Press

A collection of resources for senior care providers and their businesses.

By: Stephanie Jackson  |  Type: Article  |  On: October 27, 2017

CMS’ Discharge Planning Proposed Rule and the IMPACT on Post-Acute Care Transitions

The IMPACT Act, which is still in the process of being implemented today, was an effort to standardize those assessments across all PAC providers, so that case managers and others would be able to compare apples to apples and make the best care decisions for their patients.

No one knows better than a case manager the importance of quality data to help facilitate a safe transition of care for our patients. Quality data includes accurate, relevant and current information about the patient AND the post-acute care entities. In September 2014, Congress passed the Improving Medicare Post-Acute Care Transformation (IMPACT) Act. At the time, patient assessment data was standardized by provider type, but not across the different post-acute care (PAC) settings. So, a skilled nursing facility, a physical rehabilitation center, and other types of PAC facilities might have completely different sets of questions they asked during patient assessments, and different ways of recording that information. The IMPACT Act, which is still in the process of being implemented today, was an effort to standardize those assessments across all PAC providers, so that case managers and others would be able to compare apples to apples and make the best care decisions for their patients.

“In essence, the act seeks to standardize data elements used through various patient and resident assessment instruments by aligning certain data elements across instruments, to support our ability to measure and compare quality across the providers and settings of care,” said Patrick Conway, MD, MSc., CMS Acting Principal Deputy Administrator, and Deputy Administrator for Innovation and Quality, and CMS Chief Medical Officer, in a 2016 video from MLN Connects published on YouTube.1 “The act allows interoperability, which permits the seamless exchange of information across providers—not only PAC providers, but other providers who offer care to individuals as well. In the ideal state, important information would follow the patient, as services are delivered in hospitals and by physicians, long-term and PAC providers, and home- and community-based service providers. This will be a critical step towards coordinating care and proving Medicare beneficiary outcomes.” 

Certainly, the goals Conway mentioned are the same goals of case managers everywhere—to have a uniform way to measure and compare PAC providers in order to make the best possible decision for each patient based on his or her individual needs. But we’ve still got a ways to go.

In October 2015, just over a year after the introduction of the IMPACT act, CMS announced the Discharge Planning Proposed Rule, which would “revise the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies, must meet in order to participate in the Medicare and Medicaid programs,” according to CMS’ website.2 “The proposed changes would modernize the discharge planning requirements by: bringing them into closer alignment with current practice; helping to improve patient quality of care and outcomes; and reducing avoidable complications, adverse events, and readmissions.” Importantly, CMS says, the proposed rule would also, finally, “implement the discharge planning requirements” of the IMPACT Act.

Under the proposed rule, hospitals and critical access hospitals would be required to:

  • Develop a discharge plan within 24 hours of admission or registration;
  • Provide discharge instructions to patients who are discharged home (proposed for hospitals and critical access hospitals only);
  • Have a medication reconciliation process with the goal of improving patient safety by enhancing medication management (proposed for hospitals and critical access hospitals only);
  • For patients who are transferred to another facility, send specific medical information to the receiving facility; and
  • Establish a post-discharge follow-up process (proposed for hospitals and critical access hospitals only).

With already-heavy workloads, case managers are going to need sophisticated tools in order to be ready to meet these requirements when the rule takes full effect. For example, in order to develop a discharge plan within 24 hours as the proposed changes require, case managers will need to find a way to sift through information about hundreds of different PAC providers quickly and efficiently. Luckily, software solutions exist now that allow case managers and other hospital workers to do just that—a comprehensive database with contact and geographical information, quality scores, medical and non-medical resources, and corresponding financial information for a variety of PAC providers.

Another critical feature of such a database, when it comes to meeting the requirements of the new CMS proposed rule, is that both the clinical care team and the patient and family members can access the database to make sense of the choices available. That’s because the new rule has a lot more focus on taking into account the patient’s input in their own care. “The proposed rule emphasizes the importance of the patient’s goals and preferences during the discharge planning process. These improvements should better prepare patients and their caregivers to be active partners for their anticipated health and community support needs upon discharge from the hospital or post-acute care setting,” says the CMS website. “In addition, patients and their caregivers would be better prepared to select a high-quality post-acute care provider, since hospitals, critical access hospitals, and home health agencies would be required to use and share data, including data on quality and resource use measures. This results in the meaningful involvement of patients and their caregivers in the discharge planning process.”

