Presenting a live 90 ‐ minute webinar with interactive Q&A Medical Staff Credentialing Minimizing Liability Arising from Negligent Credentialing and Physician Lawsuits WEDNES DAY, JUNE 15, 2011 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific T d Today’s faculty features: ’ f l f Adrienne E. Marting, Partner, Balch & Bingham , Atlanta Robert C. Threlkeld, Partner, Morris Manning & Martin , Atlanta The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10 .
Continuing Education Credits FOR LIVE EVENT ONLY For CLE purposes, please let us know how many people are listening at your location by completing each of the following steps: • In the chat box, type (1) your name , (2) your company name and (3) the number of attendees at your location number of attendees at your location • Click the arrow to send
Tips for Optimal Quality S S ound Quality d Q lit If you are listening via your computer speakers, please note that the quality of your sound will vary depending on the speed and quality of your internet connection. If the sound quality is not satisfactory and you are listening via your computer speakers, you may listen via the phone: dial 1-866-443-5798 and enter your PIN when prompted Otherwise please send us a chat or e mail when prompted. Otherwise, please send us a chat or e-mail sound@ straffordpub.com immediately so we can address the problem. If you dialed in and have any difficulties during the call, press *0 for assistance. Viewing Qualit y To maximize your screen, press the F11 key on your keyboard. To exit full screen, press the F11 key again press the F11 key again.
Joint Commission Credentialing Criteria & Affordable Care Act Overlay Robert C. Threlkeld, Esq. P Partner, Healthcare Group t H lth G rthrelkeld@mmmlaw.com rct@mmmlaw.com (404) 504-7757 (Work) (404) 717-9529 (Cell) 4
5 Impact of Healthcare Reform and Impact of Healthcare Reform and Medical Staff Credentialing
Important Initiatives Under Patient Protection and Affordable Care Act that Will Impact Credentialing Creation of Centers for Medicare and Medicaid Innovation within the Centers Creation of Centers for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services (CMI) • The CMI will be the major focal point for the identification of problem areas in health care delivery and identification and testing of new models to i h lth d li d id tifi ti d t ti f d l t improve program performance. • To design, implement and evaluate Medicare and Medicaid demonstrations and pilot programs to test the feasibility, cost effectiveness and quality outcomes of new health care delivery models. • CMI may among other things develop models to focus on the establishment CMI may among other things develop models to focus on the establishment of “best practices and proven care methods” to enhance quality and cost- effectiveness. 6
Important Initiatives Under Patient Protection and Affordable Care Act that Will Impact Credentialing • To promote research and demonstration transparency by • To promote research and demonstration transparency by disseminating findings to inform law makers and interested parties about health care delivery issues, new innovative concepts, and demonstrations and pilot programs demonstrations and pilot programs • Evaluative findings to develop new objectives for basic research and new research demonstrations • Has the authority to extend and expand the operation of successful models Source: See Pub. L. No. 111-148, §§ 3021(a) and 10306. 7
Important Initiatives Under Patient Protection and Affordable Care Act that Will Impact Credentialing • Establishes a Medicare pilot program to develop and evaluate paying a E bli h M di il d l d l i bundled payment for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care that begins three days prior to a hospitalization and spans 30 days following discharge following discharge. The goal of this program is to enhance quality and The goal of this program is to enhance quality and reduce costs through coordination of care. See Pub. L. No. 111-148, § 2704(b)(2). • Establishes a hospital value-based purchasing program in Medicare to pay Establishes a hospital value based purchasing program in Medicare to pay hospitals based on performance on quality measures and extend the Medicare physician quality reporting initiative beyond 2010. See Pub. L. No. 111-148, §§ 3022 and 10307. • Establishes shared savings programs whereby incentive payment will be available if quality and efficiency standards are met. See Pub. L. No. 111- 148, §§ 3001 and 10335. 8
Important Initiatives Under Patient Protection and Affordable Care Act that Will Impact Credentialing • Other initiatives. Oth i iti ti • Extension of Never-Events Payment Policies for Hospital-Acquired Conditions. See Pub. L. No. 111- See Pub L No 111 Hospital Acquired Conditions 148, §§ 3025(a) and 10309. 9
Important Initiatives Under Patient Protection and Affordable Care Act that Will Impact Credentialing Pediatric Accountable Care Organization Demonstration Project Pediatric Accountable Care Organization Demonstration Project Demonstration project to evaluate integrated care around a hospitalization hospitalization Global Payment System Demonstration Project Medicaid emergency psychiatric demonstration project 10
Elements of Accountable Care Organizations as Driver of Quality and g y Efficiency Accountable Care Organization (ACO) Accountable Care Organization (ACO) • Means a legal entity that is recognized and authorized under applicable State law; • Identified by a Taxpayer Identification Number (TIN); • Comprised of an eligible group of ACO participants that work together to p g g p p p g manage and coordinate care for Medicare FFS beneficiaries; and • Have established a mechanism for shared governance that provides all ACO participants with an appropriate proportionate control over the ACO participants with an appropriate proportionate control over the ACO's decision making process. 11
Elements of Accountable Care Organizations as Driver of Quality and g y Efficiency Statutory Basis Statutory Basis • Shared Savings Program is part of the Patient Protection and Affordable Care Act to be codified at 42 USC 1899 and Affordable Care Act to be codified at 42 USC 1899. • It is not a demonstration program. It is part of the Statute and the effective date is January 1 2012 the effective date is January 1, 2012. 12
Elements of Accountable Care Organizations as Driver of Quality and g y Efficiency Basic Requirements Basic Requirements • Accountable for the quality, cost, and the overall care of the Medicare fee-for-service (FFS) beneficiaries assigned to it. • Enter into an agreement with the Secretary to participate in the program for not less than a 3-year period. • • Formal legal structure that would allow the organization to receive and Formal legal structure that would allow the organization to receive and distribute payments for shared savings to participating providers of services and suppliers. • I Include primary care professionals that are sufficient for the number of l d i f i l th t ffi i t f th b f Medicare FFS beneficiaries assigned to the ACO. (At least 5000 beneficiaries). 13
Elements of Accountable Care Organizations as Driver of Quality and g y Efficiency 5 Provide the Secretary with such information regarding ACO 5. Provide the Secretary with such information regarding ACO professionals participating in the ACO as the Secretary determines necessary to support the assignment of Medicare fee-for-service beneficiaries to an ACO the Medicare fee-for-service beneficiaries to an ACO, the implementation of quality and other reporting requirements, and the determination of payments for shared savings. 6. Maintain leadership and management structure that includes clinical and administrative systems. 7. Define processes to promote evidence-based medicine and patient engagement. 14
Elements of Accountable Care Organizations as Driver of Quality and g y Efficiency 8 Report on quality and cost measures and coordinate care 8. Report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies. 9. Demonstrate to the Secretary that the ACO meets patient- centeredness criteria specified by the Secretary, such as the use of patient and caregiver assessments or the use of individualized care plans. 15
Elements of Accountable Care Organizations as Driver of Quality and g y Efficiency Eligible Entities Eligible Entities • ACO professionals in group practice arrangements. • Networks of individual practices of ACO professionals. • Partnerships or joint venture arrangements between hospitals and ACO professionals. h it l d ACO f i l • Hospitals employing ACO professionals. • Such other groups of providers of services and suppliers as the Secretary determines. 16
Recommend
More recommend
