Value-based programs: Does your organization measure up?
Running a healthcare organization has never been a simple matter. After all, medicine is complicated, requiring several years of education to practice, and managing any type of business comes with its own set of challenges.
Lately, however, it’s gotten even more difficult. Reimbursements are declining, the physician fee schedule isn’t keeping pace with inflation — costs have outgrown physician reimbursement — and payers are moving away from the fee-for-service payments this industry has depended on for years, representing both an opportunity and a risk. While traditional fee-for-service payments decline, there are new incentives for care management.
All of these factors are combining to force healthcare organizations to look to value-based programs in an effort to remain profitable.
So where do you start?
Manage transitions of care
Any time one of your patients is admitted to the emergency department, your organization has an opportunity to improve his or her health. After handling the event that brought the patient in, your staff should:
Perform a medication reconciliation and review discharge instructions
Schedule any necessary follow-up appointments
Set goals with the patient and monitor progress
These tasks can improve patient health and increase revenue for your organization. Medication reconciliations, for example, can be done remotely and then billed for patients with 2 or more chronic conditions under the Medicare chronic care management fee — which is worth over $40 per patient per month.1
Treat the patient’s entire condition
Many times, when a patient visits your organization, he or she will have a specific complaint. While it’s important to address that complaint, you should also take this opportunity to evaluate the patient’s overall health and treat any conditions that come to light.
Offer same-day access
Giving patients the option to schedule same-day appointments can decrease patients’ reliance on your emergency department and empower them to manage their health. Consider extending evening and weekend hours, as well as reserving time in your providers’ schedules to book same-day appointments.
Offering services like same-day access is also required to bill for the chronic care management fee and capture that $142,156 opportunity.
Each of these tactics will allow you to improve health outcomes and meet the quality measures of various value-based programs. To learn more about how your organization can improve population health and take advantage of incentives, read “Pop health strategies that pay.”