Case managers are committed to providing the highest quality and most complete post-acute care information to our patients. We realize the importance of patient and family buy-in of the discharge plan and its direct impact on keeping the patients from being readmitted to the hospital, and I believe that most of my colleagues support the proposed rulings in the IMPACT Act to help make this a reality. We also know, however, that it’s really difficult to access current, clean PAC data (that we trust) in an efficient manner. We need a resource database that not only provides lists, qualifications and special offerings of post-acute care providers but offers quality scores to help assure the case manager is creating the best discharge plan. We have a ways to go, but I’m confident that this type of solution will blaze a new trail for our patients and care team members.

About Carelike

Carelike's extensive database of medical and non-medical transition care providers allows your discharge team to improve their efficiencies. Provider data is augmented with proprietary professional quality metrics as well as CMS scoring. Our technology provides ease of use standalone portals or EHR integration to help discharge teams select the best care providers. 

Organize your patient and family communication with our CareTrait technology. Comply with CMS initiatives including the proposed patient discharge IMPACT Act rule and significantly reduce the burden on this already over-stretched group of professionals. The solution greatly improves communication between discharge teams, patients and families and prioritizes preferred community-based services enabling the case manager to fulfill their responsibilities while improving care coordination. 

 

 

References:

1. https://www.youtube.com/watch?v=LQpGMg2-bhQ

2. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-10-29.html  

Read in about 6 minutes
By: Carelike Team  |  Type: Article  |  On: September 28, 2017

Readmission Costs Are Real and Case Managers Are on the Hot Seat

For those of us working in the U.S. healthcare system, the term “readmission” is heard on a daily basis, and it’s a term we don’t take lightly. For Case Managers and Discharge Planners, the term invokes a feeling of stress as we are responsible for making sure our patients are discharged with an airtight plan that will prevent a return to the hospital. The pressure is real.

For those of us working in the U.S. healthcare system, the term “readmission” is heard on a daily basis, and it’s a term we don’t take lightly. For Case Managers and Discharge Planners, the term invokes a feeling of stress as we are responsible for making sure our patients are discharged with an airtight plan that will prevent a return to the hospital. The pressure is real. The ramifications directly impact our jobs not to the mention the hospital’s bottom line and, most importantly, our patients’ quality of life.

The Affordable Care Act's Hospital Readmission and Reduction Program (HRRP) applies financial penalties for readmissions of Medicare patients that are higher than expected according to algorithms derived by the Centers for Medicare and Medicaid Services’ (CMS). The penalties are imposed against a hospital’s total book of Medicare business and constitute significant reimbursement reductions for hundreds of hospitals across the country. According to the Kaiser Family Foundation, total Medicare readmissions penalties will increase to $528 million in 2017, which is an increase of $108 million over 2016[1].

To reduce readmissions, we need to understand some basic facts. First, a readmission occurs when a patient is admitted to a hospital within a pre-determined time period (Medicare defines this time period as 30 days) after being discharged from a prior hospitalization and includes readmissions to any hospital, not just the one where the patient was originally hospitalized. Furthermore, Medicare doesn’t take into consideration cases where a patient is readmitted for a diagnosis completely unrelated to the original hospitalization. For example, if my mom’s discharge diagnosis was Congestive Heart Failure and she returns to the hospital due to a hip fracture, the hospital still gets dinged for a readmission.

Currently, the HRRP focuses on six conditions: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), elective hip or knee replacement, and coronary artery bypass graft (CABG). CMS will likely continue to add conditions to this list to maximize savings and improve quality over time.

So, what does this mean for the Case Manager? If you consider the six conditions eligible for penalties, you can see that these are high acuity diagnoses in need of complicated discharge services. These patients often require one or more interventions including:

  • Transfer to a skilled nursing facility for more intense post-acute rehabilitation
  • Follow-up by a Registered Nurse for medication management, especially those with polypharmacy and/or high-risk medications, vital sign assessment, wound care, etc.
  • Physical Therapy/Occupational Therapy to regain strength after a hospital stay
  • Durable Medical Equipment (DME) such as oxygen, walker, wound care supplies, etc.
  • Home care to assist with Activities of Daily Living, transportation, shopping, etc.

