value-based purchasing

The metrics considered when issuing a reimbursement are numerous, but by creating an internal system that mimics those at the federal level, medical practices will have internal data that will allow them to forecast possible payment amounts accurately.

The Importance Of Taking A Pro Active Approach To New Federal Reimbursement Mandates

Changes related to Medicare and Medicaid reimbursements occur on a regular basis, but new mandates that are expected to be enforced by 2022 require medical providers to focus on the quality of care they provide, as billing for every procedure and test is a reimbursement structure that is on its way out. While the result is designed to boost outcomes for patients, it presents those who manage a facility with a variety of challenges. If the idea of switching to value-based purchasing is overwhelming, don't fret, as there are firms that will assist a facility with the following hurdles.

Developing Metrics

The metrics considered when issuing a reimbursement are numerous, but by creating an internal system that mimics those at the federal level, medical practices will have internal data that will allow them to forecast possible payment amounts accurately. Most systems revolve around the quality of pre-op care, the success of any medical treatments, and how quickly a person resumes regular activity afterward with minimal followup appointments.

Enhance Followup Care

One of the key performance indicators is the quality of care received after treatment. Physicians must now work with social workers to create care coordination plans, which state what resources a person will need and a listing of the various providers used to ensure they are in place before a person returns home. It is imperative to have a dedicated followup care department that will provide patients with the tools they need to recover.

Cost Control Measures

Another part that is under scrutiny is the overall cost of a procedure, and Medicaid and Medicare expect medical facilities to keep costs low without sacrificing quality of care. Hospitals must now regularly review the amount of money spent on facilities, supplies, and staff and make sure they are in line with national averages. Failing to analyze this information may cause a hospital to overcharge for the services provided and cause reimbursements to be denied or drastically reduced.

The idea of transitioning from a fee for service model is no doubt overwhelming. Fortunately, Health Catalyst works with practices of all sizes and helps them develop the systems and resources to navigate the treacherous waters of reimbursement rates. Check out their site or call today to learn more and arrange for an on-site evaluation.