Most importantly transaction systems need to be placed and run consistently

Most importantly transaction systems need to be

This preview shows page 12 - 15 out of 33 pages.

Most importantly, transaction systems need to be placed and run consistently. However, exercise will become more of a repair role over time than a strategic imperative. Data now drives technological creativity in the health care sector, and successful data warehousing and analytics
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INFORMATION TECHNOLOGY 13 tools offer actionable knowledge. This section will cover a range of issues related to reimbursement issues that are facing hospitals in Georgia and around the nation today. 1. Readmissions penalties Section 3025 of the Affordable Care Act also has section 1886(q) attached to the Social Security Act. Notably, the Hospital Readmission Reduction System was developed in this portion. Wang et al. (2015) explains how the CMS changes payment and imposes fines for hospitals with more than thirty days of recovery concerning other conditions or inpatient procedures starting on 1 October 2012 (Medicare Centers and Services of Medicare) (p. 1). These fines currently include conditions such as myocardial infarction, cardiac insufficiency, and pneumonia. In the fiscal year 2015, the goal of CMS was to extend the related conditions and procedures monitored by the program to include: patients who sought care in the case of acute exacerbations of chronic obstructive pulmonary disease (COPD). The readmission fines are based on the fact that the total number of patients admitted to the hospital is held on the denominator for a given condition, and the number of re-admitted patients within thirty days. Therefore, an excess readmissions ratio relative to the national average results in Medicare reimbursement fines. It is also important to note that there is a risk adjustment for these penalties, which involves clinically significant modification of variables like the ethnicity of patients, comorbidities, and the insecurity of the patient. Recently, Medicare changed its regulations to protect from readmissions fines in cases where a physician prepared for readmission. Medicare reports that doctors prepare for readmissions in about 12 percent of heart attack cases, 6 percent of heart failure cases, and 4 percent of pneumonia cases (Zeng et al., 2015, p. 110). Providers believe that the changes demonstrate CMS is eager to answer providers ' concerns about the readmissions program, despite the recent
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INFORMATION TECHNOLOGY 14 evidence that certain readmissions are not preventable. However, Impact of Payment Scheme On Performance research conducted by Adida et al. indicates that the analysis "does not address some of the fundamental issues, including findings that the social factors that influence the patients and events in their culture that are the genuinely driving reception." For the fiscal year 2013, 2,225 hospitals were fined nationally for excessive readmissions (p. 1174). In Georgia, seventy-three hospitals were fined last year for excessive readmissions. Despite the adjustments for risk, it was found that hospitals in rural and impoverished areas were more likely to incur a readmissions penalty than those in urban areas (Verulava & Maglakelidze, 2017). Therefore, readmissions present a high financial threat to hospitals in Georgia, which are
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  • Fall '16
  • Health care provider

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