CMS not only imposes stiff penalties for readmissions, but it has also established requirements regarding which facilities patients can be sent to, which home care agencies can follow patients and which DME companies can provide supplies. In addition, there is an important element to consider around the regulations of patient choice in making decisions for the post-acute care they require. Patients need access to information to make the most informed choices.

These criteria pose challenges for the Case Manager as she tries to coordinate services and comply with regulations while at the same time, remaining cognizant of the need to discharge the patients in a timely manner. What we lack, quite frankly, are the tools necessary to facilitate this process. We need a resource database that not only provides lists, qualifications and special offerings of post-acute care providers but offers quality scores to help assure the Case Manager is creating the best discharge scenario for the patient. Furthermore, it’s essential to understand the need for a database that captures both medical and non-medical providers. The non-medical resource team is just as vital as the medical team in restoring the patient to his or her level of independence prior to the admission. Armed with this type of information, Case Managers and Discharge Planners can tackle our readmission challenge and provide the highest quality care to our valued patients.

 

About Carelike

 

Carelike's extensive database of medical and non-medical transition care providers allows your discharge team to improve their efficiencies. Provider data is augmented with proprietary professional quality metrics as well as CMS scoring. Our technology provides ease of use standalone portals or EHR integration to help discharge teams select the best care providers. 

 

Organize your patient and family communication with our CareTrait technology. Comply with CMS initiatives including the proposed patient discharge IMPACT Act rule and significantly reduce the burden on this already over-stretched group of professionals. The solution greatly improves communication between discharge teams, patients and families and prioritizes preferred community-based services enabling the case manager to fulfill their responsibilities while improving care coordination. 

 

[1] http://www.kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/

Read in 4 minutes
By: Stephanie Jackson  |  Type: Article  |  On: May 08, 2017

Leveraging CMS reimbursements for post-acute and chronic patients

With proper billing-code utilization and the right care-coordination technology to match the best providers with care seekers, physicians and health care organizations involved in the discharge planning and care coordination of chronic and post-acute patients can be reimbursed for these services.

Since 2015, the Centers for Medicare & Medicaid Services (CMS) has been reimbursing doctors and health care organizations for providing chronic care management. Unfortunately, many organizations are not receiving this reimbursement and may be missing out on federal funding for some of the sickest Medicare beneficiaries. With proper billing-code utilization and the right care-coordination technology to match the best providers with care seekers, physicians, and health care organizations involved in the discharge planning and care coordination of chronic and post-acute patients can be reimbursed for these services. 

What are the CMS reimbursements?

As reported by ModernHealthCare, CMS made payments for chronic-care claims for just 513,000 Medicare beneficiaries of the approximately 35 million individuals eligible for this program. (To be eligible, individuals must have two or more chronic conditions.) Some of this gap stems from physicians' overall lack of awareness of the billing code for care management. However, by speaking with physicians, coordinating chronic-care services and using the right care-management billing codes, CMS will reimburse physicians and health care organizations for their time. 

The source noted that approximately 70 percent of Medicare beneficiaries have two or more chronic conditions. Examples of the covered conditions include, but are not limited to:

  • Alzheimer's disease and related dementia.
  • Arthritis (osteoarthritis and rheumatoid).
  • Asthma.
  • Diabetes.
  • Hypertension.
  • Depression.
  • Cancer.

Hospitals that partner with acute care nurses, discharge planners and care coordinators can take advantage of the average $42 per patient per month reimbursement for chronic-care service coordination and specialist consultations.

As noted in ModernHealthCare, another reason some health care providers are not taking advantage of this opportunity is due to the necessary written patient permission for the reimbursements. However, the 2017 add-on now eliminates the need for written consent and allows a verbal okay from patients.

