Tuesday, January 28, 2014

Assignment 3 for my students - The plot thickens

My personal learning network fed me many ideas recently. Tonight President Obama will make his annual State of the Union address. We will certainly hear more calls for cooperation between the political parties in Congress, particularly as related to healthcare reform. The major provisions of the Affordable Care Act are taking effect now. CMS (Centers for Medicare and Medicaid Services) and the Department of Health and Human Services (HHS) are quite fully engaged now in efforts to implement the new law.

http://www.cms.gov/

http://www.hhs.gov/>

This article in Modern Healthcare helps scope out the issues right now.

http://www.modernhealthcare.com/article/20140111/MAGAZINE/301119978/outlook-2014-obamacare-sgr-repeal-icd-10-and-payment-cuts-top-the

http://en.wikipedia.org/wiki/Medicare_Sustainable_Growth_Rate

The heat is on. Physicians and other providers are under financial pressure, legal requirements, and the need to integrate information technologies. People will begin to experience the new "system" as patients very soon. There will be problems. Anything this big and complex is going to have problems. Many states, including Georgia, are not expanding Medicaid coverage. Doing so was part of the "magic," but the Supreme Court ruled that the federal government cannot force the state governments to expand Medicaid, even if most of the money comes from the federal government.

Students, in commenting to this post, please review the information in this post (including the links above) and address at least one aspect of what is going on right now. Watch or listen to the President's address if possible. It will be available on YouTube. The President's concern has to be that a sufficient number of Democrats in Congress and going to get "cold feet" and begin to side with Republicans on some of these issues. It is difficult to "see the entire picture." At least take one aspect of it and comment about how you see things here, please.

5 comments:

  1. By focusing on the CMS link I gained some valuable current information to take account of to relay to others in my community. First off the state of Georgia will not be expanding Medicaid coverage to low-income adults effective January 1, 2014. A single adult GA resident with no dependents is awarded no Medicaid and or CHIP. As far as the application for enrollment for 2014, states have the option of following the formatted model of the secretary of HHS for affordable insurance programs or use an alternative as long as it meets federal requirements. Agencies will verify Medicaid and CHIP eligibility primarily via the Social Security Administration, the Departments of Homeland Security and Labor rather than paper documentation from families. As far as the Affordable Care Act for consumers the situation appears to a positive one. For physicians and hospitals, one of the major information technology and financial worries this year will be shifting to the required new ICD-10 coding system Oct. 1. Providers that do not submit their bills using the new codes may face serious problems collecting payment. Some provider groups are pressing the Obama administration for a delay. The new coding will increase the non medical paperwork process by at least 15% which will decrease cash flow if not resolved by Oct 1 of this year. Physicians and hospitals also will be paying close attention to congressional negotiations over repealing and replacing Medicare's unpopular sustainable growth-rate physician payment formula. March and October will be the two essential months for the flow of the Affordable Care Act and we all should stay tuned.

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  2. Information that I took from Outlook 2014: Information technology
    Meeting stage 2 meaningful-use requirements ... converting to ICD-10 coding by Joseph Conn, stated that hospital leaders and office-based physicians will face daunting information technology stress tests in the coming year. 3 Stages of meaningful-use criteria for electronic health-record systems have to be met. Stage 3 has been delayed until 2017, but will have no effect on providers required to step up to Stage 2 in 2014. Meanwhile, the feds have signaled no willingness to go along with demands to once again delay the ICD-10 conversion. Russell Branzell, CEO of the College of Healthcare Information Management Executives, stated that “The need to upgrade your systems hits right at the peak of getting ready for ICD-10. There is still a lot of concern on the physician side for ICD-10 readiness. Do you really load up a physician with retaining all their codes at the same time you're going to ask them to change their system? We're just asking for some flexibility on timing.” A recent survey report released by the Workgroup for Electronic Data Interchange found that providers and health plans are “behind the curve” on ICD-10 readiness.

    http://www.modernhealthcare.com/article/20140104/MAGAZINE/301049946/outlook-2014-information-technology

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    Replies
    1. Thank you, Edwin. Everyone has known that ICD-10 will have to become implemented soon. Perhaps there was faith in some "miracle at the end" (such as computer based expert systems that will "translate ICD-9 codes into ICD-10 codes). This coding is critically important both for medical reasons and for financial reasons. I don't understand why medical coders don't receive more respect for what they do and for the knowledge/skills required to do their work correctly.

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    2. From what I have read here recently and saw on the news is some Democrats are attempting to distance themselves from the affordable care Act. One reason is because is the act is leading to jobs being lost. Ironically you some Democrats stating this is good and equals more family time and could lead to better family values, not realizing this could also lead to losses of homes and relying more on the government for assistance (food stamps). Some patients and doctors are also arguing that despite the bill stating you will be turned down for pre-existing conditions some people’s health insurance is being cancelled while they are in the middle of being treated because of Obamacare.
      I felt that by putting President Obama in office would lead to healthcare companies that already exist having to make insurance affordable and create competition. I never thought it would up like this.
      Democrats say Obamacare will lead to better work-life balance. The guardian
      Gary Devine Oakland County Republican Examiner Democrats admit Obamacare is a job killer
      State of the Union 2014: GOP’s guests highlight Obamacare trouble
      Read more: http://www.politico.com/story/2014/01/state-of-the-union-2014-republican-guests-102719_Page2.html#ixzz2syf0bdxl

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