1018 - Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting on Revenue Capture

Reimbursement tied to quality performance has become a reality for hospitals and physicians.  CMS’ aggressive goals aimed at increasing the percentage of Medicare payments associated with quality outcomes versus quantity may be rocking our boats, but with the right knowledge and tools, we can plot a course for success.   Healthcare organizations’ drive to implement and meet Meaningful Use will broaden with a strong emphasis on value-based care and risk-based payment models that tie quality outcomes to reimbursement.  The traditional revenue cycle model focusing primarily on maximizing service dollars and getting clean claims out the door will need to adapt to new value-based care and alternative payment models.  Financial as well as clinical strategies must be redesigned and executed in this new value-based care environment. Programs such as Value-Based Purchasing (VBP) and MACRA are catalysts of this movement.  Because we all know “the devil is in the details,” this session will delve into the specifics of each program, its reporting requirements, scoring methodologies, and direct impact on reimbursement.  This will be followed by an in depth discussion of infrastructure and other resource needs, process considerations, and overall revenue at risk.  Providers, CIOs, Quality Leaders and IT Informatacists will find this information valuable in navigating the new normal in healthcare payment reform planning for the future of health care reform. Jodi Frei is the Manager of Organizational Informatics at Northwestern Medical Center in St Albans, Vermont, a HIMSS Stage 6 organization.  She has an undergraduate degree in Physical Therapy and a Master’s Degree in Managing Innovation and Information Technology.  She has over 20 years of healthcare leadership experience and is passionate about leveraging technology to improve clinical and business outcomes.  Jodi currently has oversight of all EMR functionality and optimization within her organization. Jodi has led her organization through successful Meaningful Use attestations and has been a key player with population health initiatives. William S. Presley is Vice President at Acmeware responsible for Product Development. Bill has 18 years’ experience with extensive experience in healthcare information technology including 8+ years at New England Baptist Hospital where he was a member of the hospital management leadership team and oversaw the software development team producing various clinical and financial applications. Under Bill’s leadership, New England Baptist developed leading edge applications including eDoc, a MEDITECH integrated web-based EMR software product. Released in 2005, eDoc featured Medication Reconciliation, Home Medication Management, Discharge Orders, and Electronic Prescribing. Bill completed his undergraduate studies at Wentworth Institute of Technology where he received a Bachelor of Science degree in Computer Science.

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