According to CMS, the payable CCM service codes include:

  • CPT code 99490: covers 20 minutes of clinical staff time once a month for patients with two or more chronic conditions at significant risk of death or functional decline. The chronic care management services are required to have established, implemented, revised or monitored a comprehensive care plan.
  • CPT code 99487: covers 60 minutes per month of clinical staff time for complex chronic care involving moderate or high complexity medical decision making.
  • CPT code 99489: covers additional 30-minute block for qualified clinical staff time, once per month.
  • HCPCS code G0506: an add-on, covers qualified clinical staff time for the initiating visit with a patient to develop a comprehensive assessment and care plan.

Some of the services included under the CCM cover:

  • Continuity of care with designated care team members.
  • Comprehensive care management planning.
  • Transitional care management.
  • Coordination with home- and community-based clinical service providers.

Qualified clinical staff include:

  • Physicians.
  • Certified nurse midwives.
  • Clinical nurse specialists.
  • Nurse practitioners.
  • Physician assistants.

CMS also noted that CCM services are priced in both facility and non-facility settings, including skilled nursing, nursing, assisted living or other facility settings.

Reducing patient hospital readmittance

Patient readmittance in the first 30 days results in a CMS reimbursement penalty, so it's imperative that discharge nurses have top quality care providers for post-acute and chronic patients.

Unfortunately, research studies showed that 17.3 percent of Medicare fee-for-service patients aged 65 and over were readmitted within 30 days in 2012, according to the National Health Statistics Report. Readmissions occurred due to care coordinators poorly managing transitions during discharge, infections or complications caused by the hospital stay or the reappearance of the condition that led to the hospitalization in the first place.

Reducing readmissions falls on care coordinators in charge of locating care providers with the skills and qualifications that best suit the needs of the patient.

To accomplish this, care coordination companies, such as hospitals or health IT companies, are building discharge-planning software. However, these platforms need a robust database of talented and experienced care providers to ensure post-acute and chronic patients recover quickly and do not need readmittance.

 

Care coordinators need to reduce the hospital readmission rate of chronic patients.

Care coordinators need to reduce the hospital readmission rate of chronic patients.

Follow-up calls between visits to primary care physicians

One way to help reduce the chances for chronic and acute patient readmission is to provide ongoing treatment and care following a hospital discharge. This enables an open dialogue and regular visits to ensure the patient is following the physician's recommendations. 

Individuals receiving ongoing treatments from their primary care physicians and suffering from two chronic conditions need extra care providers in between doctor visits. Aligning these care services along with the CMS reimbursement is important to capture lost revenue opportunities.

How Carelike can help

Sometimes the biggest obstacle to taking advantage of the CMS reimbursement is finding the best-suited care providers to deliver post-discharge and follow-up services. Matching a nurse without the right qualifications can lead to readmission, which penalizes the reimbursement. Often, as noted by the Center for Healthcare Quality & Payment Reform, the inability to receive good primary care support in the local community is a main contributor to preventable readmissions.

Care coordinators arranging for discharge planning or long-term follow-up services for chronic patients need easy access to a wide range of care providers. Further they need the ability to accurately tailor their searches to locate the most appropriate health care professional to align with unique care seeker needs. By identifying the best local care providers for managing post-discharge chronic care patients, hospitals can reduce their readmission rates and ensure they're receiving the full CMS reimbursement.

Carelike creates a custom portal for care coordinators, who can then use licensed data that focuses on either national or local/regional care providers. Hospitals that already have their own systems can rely on Carelike's API that simply plugs into existing systems for easy access to the extensive database.

Using Carelike's dashboard, care coordinators can easily track patient statuses, add noted, document care transitions and take advantage of the extensive database of providers who all manage chronic and post-acute conditions. This provides an additional layer of context during the transition phase that's crucial for communicating additional information about patients.

Companies in the process of building a software solution to meet the growing need of matching care providers with care seekers could benefit from using the Carelike database.

Carelike provides the technology and resources to help hospitals, health care organizations and care coordinators take advantage of CMS reimbursements for chronic care and post-acute care management. Click here to learn more about Carelike.

Read in 5 minutes
By: Stephanie Jackson  |  Type: Article  |  On: February 06, 2017

Tech making an impact on home health care services

Carelike's senior housing and elder care directory, coupled with its CareMatch technology, lets care providers quickly and easily post business information and service offerings.

