this so hard we can’t participate,” Blum said at a meeting sponsored by the College of American Pathologists.  Some stakeholders have told federal officials that the proposal “isn’t a good deal,” he said (Adams, 5/2).

Politico ProExpert: ACOs Challenged By Lack Of Data

Health care may be cutting edge when it comes to scientific innovation, but it is very backward when it comes to best practices in business, a quality expert charged Monday.  Margaret O’Kane, head of the National Committee for Quality Assurance, an accrediting and evaluation body, said that problems with data collection and information technology in the health industry could impede the formation of accountable care organizations (Feder, 5/3).

Modern HealthcarePatients May Present ACO Concerns Of Their Own Officials Say

Some of the biggest concerns arising from proposed accountable care organization rules may end up coming from patients and not health care providers, according to a senior CMS official.  Health care providers have outlined a series of concerns to the CMS since the agency proposed ACO rules on March 31 to create coordinated care groups that aim to slow the growth in health care spending while making member-clinicians eligible to receive a share of the resulting savings (Daly, 5/2).

Audits: Don’t Cross The Line When Teaching Staff How To Respond To Auditors, Surveyors

Home Care Week, May 6, 2011 (to subscribe call 800.508.2582)

Beware ever saying this.

Solid bet:  “With all the different entities out there doing audits, it’s not a matter of if but when someone will knock on your door,” says attorney Paula Sanders with Post & Schell in Harrisburg, Pa.  And part of your preparation for such an event should include educating staff about how to deal with auditors in an appropriate way.

“You can’t tell staff not to speak to an investigator but you can inform them of their rights – those are two totally different things,” Sanders relays.  “The policy would be that ‘we cooperate, we tell the truth, we don’t hide things.’  That’s where the training piece comes in.  You don’t want a rogue manager running around saying, ‘Don’t say anything.’  And then boom, you’re hit with an obstruction of justice charge.”

Sanders says she doesn’t have a problem with training people to understand how to reply to questions, which is what attorneys do to prepare people for a deposition.  “You teach people to listen to the question and answer and not guess or be afraid to say:  “I can’t recall but I will check into it” or “I am not certain about the answer, but I will find out for you,” Sanders says.

“What often gets people into trouble is speculating in an effort to be helpful,” she warns.

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