Value-based care (VBC) is not a new concept. The Centers for Medicare and Medicaid Services (CMS) has slowly implemented guidelines and reimbursement schedules to facilitate positive patient outcomes over many years. However, 2019 is proving especially transformational for hospitals, skilled nursing facilities and home health agencies.
The evolution from fee-for-service to valued-based care affects all care providers within the ecosystem. Healthcare industry leaders who understand the changes and find ways to adapt will thrive under the new guidelines. Here are tips to help companies stay ahead of the curve!
With reductions in CMS reimbursement for nurse and therapy visits, care providers must optimize intra-organizational communication. There’s simply less room for oversight when redundant visits may not be billable. Teams that are meticulous in sharing details of visits, patient progress and areas of concern will proactively manage populations more effectively.
Investments in advanced electronic health records (EHR) technology, software solutions and mobile phone apps are no longer luxuries in healthcare. Patients demand the convenience, and improved sharing of data is also critical for care teams. Furthermore, healthcare companies are implementing virtual care and remote patient monitoring (RPM) solutions for improved efficiency and outcomes.
Virtual care and RPM technology is playing a bigger role in supplementing in-person nurse and therapy visits, given changes in CMS reimbursements. In fact, virtual care visits and RPM data collection are actually reimbursable in some cases now. So, it’s not just a matter of cost savings but also revenue generation!
Value-based care requires various healthcare providers to work together closely in order to streamline the continuum of care and improve patient outcomes. Hospitals no longer operate as an island, discharging patients to skilled nursing facilities only to forget about their well-being. More and more, large health systems are tracking patient results long after discharge
Hospitals face CMS penalties for preventable readmissions and poor patient outcomes. Therefore, care facilities and home health agencies that don’t facilitate successful outcomes are less likely to receive referrals. Forward-thinking nursing facilities and home health agencies should propose official hospital partnerships that inspire confidence through effective sharing of patient data, resources and technology.
Accurate medical coding is one way healthcare providers can mitigate any losses in revenue due to CMS changes in reimbursement. Proper billing won’t generate “magical” revenue out of thin air. However, it does ensure that money isn’t being left on the table.
Skilled nursing facilities and home health agencies should crunch the numbers and determine if it makes financial sense to hire extra coders. In addition, specialized coders who are experts in value-based care should be considered for new opportunities. Finally, investment in value-based coding education for existing staff may be well worth the expense.
The transition from fee-for-service to value-based care has proven challenging for most nursing facilities and home health agencies. However, with all change comes opportunity. Companies that think creatively and stay ahead of the curve will ultimately find ways to maximize revenue and reduce costs.
If your organization is in need of nurses or other healthcare professionals, be sure to talk to San Diego’s premier medical recruiting agency today!