Home care aides have long been facilitators of independence and good health for seniors. From providing assistance for individuals who want to age in place to ensuring their clients remain active participants in their communities, it's crucial that care providers have the means to promote this self-sufficiency.

Thankfully, an assortment of emerging technological devices and internet platforms have arisen that ease the facilitation of this independence and health lifestyles for seniors.

Social media keeps everyone connected

Facebook, Twitter, Pinterest and other social media outlets have made the world more interconnected than ever before. While Facebook began solely as a means for college students to stay linked, it quickly transformed into a global network accessible to people of all ages. Increasingly, older adults are using the channel. According to a 2016 survey conducted by Pew Research Center, 62 percent of online individuals ages 65 and older log in and use Facebook - a jump of 14 percentage points from the 48 percent of this cohort who reported using the site in 2015.

"Facebook keeps seniors connected with friends and families."

One of the great things about social media is that it allows seniors to interact with friends, families and even strangers - a key component to remaining independent and healthy. However, the service also provides a channel for seniors to keep everyone updated about health problems or other issues preventing them from living life to the fullest.

Wearable technology

As computers become smaller and more ubiquitous, innovative companies have been incorporating technology into just about everything. This has facilitated the advent and growth of wearable technology. And it's having an impact on the home health community for good reason. 

Each year, roughly 33 percent Americans ages 65 and older and half of people 85 and older, experience a life-changing fall, Live Science reported. These slips can cause severe injuries and prevent individuals from reaching their phone to contact an emergency service.

A medical alarm system that includes a pendant or device that senses a sudden fall and impact reduces the chances for long-term injuries or worse. These devices have become much more advanced in recent years, with internet connections and immediate contact methods if the wearer doesn't respond.

Increased access to wearable technology allows home care aides to stay informed of any potentially dangerous slips or falls that might occur to the seniors they assist.

 

New technology has been key in allowing home health aides boost their quality of care.

New technology has been key in allowing home health aides boost their quality of care.

Matching with the best care aides

Finding the right home care aide and matching him or her with the ideal person is crucial for maintaining solid relationships. 

Carelike's senior housing and elder care directory, coupled with its CareMatch technology, lets care providers quickly and easily post business information and service offerings. The information is then sent to Carelike’s network of Channel Partners who license and view the provider information in order to make referral recommendations to their patients.  This robust and comprehensive search technology connects the most ideal care provider candidate best suited to the care seeker’s needs. For a minimal fee, care providers can set up a detailed profile with a comprehensive list of qualifications and experiences. This enables the CareMatch technology to produce more accurate connections that allow for better relationships between care providers and care seekers. 

Read in about 3 minutes
By: Stephanie Jackson  |  Type: Article  |  On: November 16, 2016

Uber used as transportation for home health providers

The terms "Uber" and "healthcare" have been used together a lot in the news lately, and it's no wonder.

Ride-sharing apps like Uber have taken over a considerable share of the transportation market in the past several years, especially in cities. Though the benefits of grabbing a ride from your phone are obvious for the general public, many businesses in the private sector are beginning to capitalize on the affordability and ease of use with Uber, including the healthcare sector.

Paving the way
Circulation, a transportation platform based in Boston, is now setting up a platform with health systems to arrange rides with Uber's application programing interface. Many experts working within Circulation believe this model has huge potential, as it could provide a reliable form of transportation for home health workers. It also works on demand to deliver high-quality healthcare workers to patients suffering from non-emergency medical issues safely and accurately. According to Home Healthcare News, John Brownstein, Circulation's co-founder, Harvard Medical School professor and a health care adviser to Uber, Circulation is already looking toward the future.

"That would be the next phase of this platform," he said. Brownstein went on to explain that Circulation was "designed with seniors in mind … there's definitely an opportunity to use Circulation for on-demand home health services." 

 

Apps like Uber could become a useful tool in the home health industry soon.Apps like Uber could become a useful tool in the home health industry soon.

Working with hospitals and providers to use Uber for home healthcare could indeed help many seniors suffering from cognitive issues, such as dementia and Alzheimer's. These patients might feel more comfortable seeing a medical professional in their own homes. The same could be true for homebound seniors with physical impairments, such as those who rely on a cane or wheelchair to get to their appointments.

