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revised_term_case_presentation.pptxTerm Case Competition.
Group 2:
Kristina Charles
Melissa Hervas
Dayana Lewandowski
Marcella Ortega
Daylen Torres
Maridellis Utset
November 20th, 2016
Background:
C.W. Williams Healthcare Center was started by the first African American surgeon from Charlotte’s largest hospital in 1980. His passion for the health needs of the poor and wanting to make the world a better place for those less fortunate, was his ultimate concern.
In essence, the ACA, signed into law March 2010 by President Barack Obama will focus on …
the uninsured Americans granted health insurance
provide all screenings, and services as recommended by the U.S. Preventive Services Task Force.
establish lower healthcare costs
enhance system productivity
Major Ruling Beneficial to C.W. Williams
The ACA provides new options and incentives to help states rebalance their Medicaid long-term care programs in favor of community-based services and supports rather than institutional care (Paradise, 2015).
Accountable Care Organizations
Group of doctors, hospitals and other health care providers who come together voluntarily to give coordinated high quality care to their Medicare patients.
The goal of Accountable Care Organizations are to avoid unnecessary duplication of services and preventing medical errors. This ultimately results in savings for the Medicare program.
Goal of ACOs
C.W. Williams and ACOs
Currently one of C.W. Williams obstacles is the consortium being formed with the state to pay for Medicaid patients. If the state agrees to partake in this, all of C.W.’s patients, that require hospitalization, will no longer have the choice of which hospital they'd like to be admitted to.
CMC has expressed an interest in the patients of C.W. Williams
Older patients of C.W. Williams prefer CMC over Presbyterian.
It’ll be easier to form an ACO since the majority will be Medicare patients and there will only be one hospital affiliation.
Patient- Centered Medical Home (PCMH)
Patient-centered medical home is a model of care that aims to transform the delivery of comprehensive primary care to children, adolescents and adults. Through this model, practices seek to improve quality, effectiveness and efficiency of the care they deliver while responding to each patient’s unique needs and preferences.
Anti-Kickback & Stark Law Implications
Anti-Kickback Statute Prohibits:
Offering, paying, soliciting or receiving anything of value to induce or reward referrals to generate Federal health care program business.
Stark Law Prohibits:
A physician from referring Medicare patients for designated health services to an entity with which the physician has a financial relationship unless an exception applies.
References
Centers for Medicare & Medicaid Services (2015). Accountable Care Organizations (ACO). Retreived November 11, 2016, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco/
Harris, D.M. (2014). Contemporary Issues in Healthcare Law & Ethics. Chicago, IL. Health Administration Press.
National Association of Community Health Centers (NACHC). (2004). Affiliations Between Health Centers and Other Community-Based Providers. p. 25. Retrieved November 11, 2016, from http://bphc.hrsa.gov/archive/technicalassistance/resourcecenter/managementandfinance/affiliationsbetweenhealthcentersandothercommunitybas.pdf
Paradise, J. (2015, March 09). Medicaid Moving Forward. Retrieved November 11, 2016, from http://kff.org/health-reform/issue-brief/medicaid-moving-forward/
The Henry J. Kaiser Family Foundation (2013). Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth. Retrieved November 11, 2016, from http://kff.org/health-reform/issue-brief/community-health-centers-in-an-era-of-health-reform-overview/
