Hospitals; Ten-Step Plan for Increasing Service Income and Ensuring Quality Outcomes

1. Market and promote service availabilities to physicians and consumers.
2. Expeditiously collect the physician orders and patient diagnosis, and convert orders to facility procedures.
3. Identify and confirm the patient, guarantor, insurance plan(s) and eligibility, including medical necessity when applicable.
4. Ensure proper service, service(s) sequence through clinical review of patient's history, linking to pre-service testing when warranted.
5. Arrange payment program with patient/guarantor and insurance plans.
6. Solicit patient preferences and special needs related to times, locations, transportation, and caregivers.
7. Schedule and coordinate applicable resources for services, special needs, preferences, and set up patient reminder program.
8. Expeditiously deliver services.
9. Arrange for follow-up services prior to discharge.
10. Monitor and manage process activities, including automatic priority-driven alerts.

Client News: Casas Named Chief Nursing Officer at ETMC Henderson

Miguel Casas, MBA, MSN, RN, has been named chief nursing officer at East Texas Medical Center (ETMC) Henderson.  Casas will assume his duties on Nov. 14. In his new position, he will oversee all nursing staff, coordinate care among all hospital departments and ensure compliance with all federal and state regulations, among other duties.

Casas most recently served as nurse manager for the ETMC Specialty Hospital in Tyler, a 36-bed facility offering long-term, acute care for patients with complex medical conditions. Prior to joining ETMC in 2005, he served in clinical positions in the oncology and emergency departments at Mother Frances Hospital in Tyler and in the intensive care unit at the University of Texas Health Science Center in Tyler. He served in the United States Air Force from 1989 to 1996.

Casas recently earned dual master’s degrees in nursing and business administration from the University of Texas at Tyler, where he previously earned his bachelor’s degree in nursing.

“We are excited to have Mr. Casas join our team at ETMC Henderson,” said Administrator Mark Leitner. “His nursing and management experience across a variety of clinical areas, coupled with his education, will make him a tremendous asset to our hospital and community.”

Visit ETMC online at: http://www.etmc.org/

Happy Veterans Day!

Today we honor the courage & sacrifice of our U.S. military veterans and their families!

Client News: East Texas Medical Center Regional Healthcare System Goes Mobile with iTriage

Source: ETMC Press Release

East Texas Medical Center Regional Healthcare System has expanded its presence in the growing mobile market through a partnership with iTriage® -- a consumer healthcare application that gives users on-the-go access to medical information and providers. 

Mobile users have quick and easy access to symptoms, diseases and hospital information. iTriage is available as a free download through the app stores for iPhone® and Android® mobile devices, and any Internet-enabled device at http://www.itriagehealth.com/. 

According to the most recent Nielsen statistics, 40 percent of mobile consumers in the U.S. now own a smartphone, with 50 percent adoption predicted by the end of 2011. 

This growing trend has led ETMC to reach out to mobile users in the community by providing convenient access to information about its facilities and services. 

Schumacher Group, the nation’s third largest emergency and hospital medicine management firm, is partnering with ETMC to bring iTriage to ETMC hospitals throughout the region. This state-of-the art technology gives East Texas residents the resources to learn more about a specific medical condition and make the most informed decision about where to seek treatment. iTriage lets users: 

• Research medical symptoms 
• Learn about possible causes and treatment options 
• Obtain medication information for treatment of a specific condition 
• Find detailed ETMC information like services, specialties, hours of operation and turn-by-turn directions 

“Our partnership with iTriage allows us to provide more information about the services we offer throughout East Texas and helps our patients make informed decisions about where to seek attention for their medical needs,” said Art Chance, vice president of operations for ETMC. “We are proud to offer the latest technology to our community, which reinforces our commitment to enhancing the patient experience.” 

“ETMC’s decision to partner with iTriage speaks directly to their belief in providing cutting-edge medical care through advanced technology,” said Peter Hudson, MD, iTriage co-founder. “At iTriage, we are leading the way in creating new opportunities for healthcare providers to engage with patients by using integrated mobile technology, and we look forward to working with this experienced hospital to increase patient engagement.” 

About iTriage, LLC 
Headquartered in Denver, CO and co-founded by two emergency physicians, iTriage offers a unique Symptom-to-Provider™ pathway that empowers patients to make better healthcare decisions. iTriage helps people answer the two most common medical questions: “What condition could I have?” and “Where should I go for treatment?” 

Millions of consumers around the globe have downloaded iTriage on their mobile devices and thousands of healthcare providers use iTriage to reach and communicate critical facility and service information to patients. 

For more information, please visit www.iTriageHealth.com.  

ACO UPDATE: Final ACO Regs Include Bigger Bonuses

Source: ModernHealthcare.com
Written by: Melanie Evans

Medicare accountable care organizations could see larger bonuses and face fewer quality measures under rules issued by the CMS.

In final rules for Medicare accountable care organizations (PDF), published today, the CMS said it would no longer require all ACOs to face potential penalties, and it increased possible bonuses. The final rule also proposed half the number of quality measures included in draft rules released last March. Under accountable care, healthcare providers that reach quality and cost-saving targets are eligible to share in the savings.

Federal officials, speaking to reporters after the rules were released, stressed the changes were a response to the crush of comments on draft rules. CMS Administrator Dr. Donald Berwick described the volume of replies as a “mountain” of comments.

Hospitals and physician groups largely rejected draft proposals as too risky and too demanding. High-profile physician groups that tested an early model of accountable care declared the draft rules unworkable in a letter that said none would participate without significant changes.

The CMS also proposed an advanced-payment program for small physician-owned and rural hospitals that lack capital to start an accountable care group. Under the program, up to 50 small ACOs will quality for upfront payments that will be paid back as providers reduce Medicare costs. The Center for Medicare and Medicaid Innovation will award up to $170 million under the program.

Agreements for Medicare ACOs and the advanced payment program will begin next year on two dates: April 1 and July 1.

Under the Medicare accountable care final rules, the CMS would monitor quality performance using 33 measures instead of the 65 measures proposed in March.

As proposed in March, ACOs may choose one of two incentive options under the final rule. However, providers no longer face possible penalties under both options. Previously, providers that failed to achieve quality and savings targets could be at risk for penalties either for one year or three years, depending on the option. The CMS eliminated the possible one-year penalty under the final rules.

The CMS also increased the amount of bonuses that providers may earn. Now, once providers clear a savings target, the CMS agreed to share savings earned from the outset. Previously, providers were eligible to share savings after the first 2% in cost-reductions.

The CMS also relaxed one major capital-intensive requirement. Primary-care providers in accountable care organizations no longer face a requirement that at least half must have earned “meaningful use” designation by the second year.

The CMS also removed from the final rule some quality measures tied to electronic health records. One measure of EHR use remained, but somewhat altered: percentage of primary-care physicians who qualify for electronic health record incentive programs. The CMS said the measure will be weighted higher than quality measures.

Patients will no longer be assigned to accountable care organizations retrospectively, the CMS said. Medicare enrollees will be assigned to ACOs prospectively, every three months, but the CMS will review assignments at the end of each year.