Is an 'Uber for healthcare' on the rise?
The terms "Uber" and "healthcare" have been used together a lot in the news lately, and it's no wonder. After all, on-demand services are incredibly easy to use and convenient, which is not the case for healthcare in many ways. Wait times to see a healthcare professional are rising, and many people want the personal connection with providers that quick appointments don't always allow. It would seem that an "Uber for healthcare" would solve many of these issues.

Still, there are some professionals in health tech who are wary about on-demand health services. In a recent TechCrunch article, the argument is that healthcare is a multi-faceted need for consumers and can't be solved in the one-time transaction, such as a ride to the airport. Most people, the author argues, value the doctor-patient relationship above anything else, which can be hard to nail down in an on-demand experience.

However, that's not to say that Uber can't be a great stand-alone tool for health systems to use for homebound seniors or patients with cognitive decline. Brownstein also spoke with the Boston Globe about a project he led last year called UberHEALTH, which successfully helped transport medical professionals in Boston and 35 other cities to administer more than 2,000 flu shots. In a survey given to those who participated in the program, 78 percent said that the delivery of the vaccine was crucial in deciding to be part of the platform.

While it's still unclear whether or not Uber will turn into a fixed part of the healthcare system, there are signs that it could become more common in the home health sector in the future. 

Read in about 3 minutes
By: Stephanie Jackson  |  Type: Press Release  |  On: November 15, 2016

Carelike, LLC. leads change in senior care referral industry

Carelike differentiates from its competitors by giving care seekers access and transparency to all providers in their area, not just those who pay for a profile. Carelike displays all available information, truly giving families the power of choice and the ability to make informed decisions.

Carelike, LLC. leads change in senior care referral industry

Media contact:
Stephanie F. Jackson
Carelike, LLC.
Tele: (404) 250-8370

ATLANTA, GA. (November 15, 2016) -- As many Americans (especially baby boomers) are discovering, finding the perfect care service for a senior loved one is challenging. Per data from a 2015 AARP report, approximately 43.5 million adults provided unpaid elder care, mainly to relatives. This number only stands to grow as baby boomers age, and Carelike has come up with a solution.

With most senior-placement companies, care seekers use online or call-in services to find an assisted living community or home health aide for their loved one. However, they only get information from a small, select number of providers who have a contract to be listed on that referral company's website. This means care seekers miss out on many providers who might more closely fit their needs, have more esteemed credentials or elicited better patient reviews.

The senior care referral industry has been around for years, and so has Carelike (previously SNAPforSeniors). The organization is well-connected and has the experience and expertise required to drive a much-needed change to the industry. Their business model has always put the care-seeker first. Everyone who is a licensed senior care professional - not just those who "pay to play" - shows up in Carelike's comprehensive database of providers. This is because Carelike pulls from 400 different sources to gather data on senior and post-acute care providers. The organization then goes to great lengths to clean, filter and augment the data to give care seekers the most up-to-date and accurate picture of each provider.

This methodology has made Carelike the preferred partner for organizations who help consumers find care, which include renowned health organizations, health insurance companies, care management companies, EAPs and patient advocacy groups, including the Alzheimer's Association.

If you haven't heard of Carelike, it may be because the company has always worked behind the scenes providing well-known, reputable organizations with data. Now that this company aims to appeal to consumer care seekers, Carelike will share providers' information with not only organizations who license the data but with family members looking for senior services through their new consumer search site.

Carelike is the only online senior listing company that provides that type of exposure for providers - to both consumers and professional care-seekers at organizations who license the data. Meanwhile, Carelike differentiates from its competitors by giving care seekers access and transparency to all providers in their area, not just those who pay for a profile. Carelike displays all available information, truly giving families the power of choice and the ability to make informed decisions. Discover the possibilities for yourself at CareLike.com.

Read in 2 minutes
By: Carelike Team  |  Type: Blog  |  On: February 11, 2016

The future of value-based health care

The implementation of the Affordable Care Act launched the transition from the traditional fee-for-service payment model to value-based care, signaling an overall shift in current and future health care industry trends.

