Affordable Care Act has dictated numerous changes that Healthcare Providers and Payers are now responsible for. These changes are driving up healthcare costs and at the same time causing consolidation among Providers, Physician Groups and Hospitals in order to survive. TBS is working with both the Provider and Payer segments to address the ever changing regulations associated with the Affordable Care Act.

 Medicare and Medicaid

Medicaid, the nation’s main public health insurance program for low-income people, now covers over 65 million Americans – more than 1 in every 5 – at least some time during the year. The program’s beneficiaries include many of the most disadvantaged individuals and families in the U.S. in terms of poverty, poor health, and disability. The Affordable Care Act (ACA) provided for a broad expansion of Medicaid to cover millions of low-income uninsured adults whom the program has historically excluded. However, as a result of the Supreme Court’s decision on the ACA, the Medicaid expansion is, in effect, a state option. Almost half the states are moving forward with the Medicaid expansion. But the others, which are home to half the uninsured adults who could gain Medicaid coverage under the ACA, have decided not to expand Medicaid at this time or are still debating the issue.

Medicare which is the social insurance program for those over 65 and those younger with disabilities. The Medicare system currently services over 50 Million Americans and is also growing rapidly with the aging population. A major problem now facing Medicare Providers is that Medicare is now  fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments. Even though the nation’s readmission rate is dropping, Medicare’s average fines will be higher than ever for many hospitals.

Under the new fines, three-quarters of hospitals that are subject to the Hospital Readmissions Reduction Program are being penalized. That means that from Oct. 1, 2014 through next Sept. 30, 2015 they will receive lower payments for every Medicare patient stay —  not just for those patients who are readmitted. Over the course of the year, the fines will total about $428 million, Medicare estimates.

Currently there are not enough Providers to service the amount of new patients coming into the system. That fact along with the reduction of fees for these Government sponsored programs as well as the overall rising costs of Healthcare, significant changes are needed to assist the issues Providers are faced with.

TBS has numerous systems and solutions that will assist both Medicaid and Medicare Providers to institute better and more efficient processes needed to meet the ever changing regulatory demands, increased costs, reduction of staff and reduction of service fees. Our solutions come from our managements  years of experience in healthcare as well as the many Partners we utilize that provide the solutions to the needs our Healthcare clients are faced with. Our service in this area is not just a band aid approach. Our solutions will include deep planning,  process improvements and in many cases resulting in the complete restructuring of the organization by combining services with other provider groups faced with the same issues.

(DSRIP) Delivery System Reform Incentive Payment Program

States across the country are taking up the charge for delivery system and payment reform. A sustainable Medicaid program will require more efficient and effective health care delivery that improves health outcomes. Through Medicaid-led initiatives, federal grants and programs, and multi-payer efforts, Medicaid directors are actively engaged in efforts to improve quality, contain costs and increase the value of the Medicaid investment.These efforts range in size from small focused pilots around specific communities or disease states, while others are more sweeping in scope and impact. One such tool for system reform is the Delivery System Reform Incentive Payment Program (DSRIP). In DSRIP, states procure a Section 1115 waiver that allows the state to reward providers for implementing successful delivery system and payment reform projects.This is a hospital-based effort and is financed by redirecting supplemental payments that have traditionally only been available to hospitals for the provision of uncompensated care. States pool a portion of their existing uncompensated care funds (and supplement with additional resources at times) to target and reward specific quality improvement goals.
Below is a Transnational Business Solutions’ white paper on Technology Approach for Performing Provider Systems To Create Integrated Delivery Systems (NY DSRIP Project 2ai)

BISIL WISE DSRIP White Paper Ver 4.0 Arjun_Page_01 Web2

Download here or View online

To date, seven states have created a DSRIP, including California, Kansas, Massachusetts, New Jersey, New Mexico, New York, and Texas.While these programs differ in scope (two hospitals are participating in Kansas verses 21 public hospitals in California), the programs have many similarities.TBS will be working with many of the DSRIP applicants in their efforts to improve healthcare for their individual groups. Many hospitals and Community Health Centers are combining their efforts by forming new Performing Provider Systems. These combined organizations will be instituting new technologies that create efficiencies in their healthcare processes. TBS will assist in the Project planning stages right through the implementation and review of success for the projects each DSRIP applicant has submitted.

Meaningful Use Incentive Program

The Medicare and Medicaid EHR Incentive Programs provide financial incentives for the meaningful use of certified EHR technology to improve patient care. To receive an EHR incentive payment, providers have to show that they are meaningfully using their EHRs by meeting thresholds for a number of objectives. The EHR Incentive Programs are phased in three stages with increasing requirements.

Eligible professionals participate in the program on the calendar year, while eligible hospitals and CAHs participate according to the federal fiscal year. Providers must attest to demonstrating meaningful use every year to receive an incentive and avoid a Medicare payment adjustment.

TBS assists Provider Systems in their effort to implement the certified EHR technologies and the ancillary requirements such as secure certified communications systems. The planning and application process as well as the implementation and reporting necessary for funding is an arduous undertaking which in the case of larger provider groups requires the assistance from outside consultation of which TBS has a high level of expertise.


Physician Practice Change Management

One of the key goals of the NY Delivery System Reform Incentive Payment (DSRIP) Program is to facilitate the transition to a healthcare financing system for the treatment of Medicaid patients in NY State that is at least 90% value-based by the year 2020. For this to occur, physicians and other practitioners must change their practice patterns. For decades, they have stressed volume (and high expense) over demonstrable value. There are many challenges that need to be addressed and overcome. TBS has instituted a conprehensive Change Management Program directed specifically at the DSRIP PPS’s, ACO’s and Physician practices. Please contact us to find out how we can customize a program to meet your organizations needs.

Read TBS White Paper on Practice Pattern Change Management for NY DSRIP!