“No margin, no mission.” It’s long been the rallying cry of healthcare leaders who understand that they cannot serve the needs of their communities and patients without at the same time ensuring that their organizations are financially sound. However, a recent study published in Health Affairs found that 55% of for-profit and not-for-profit acute-care hospitals were not profitable.
Hospitals and post-acute care providers such as home health and hospice organizations are working more closely together than ever before. Each year, 10 million Medicare beneficiaries are discharged from hospitals into various post-acute care settings. Two-thirds of these people have two or more chronic conditions, with 14% having six or more.
Healthcare is well down the road towards full value-based reimbursement and it is important for providers – especially practitioners – to understand they can achieve success with payment being tied to value by focusing in three areas:
On the journey to improved clinical and financial health, hospitals are all looking for a silver bullet that simply isn’t there. Value-based care comes in many forms that will be used simultaneously to bridge from health care’s current fee-for-service (FFS) to global capitation. The job of health care leaders is to figure out how to navigate the complexity associated with managing the many payment and delivery models. That means not only understanding the administrative, payment and delivery impacts of the models being deployed but also knowing how to measure performance across each of the models.
For our industry, it’s no longer a question of “if” or even “when.” The shift from volume to value is in full swing, and the pace of change is rapid. Push has finally come to shove, and there is no doubt that reimbursement will be based on your ability to achieve the highest quality outcomes for patients.
Download our infographic to learn which four areas healthcare innovation is creating benefits for both payers and providers.
We all know the risks associated with self-pay patient accounts. The cost to collect is up to three times higher than on commercial insurance accounts, and the longer a self-pay balance goes unpaid, the lower the probability you will ever collect. The reality is, these problems are here to stay because of rising healthcare costs and more high-deductible, consumer-driven healthcare insurance plans.
In February 2016, Centers for Medicare & Medicaid Services made a game-changing announcement that affects the quality measures reporting requirements on providers generally and on physician practices specifically. The CMS said it and major private health insurers and major physician organizations agreed to standardized core sets of quality measures for seven delivery models and clinical services lines. In short, the agreement means that physician groups will be collecting and reporting the same set of quality measures to all payers for a particular delivery model or clinical service line.
Ninety-three percent of our nation’s total Medicare spending is on beneficiaries with multiple chronic conditions, according to the Centers for Medicare & Medicaid Services (CMS). With the new chronic care management (CCM) payment program authorized by the CMS, it is now financially feasible for physicians to deliver care between office visits.
For health care providers, the journey to value-based care starts by taking the first step. For many primary-care physician practices, that first step can — and, in many cases, will — be Medicare’s new Comprehensive Primary Care Plus, or CPC+, initiative.