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Top 12 Uncertainties Hovering Over Healthcare

Cheryl Clark, for HealthLeaders Media, November 21, 2011

The legislation defined such transfers of value as stocks and stock options, ownership interest, dividends, profits, consulting fees, honoraria, gifts, entertainment, food, travel, education, research, charitable contributions or royalties.

The data collected is to be publicly viewable, according to the ACA by Sept. 30, 2013.

12. Value Based Purchasing Incentive Payments

Although the formula for rolling out incentive payments for hospital quality has been set through 2014, hospital providers are nervous about what CMS will add to the mix for 2015, allowing them to earn back a portion or all of the 1% that all will receive in cuts to fund the program.
"We'll be seeing the results in October," Bankowitz said.

It dropped some eight hospital acquired conditions such as falls and pressure ulcers and the Agency for Healthcare Research and Quality composite measures for 2014.  But those and several other measures are expected to creep back in or be added anew, such as all-cause readmission rates and the number of patients infected with hospital-acquired Clostridium difficile.

Another important decision coming from CMS anticipated in the coming year is how incentive payments will be allocated and to whom. Under the Affordable Care Act, any hospital that received CMS immediate jeopardy citation would be precluded from earning back any of the 1% of payments that are cut to hospitals across the board.

That's 12, and that's enough for 2012. However, this is not a complete list.  There are at least eight other influential rules and policies anticipated in 2012.  Stay tuned.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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6 comments on "Top 12 Uncertainties Hovering Over Healthcare"


Janice (11/30/2011 at 1:52 PM)
I agree with Lanay - having coded and reviewed thousands of records in my career, patient non-compliance is a major reason especially for CHF readmissions. Patients are adequately trained during the admission but it is too easy to slip back into old habits when they go home. What makes non-compliance easy is that many of the CHF patients may be on low incomes, and eating appropriately, which is a major player in CHF, may be next to impossible. Patient non-compliance should be excluded from the readmissions for CHF (there is a ICD-9-CM code for it).

Kandi O'Brien (11/29/2011 at 10:59 PM)
It is great to see that the government wants to [INVALID] measures to prevent harm. However, the affects of some of these measures excludes a lot of common situations. Ex: 30 day rule. Most of these PTA have multiple chronic issues and they have totally separate issues that land them in the hospital. The entire visit /week stay shouldn't be denied when there was no wrong doing in relation to the initial treatment. There also should be more regulation on insurance companies. They are making money every year while everyone else faces cuts. Increases for our tax rates have to be approved, maybe the increase for premiums should have a similar plan. Having worked on both sides I am confident that there is a middle ground, however, the wrong people aren't usually at the table to make those decisions.

Lanay (11/29/2011 at 5:48 PM)
In addition to that which is listed regarding readmission for selected illnesses they need to consider patient non-compliance with treatment that directly leads to the readmission.