In the rapidly changing healthcare landscape, payers are asking Podiatrists to shift from volume-based care fee for service to a value-based reimbursement structure fee for value with a population health approach. This evolution toward value-based reimbursement benefits the patient, the healthcare provider, and the payer. Value-based reimbursement encourages healthcare providers to deliver the best care at the lowest cost. In turn, patients receive a higher quality of care at a better value.
Podiatrists are aware of the efforts underway to transition the United States healthcare fee-for-service payment system away from one based on volume to one that is determined by “value” and links costs to improved patient outcomes. The problem with the current system is that patients who stay in service the longest and have the most procedures and therapeutic interventions generate the greatest revenue regardless of whether outcomes are favorable.
For podiatrists who treat Medicare patients, value-based reimbursement is about to get real. The Centers for Medicare & Medicaid Services is gearing up for next year’s launch of its Merit-Based Incentive Payment System (MIPS), which will factor value, and not solely services performed, into the Medicare reimbursement a provider receives.
If that program is a success, other insurers will likely follow suit with pay-for-performance plans of their own.
Understand That Customer Service Is Essential
The patient experience is more than just clinical care. Podiatrist practices will need to change their approach to patient intake by having staff members take on more of a customer service role. This is especially important for recurring patients. Sit down with each patient and help them understand the financial details of their health care, from pre-admission through the entire care process. Increased interaction, patient education, and patient assistance through this hands-on approach dramatically improves the patient experience, and in turn, increases revenue for your practice
The good news is that these challenges are not that overwhelming, and podiatrist professionals have long managed as the market evolves and organizations find the right mix. Here, we’ve identified important key considerations to consider as they prepare for the ambiguous future ahead.
Making Data More Actionable & Meaningful
Today’s health care organizations are accumulating an overwhelming amount of data, including patient-reported information, social determinants of health, clinical and claims data. With all this information, it can be difficult for organizations to sort out what they do and don’t need – but data is only valuable if it results in informative and actionable results.
Bringing all of this data together to form a substantial record that has a 360-degree view of each individual can be keys to an organization’s success. This view enables organizations to understand the opportunities for care interventions to ensure quality measures are being met and can provide a deeper level of analytics into areas such as utilization.
Standardizing the Care
In this complex ever-evolving health care industry, standardized care is a beacon among health plans, risk contracts, and shared savings programs. In a time where health systems and providers are balancing new regulations, health plan variations, and individual people and population demands, adhering to a standardized level of care removes some of the complexities, while ensuring quality and safety are paramount. Processes and metrics to define standardized care help to ensure patients receive consistent, quality care, every time.
Managing Care & Engagement
Engaging with patients goes beyond helping them manage their conditions. Active participation and shared decision-making are vital, and it’s most effective when an individual’s goals are identified in conjunction with the appropriate tools to make it easy and convenient for them to achieve their desired outcomes. For podiatrists, engaging patients depends on the insights generated from actionable, measurable data.
Additionally, front-end revenue cycle processes are now more important than ever, meaning that collecting the correct patient data before service is critical to ensuring clean claims. In order to improve revenue, providers should emphasize eligibility authorization, collection of copayments, and collection of patient deductibles.
Value-based reimbursement helps in preparing for an evolving patient population with:
- Increased access to care, can lead to more patients and less network leakage
- A more engaged patient population that is responsible for its own care. Patients, in turn, want more insight into their care and value for their dollar
- Increasing market share when patients have more choice in where they receive care
As healthcare delivery moves toward value-based reimbursement, the business model and the care model become increasingly intertwined. Changes made to care processes can have a significant impact on financial performance. Organizations need tools that help them identify their revenue cycle management, cost drivers and provide insight regarding how cost, quality, and care decisions impact the network as a whole.