According to Healthcare.gov, “On average, each year, one in seven Medicare patients admitted to a hospital has been subject to a harmful medical mistake in the course of their care. And nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days”
This statement brings about some serious questions pertaining to the quality of our practitioners. Most of us trust our doctors’ diagnoses; when they tell us that our sniffles are due to allergies, we can’t help but believe them and take their word for it. We typically don’t seek a second opinion because we are inclined to believe that “the doctor is always right.”
But the statistics don’t lie; in a group of seven Medicare patients, one has been misdiagnosed. At one point, could it have been you?
This problem is linked to a practitioner’s tendency to “refer” his/her patients to a doctor that specializes in the medical issue at hand. As a result, a patient often undergoes duplicative tests in the diagnoses process, an expensive error that could be prevented by coordinated care. Or, that practitioner was not qualified for their job, but managed to sneak by the credentialing system.
Therefore, the new Accountable Care Organization (ACO) health network offers bonuses to providers that keep patients healthy and out of the hospital, hence preventing the excessive use of costly equipment and encouraging coordinated care between practitioners. If a hospital elects to join the ACO network, they are expected to provide nothing short of high-quality care to their patients.
You’re probably asking yourself, “What does this have to do with me?” And the answer is: everything! Consider yourself a hospital “gatekeeper”; you determine the fate of every applying/renewing practitioner that wishes to work there.
If a practitioner’s credentials don’t “add up,” then you can’t let them in. But if your credentialing software isn’t efficient, an unqualified practitioner could “sneak” right by you. If your hospital is a part of, or wishes to join, the ACO network, the staff needs to be qualified and capable. And the process starts with you!
Are you ready? ACO’s must develop a separate management and quality system including, but not limited to:
- A governing body with a Medical Director, CFO, Executive Director and Quality Team.
- A compliance team for patient outcomes, credentialing and CMS’s 65 Measured Outcomes. After year one it’s a pass/fail system. Any inability to meet or exceed the 65 quality measures will result in financial risk for the ACO.
- A technology team for EMR, data gathering, Health Risk Assessments, patient satisfaction, etc.
IntelliSoft Group offers two distinctive solutions for ACO’s:
IntelliSoft’s IntelliCVO (formally Cambron Credentials): With a combined experience of 85 years, this credentialing service provides a complete range of Primary Source Verification and Payer Enrollment outsourcing capabilities for any size organization requiring temporary overflow or full-time assistance with primary source verification credentialing, re-credentialing and payer enrollment.
For an in-house solution, IntelliSoft’s IntelliCred software meets Joint Commission, NCQA, and URAC credentialing standards, and alerts you of critical status changes and expiring credentials. It’s important to keep your hospital on its feet, and that necessitates credentialing software that accurately determines capable practitioners.
Version 11.2 of IntelliCred helps manage a practitioner’s criteria-based core privileges, and alerts hospitals to an individual’s personal references and competence to perform procedures. This helps keep unqualified practitioners out of the operating room, and furthermore saves lives and reputations.
Visit us at http://www.intellisoftgroup.com
