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Medicare Is Overhauling Its Payment System – Will You Be Prepared?

There is a fundamental and significant change coming in the manner in which Medicare will pay hospitals and doctors for their services. This new payment model will be based on quality of care as opposed to the older, volume-based methodology. According to an Associated Press story this week that was reported in USA Today, Modern Healthcare and other major news media, President Barack Obama has said he hopes this shift in the Medicare reimbursement model will be a catalyst for improving spending in the nation’s $3 trillion healthcare system. The administration also wants state Medicaid programs to join the payment-for-quality initiative.

“It is in our common interest to build a healthcare system that delivers better care, spends healthcare dollars more wisely and results in healthier people,” Health and Human Services Secretary Sylvia M. Burwell said. Building on experiments under the Affordable Care Act, Burwell has set a goal of tying 30 percent of payments under traditional Medicare to new models of care by the end of 2016. That would rise to 50 percent of payments two years thereafter.

These new delivery models include accountable care organizations (ACOs) and other patient-centered initiatives, in which doctors must coordinate care to help keep patients from landing in the hospital for avoidable problems. These quality-based initiatives require care coordination across the entire continuum of delivery utilizing HIEs, EHRs, Hospital Information Systems, and other specialized technology applications.

Improved communication is the foundation and the first step toward achieving collaborative care coordination and meeting the new Medicare delivery models. A viable communication system can connect the right person at the right time with right patient care information. And, in today’s healthcare environment, that communication solution must be secure and HIPAA-compliant. Implementing a communication solution that includes secure text messaging allows healthcare providers to use their mobile devices to send and receive patient information, while maintaining patient privacy and protected health information (PHI).

The next critical step in the care coordination process is to bundle secure text messaging with care transition notifications (CTN) across the healthcare delivery continuum. Real-time patient notifications close gaps in care across multiple delivery settings, improve outcomes and reduce unnecessary hospitalizations and readmissions.

Using a CTN solution, healthcare providers can be alerted to patient ED arrivals, admissions, discharges, and transfers in real time and help them keep tabs on their patients and track them throughout the care continuum, regardless of the delivery setting. Providers are immediately aware of their patients’ locations, who the admitting physician was, who is the attending, diagnoses, and other vital information.

Medicare’s goal of a quality-based reimbursement model which relies heavily on care coordination is on the way and it’s achievable with mobile care transition notifications and secure text messaging as integral solutions in the ongoing care management process, They will significantly facilitate care coordination, reduce unnecessary healthcare costs – and most importantly -- improve the delivery of healthcare.

Click here to see how CTNs are facilitating care management to improve care continuity among providers and reduce unnecessary costs. Interested in learning how Cureatr can help you be prepared for the new Medicare reimbursement changes? Please contact us and we’ll be in touch.


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