The implementation of the Affordable Care Act launched the transition from the traditional fee-for-service payment model to value-based care, signaling an overall shift in current and future health care industry trends. This greater emphasis on quality has clear advantages for patients, but it also brings benefits for the economy.

The New York Times said that experts estimate approximately $6.6 billion of the $2 trillion spent on health care annually goes to tests and hospitalizations that do nothing to promote patient well-being. Fee-for-value reimbursements encourage physicians and their teams to focus on what patients truly need. Here are just a few of the myriad changes that physicians can expect with this switch:

Value will be in high demand

The saying “if you give someone an inch, they’ll take a mile” holds true for patients receiving value-based care. Once consumers have experienced the health advantages of this new reimbursement model, the demand for high-quality care will surge. A report by the Healthcare Financial Management Association concluded that all stakeholders, from patients and consumers to government agencies and health plans, want to know what they’ll receive for their money in terms of care. They want physicians who can not only provide this information but follow through with quality.

This demand will serve as one of the many drivers of change in the health care industry, according to HFMA, contributing to transitions in culture, business, performance and risk management. Physicians will respond to this call in all they do, from conversations with patients to how they use data. For instance, doctors must explain their reasoning to patients when they order a diagnostic test, so consumers can understand how it contributes to their well-being. In fact, medical specialty societies have worked together to create the Choosing Wisely list, which outlines an extensive list of procedures and tests that patients should question.

Meanwhile, Healthcare IT News explained that the demand for value will require doctors to display more transparency when it comes to discussing treatment options and success rates. Physicians may meet this criteria by giving patients more control over their care, which may be as simple as allowing them to choose between brand-name prescriptions and generic medications.

Primary care will be more abundant and accessible

This point has two components: filling the primary care shortage and increasing availability of care. For the former, the problems associated with a lack of physicians will only get worse with time. As the Health Resources and Services Administration explained, the number of providers will increase 8 percent by 2020, while the demand for primary care will elevate by 14 percent. This shortage is problematic in terms of providing value-based care because with fewer doctors and greater responsibilities, patients won’t be able to receive the attention needed for boosting their well-being. Clearly, change is necessary to close this gap.

One solution is more nurse practitioners. Unlike registered nurses, NPs have the ability to write prescriptions and order diagnostic testing, similar to physicians. Additionally, the number of NPs is projected to grow 31 percent by 2024, according to the Bureau of Labor Statistics, which can help alleviate the primary care shortage.

At the same time, increasing physician’s accessibility can help meet the demand for high-quality care. For instance, electronic health record integration will carry increasing importance in the next few years, and email communication might become more frequent. This way, patients don’t have to schedule appointments and wait weeks to simply ask their doctors questions.

Greater emphasis on care coordination

A 2010 Practice Fusion survey found that patients see an average of 18.7 physicians in their lifetimes. Because patients visit several medical providers for various health issues, care coordination holds high importance, but the switch to value-based reimbursement makes it even more crucial for patients and health care professionals alike. According to the U.S. Department of Health and Human Services, the very basis of care coordination involves improving quality and efficiency, but it requires collaboration among all professionals in the patient's health care team. As such, physicians must communicate, be aware of the patient's goals and needs, aid in the care transitions and agree on responsibility.

The progression of value-based care paints a bright future for the health care industry. However, care providers must adjust their practices and prepare for the transition to meet patient expectations.

 

Source:

  • http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html?_r=1
  • http://www.hfma.org/Content.aspx?id=1126
  • http://www.choosingwisely.org/doctor-patient-lists/
  • http://www.healthcareitnews.com/news/5-healthcare-imperatives-patients-demand-more-personalized-treatment
  • http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/
  • http://www.prnewswire.com/news-releases/survey-patients-see-187-different-doctors-on-average-92171874.html
  • https://pcmh.ahrq.gov/page/defining-pcmh
  • http://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html
  • http://www.isc.hbs.edu/health-care/vbhcd/pages/default.aspx
  • http://hitconsultant.net/2015/04/28/12-things-about-value-based-reimbursement/
  • http://www.modernhealthcare.com/article/20150128/NEWS/301289952
  • http://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm
Read in 4 minutes