Physician Ratings May Be Coming to a Clinic Near You

Published on January 16, 2013 by arothstein

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 Health Care ManagementACO’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.

Health Care ManagementThese 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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