When it comes to shifting models of physician compensation, there are many considerations ,and at times, it can be difficult to decide where your focus, as a physician or a payer, should be. As we move toward value-based payment models, we might want to consider what values already exist within our healthcare organizations that will be reflective of this shift - and by supporting them, we can lead the charge to newer payment models.
One element of revenue cycle improvement that will be coming to the forefront with the implementation of patient-centered care is patient loyalty. As a hospital, your staff and facility might provide a patient with top-notch care. Overall, they may emerge healed and satisfied with how they were treated - but then, they get their bill! If your hospital’s billing department isn’t equipped to continue that positive patient experience after the patient is discharged, you may be losing patients.
Build It - And They Will Come? Maybe Not. It’s no secret to anyone in the healthcare industry that there’s a huge emphasis on patient satisfaction scores these days - predominantly because they are so closely linked with reimbursement in the new healthcare landscape. Hospitals are taking ‘satisfaction’ a step further- how about patient aesthetic?
Improving patient satisfaction is a laudable and necessary goal for any hospital, particularly when revenue is at risk based on patients’ opinions regarding quality of care. But patient satisfaction measures should not be confused with good medicine – a nobler objective that delivers richer results. Scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) can bring bonuses to hospitals that do well on the survey. Those that don’t may risk losing some Medicare funding under the Hospital Value-Based Purchasing Program. So it’s understandable that hospitals care a great deal about HCAHPS. But the survey scores should not be seen as a proxy for good medicine.
Are you one of many hospitals being dinged with CMS penalties? Are you ready to be dinged for Hospital Acquired Conditions, in addition to readmissions and value-based purchasing? How can a hospital remain profitable? In terms of hockey, the penalty box is where players are sent when they have committed an act which is against the regulations of the game. The player is forced to sit in the penalty box for a period of time, causing the team to play with less players, until the penalty time has lapsed.
When it comes to assessing healthcare quality, we’ve already talked about the trouble with defining ‘quality’, the patient’s perspective and touched on the value of HCAHPS data. The final piece of the puzzle is how do healthcare organizations, hospitals and providers use the HCAHPS data to improve their outcomes?
When it comes to defining healthcare quality, the opinion of the patients might be the most important of all. They are, after all, the ones on the receiving end of care. When you strip away the financial concerns, the administrative politics and all the other things that make healthcare a business, we remember that the end is that we will provide care to patients in need. Their experience of that care, when quantified, can give providers and hospitals a baseline evaluation of their strengths and weaknesses as a healthcare organization.
A standardized definition for quality has been elusive; though most will agree that the term “quality” in healthcare refers to the patient’s overall experience, or, encounter with the healthcare system.
One of the greatest challenges in healthcare currently is not so much a matter of practice, but definition. How has ‘value’ been defined and do we need to alter our definition to reflect the ongoing evolution of our healthcare system?
The Readmission Reduction Program is designed to reduce healthcare spending while improving quality. There are both proponents and opponents of the program. Let’s delve into the improvements that could be made to the current system. So, as most of you are aware, CMS under the direction of HHS created the Hospital Readmission Reduction Program in order to reduce healthcare spending while improving the quality of care. The program is being phased in beginning with a 3 year baseline period in which hospitals were required to report all readmissions (within 30 days). CMS assessed and analyzed all of the available readmission data to determine how penalties should be assessed, for which conditions, and excluding certain circumstances. Beginning in October 2012, penalties were assessed to over 2,200 hospitals, equating to about $280 million. The phase in included an increase in penalties from 2013 to 2015 from 1% to 3%, where it is currently capped. Initially, there were 3 conditions included: Acute Myocardial Infarction, Heart Failure, and Pneumonia. For 2015, CMS is proposing 2 additional conditions: Chronic Obstructive Pulmonary Disease and Elective Hip and Knee Replacements.