By Cathryn Domrose
Medicaid expansion. Changing systems of payment. Electronic health record conversion. The phrases float at the bottomof a TV screen or flash in headlines, but what do they really mean? To help keep readers informed,
Nurse.comhighlights some im- portant healthcare policy issues for nurses to watch.
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Medicaid expansion
What’s happening now: As part of the 2010 Affordable Care Act, states were supposed to expand Medicaid to cover people up to 138% of poverty level, but in 2012, the U.S. Supreme Court ruled states could opt out of the program. So far, 28 states and the District of Columbia have expand- ed their Medicaid programs, 16 have decided not to and six are considering doing so as ofMarch 6, according to the Kaiser Family Foundation. Six states that have expanded Medicaid received waivers allowing them to make certain requirements such as charging co-pays or premiums.
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Pay for performance
What’s happeningnow:The U.S. Department of Health and Human Servicesplans tomake30%ofMedi- care payments to providers through alternative reimbursement models, such as accountable care organiza- tions orbundledpaymentprograms, bytheendof2016, increasingto50%
by2018.TheCenters forMedicare& MedicaidServices linkednearly85% of traditional Medicare payments to quality through accountability programs, such as readmissions re- duction and value-based purchas- ing, that hold back a percentage of payment if certain quality standards are
notmet.CMS plans to increase those to 90% by 2018.
ICD-10 conversion
What’shappeningnow:AfterOct. 1, allhealthcare services are required to upgrade to theWorldHealthOr- ganization’s “International Classifi- cation of Diseases, 10th edition” as the standard numeric code system for diagnosis and medical billing. The newsystemof seven-digit codes ismore complex andmore accurate- ly describes a patient’s condition, said LindaHarrington, PhD,DNP, RN-BC, CPHIMS, FHIMSS, vice president and chief nursing infor- matics officer at Texas Division of Catholic Health Initiatives in Houston. But ICD-10 also ismore cumbersomebecause there aremany more diagnoses, she said.
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