Implementing regulations will require significant process improvements combined with innovative technologies. By improving their business practices, health providers can lessen the risk of reimbursement reduction, moderate the cost of making improvements, and help strengthen patient outcomes. Three core areas need to be addressed to accomplish the legislative requirements.
Regulatory oversight
The Recovery Audit Contractor (RAC) program will expand to include not only additional classes of Medicare benefits but also state Medicaid programs. To successfully handle the expanded RAC program, providers must overcome challenges related to the management of complex processes and the risk of missed deadlines or incomplete evidence. In addition, providers can use the analysis of past audits to help avoid future compliance issues. A RAC audit management solution from Microsoft can help hospitals:
- Enhance audit teams’ ability to manage complex tasks.
- Improve compliance with business-performance guidelines.
- Centralize the data-collection process.
- Help strengthen future audit results.
- Enable audit teams and managers to work in a collaborative environment.
Delivery system reform
Health reform has linked readmissions and reimbursement, making patient readmissions an even more important risk- management and revenue- protection action. To decrease readmission rates and help avoid reimbursement consequences, hospitals must actively oversee patients after they have been discharged, identify patients who are at risk in the home setting, and manage self-reported patient data. A chronic condition management solution from Microsoft can help hospitals:
Use integrated data collected by staff, line-of-business applications, and patients to determine when to offer proactive care.
Increase productivity by reducing the time and staff necessary to administer patient-outreach programs.
Save time and reduce the potential for human error by standardizing processes and moving paper-based processes online.
Provide better service, strengthen communications, and improve responsiveness by sharing patient information between systems.
Quality improvement
Hospitals have been reporting various quality data, such as Core Measures and Hospital-Acquired Infections, to government agencies for several years. Under PPACA, reimbursement will now be based on actual performance on those quality measures. This means clinical data needs to be collected, integrated, analyzed, and reported in near-real time, so as to allow caregivers to take meaningful actions to produce quality outcomes. In addition, reform regulations now require non-acute facilities to start the quality reporting and improvement process. A health performance management solution from Microsoft can help providers:
Improve outcomes by promoting a self-service business intelligence (BI) environment for key clinical decision-makers.
Improve coordination and support between care teams by providing clinical managers with intuitive tools to analyze quality-performance metrics.
Provide clinical workers with integrated analytics to help them take action on performance data in real time.
Help users collect, analyze, manage, and report on data from multiple systems, applications, teams, and departments.
Provide consolidated access to patient information through a single, unified view.
Use scorecards, dashboards, and key performance indicators to improve accountability and alignment for quality across the organization.
