Physician Ratings May Be Coming to a Clinic Near You
Published on January 16, 2013 by Karen Newmeyer
Contributed by Tim Sutton, Health Care Management and Health Fitness Specialist, Broadview University
That’s right! How well your doctor treats their patients will be evaluated and the physician will be reimbursed accordingly. This may be a new concept in health care. However, your doctor won’t be alone in this process. The Department of Health and Human Services (HHS), as part of the implementation of Obamacare, mandates that physicians, clinics, and hospitals organize themselves into Accountable Care Organizations (ACO). These ACO’s, will then be evaluated and reimbursed based on these evaluations.
ACO’s, organizations of healthcare providers, will deliver coordinated care and chronic disease management in order to improve the quality of care their patients receive. The ACO’s will also be required to serve a minimum of 5,000 Medicare patients. The organization’s payment for these services is than tied to achieving healthcare quality goals and outcomes that result in cost savings. Those providers that do not adapt to this new mandate will be reimbursed by Medicare (all insurance carriers will surely follow), at a lower rate.
Health and Human Services has 59 proposed measures for evaluating the quality of care Medicare patients receive. Quality measures in the areas of patient satisfaction, care coordination (among care givers)/patient safety, preventive health and management of “at risk” populations will be the primary focus.
- Seven areas of the patient/care giver experience will be used to evaluate patient satisfaction
- Nine separate areas will be used to document screening for preventive services using physician reports
- Twenty-five reports will be required by HHS to document the treatment afforded to “at risk” population groups, such as those with diabetes, heart failure, coronary artery disease and hypertension
- Eighteen additional reports related to Medicare claims reporting will also be used to further evaluate the quality of care your doctor and his staff provide.
These new measures will make it imperative that care givers implement an up-to-date electronic health record system in order to document those services and test results.
The implementation of this program is set to begin soon. Feedback from care providers is being sought by HHS now and a 30 day time period has been established to review suggestions. Once the feedback period has expired a start date will be set to implement these new reimbursement rules. Most believe it will start sometime this year. All these reports will be made available to the public.
This program will require the services of an additional employee, or several employees for each clinic depending on size. This will be great for future employment of Medical Assistant, Billing and Coding, Medical Administrative Assistant, and Health Care Management graduates, but bad for bringing down the cost of health care.
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