Healthcare Ecosystems

CAMC is constantly evolving and following the enactment of the Affordable Care Act (ACA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act, it was decided that a Cost-Benefit Analysis (CBA) (See detailed spreadsheet – Appendix A) should be performed to ensure compliance with these acts. Adoption of the EHR will mean that CAMC would qualify for incentive payments from the Medicaid and Medicare programs for if they can demonstrate that they are making “Meaningful Use” of an EHR system to

Healthcare facilities are required to maintain licensure, certification, and accreditation in order to receive payments from federal government programs such as Medicare. Healthcare facilities must meet the minimum standards in order to operate, such as sufficient staffing, personnel employed to provide services, the quality of equipment, buildings, and supplies, and services provided, including health records. (LaTour, 2013) Medicare has developed Conditions of Participation and Conditions for Coverage, which identifies specific criteria that must be met in order to receive reimbursement from Medicare. Medicare implements these guidelines in order to

Specifically, the AHCPII is meant to improve Arkansas’s health system through three approaches: patient centered medical homes, health homes, and episodes of care.

In 2009, the U.S. Government passed The Health Information Technology for Economic and Clinical Health (HITECH) Act, as part of the American Recovery and Reinvestment Act of 2009, to promote the adoption and meaningful use of health information technology (Mangalmurti, Murtagh and Mello 2060). The HITECH Act authorizes grants and incentives to promote the “meaningful use” of electronic health records (EHR) by providers (2060). The effect is a high commitment to a technology-led system reform, urging a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical

In response to the “Patient Protection and Affordable Care Act (ACA) amended by the Health Care and Education Reconciliation Act (Reconciliation Act), collectively referred to as healthcare reform” (); Wishard-Eskenazi Health of Indianapolis, Indiana has begun to make milestone changes to meet the requirements of the healthcare reform. Being a leader in today’s technology which began thirty years ago with development of one of the nation’s first electronic medical record and continues to excel in the healthcare informatics technology today continues to use this technology in quality improvement initiatives, support for future technology research and improving the quality care of the patient.

Baptist Health, headquartered in Louisville, Kentucky is the largest not-for-profit healthcare organization in the state. The vision of this HCO is to be nationally recognized as a healthcare leader in the state of Kentucky. Baptist Health was originally founded in 1924 as a single 120 bed hospital in Louisville, Kentucky. Expansions in 1953 with the addition of Western Baptist Hospital in Paducah, Kentucky and in 1954 with the addition of Central Baptist Hospital in Lexington, Kentucky created the foundation for the HCO known today as Baptist Health (Welcome to Baptist Health hospitals and clinics in Kentucky, 2013).

In order for a hospital to be eligible for reimbursement through Medicare, they have to show that they are compliant by way of the Conditions of Participation. One way to show this is by getting an accreditation through The Joint Commission who meets the Medicare Condition of Participation standards. (La Tour, 2013).

insurance for Americans that are aged 65 and over and younger people with disabilities. It was the

The American Recovery and Reinvestment Act (ARRA) of 2009 identified three main components of meaningful use: the use of a certified EHR in a meaningful manner, electronic exchange of health information to improve quality of care, and the use of technology to submit clinical outcomes and quality measures (Heath Resources and Service Administration, n.d.). ARRA includes many measures to modernize our nation’s infrastructure, with the “Health Information Technology for Economic and Clinical Health (HITECH) Act” being an example. The HITECH Act is an effort led by Centers for Medicare and Medicare Services (CMS) in support of electronic health records and meaningful use (Centers for Disease Control and Prevention, CDC 2016). According to Galbraith (2013), the HITECH Act aims to promote the use of EHRs by providing over $27 billion in monetary incentives for health care providers that become “meaningful users”. CMS uses these core objectives to determine if a health care provider has satisfied meaningful use and is eligible to receive financial incentives (Galbraith, 2013).

Founded in 1841, New York University Langone Medical Center is considered one of the nation’s top health care centers. Located in Manhattan, NYU Langone Medical Center consists of four hospitals -Tisch Hospital, with 705 acute-care beds; Rusk Institute of Rehabilitation Medicine, the first hospital dedicated solely to rehabilitation in the world, with vast inpatient and outpatient rehabilitation services and programs; Hospital for Joint Diseases, contains 190 acute-care-beds and is one of the five hospitals in the world dedicated only to orthopedics and rheumatologic conditions; and the Hassenfeld Pediatric Center, which is composed by a full array of children’s health services.1

In today’s seemingly ever-changing world of healthcare regulation, medical professionals are burdened with many compliance requirements. On October 14, 2016, the Department of Health and Human Services released its final rule implementing the Quality Payment Program as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Starting January 1, 2017, clinicians who are reimbursed by the Centers for Medicare and Medicaid Services(CMS) are required to participate in the Quality Payment Program (QPP). (Centers for Medicare & Medicaid Services, 2016) The QPP replaced the Sustainable Growth Rate formula with the new payment structure in which clinicians are rewarded for delivering high quality care. There are now two pathways for

In addition to the core elements, providers will have to choose any five of the ten additional tasks to implement in 2011-2012. Some examples of these might be clinical lab results, patient appointment reminders and drug-formulary checks. This gives the providers a chance to choose their own path toward full EHR implementation and meaningful use. Legislation ties payments to the achievement of advances in health care processes and outcomes. The regulations are specific as to when providers will have to use particular functions in order to be considered meaningful users. The meaningful use rule acknowledges the urgency of adopting the electronic health record and recognizes the challenges it will pose on all providers.

HITECH Act provides billions of dollars in incentive payments through Medicare and Medicaid programs to providers that meaningfully use EHR. The HITECH Act also revised many segments of the Social Security Act (SSA) and in doing so, recognized the accessibility of incentive payments to providers to encourage the acceptance and Meaningful Use of Certified Electronic Health Record Technology (CEHRT). The ARRA provides the incentives to the following groups: hospitals, healthcare clinics, private practices, nursing facilities, long term health care facilities, and metal institutions.

The road to patient-centered care was paved with the passing of the HITECH act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use EHRs privately and securely to achieve specified improvements in care delivery. If providers do not become meaningful users of EHRs by 2015, penalties will be triggered through reduced Medicare payments. These provisions aim to create a nationwide electronic health system that is efficient and secure to improve health outcomes and lower the cost of healthcare. To accomplish these goals, the federal government allotted $19.2 billion of funding to promote the adoption and meaningful use of interoperable health information technology and electronic health records (EHRs).

The Health information exchange or also known as HIE is the sending of healthcare-related data electronically to facilities, health information organizations and government agencies according to national standards. The goal is to be able to access and retrieve data more efficient, safer, and to improve the quality of care and patient safety and reduce healthcare costs.