PIAA Medical Liability Conference Notes post-Lunch Break

After the lunch break for the first day of the PIAA Medical Liability Conference, I had the opportunity to attend two more educational sessions. Following are some of the notes I compiled:

• Quality Measures and Data Collection: What is the Real Impact on Patient Safety

* The quality benchmarks required by the Centers for Medicare & Medicaid (CMS) were promoted as a means to improve the quality of healthcare delivery. What was less publicized is that the CMS requirements are directly tied to the pay for performance effort to change how medical care will be reimbursed. This will have impact healthcare systems reimbursements significantly.

* Medicare and third-party payors are devising metrics. If you meet them, CMS and third-party payors will pay you more, or at least not decrease your reimbursement.

* Healthcare quality reform has been underway for almost a decade. The Affordable Care Act has more to do with insurance reimbursement reform.

* Outcome metrics will be made public. Not meeting those metrics can damage the public’s perception of your facility.

* By 2015, your efficiency scores will comprise 20% of your reimbursement.

* Readmission penalties do not take into account the patient’s adherence to doctor directives and medications or complying with follow-up exams.

* Front-end documentation will be critical to avoiding readmission penalties. If a patient is treated for one condition and comes back for another issue, it could be considered a readmission if front-end documentation is not properly made.

* The bureaucratic requirements are causing more physicians to seek hospital employment over independence. They fear the regulations and documentation requirements.

• Healthcare Reform: New Developments and Long-Term Implications

* The transition from volume-based to value-based reimbursement is going to be the biggest challenge since the institution of Medicare.

* Between 2010 and 2015, there will have been 14 payment reforms enacted that focus on incentivizing quality and efficiency.

* It’s not known whether physicians in private practice will have access to the resources and knowledge to practice evidence-based medicine as defined by CMS.

* It costs around $1.8 million to set-up an Accountable Care Organizations. Few private practices have the resources to do so.

* The medical homes concept was first developed n 1964. Old ideas are new again.

* MPL insurers have three options going forward: 1. Do nothing, wither and die 2. Build on base of independent practices, but partner with practices on new ways of doing business 3. Diversify service mix and customer base.

* Traditional MPL insurers can no longer compete with a sole focus on independent physicians.

Phew… It’s been a long, very informative day. For more detailed coverage of the PIAA Medical Liability Monitor, subscribe to Medical Liability Monitor and catch my wrap-up in the June issue.

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