Am I a preferred post-acute and chronic wound care provider?
This is the question all post-acute and chronic wound care providers should be asking themselves. Centers for Medicare and Medicaid (CMS) and other healthcare payers have introduced new value-based reimbursement models, including Bundled Payment Initiatives, Accountable Care Organizations, Patient Centered Medical Homes, and more. In fact, by 2018, fifty percent of all CMS’s payments will be tied to value-based metrics.
Due in part to financial incentives, hospitals are becoming more focused on transitioning discharged patients to the highest value provider to reduce incidence of readmissions and lower the overall spend per patient. Post-acute and chronic wound care patient referrals have historically been based on availability, geography, patient or family preference, physician preference and/or the hospital’s history with a particular post-acute and chronic wound care provider. Emerging value-based models will require providers to form narrow networks to achieve the best clinical and financial outcomes in the most appropriate setting. ACOs and other value-based payers are already selecting long-term providers as their “partners of choice.” These networks will be very selective in choosing their post-acute and chronic wound care partners. Providers need to be asking themselves two key questions: “What value to do I bring to a network?” and “How do I get a seat at the table?”
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How Will Networks Choose Their Provider Partners?
Post-acute providers need to adopt a sense of urgency and position themselves to be the “partner of choice” to hospitals and emerging local and regional clinically integrated networks. What criteria will networks use to select their partners?
IT Infrastructure - Data will be “king” for these networks. Preferred partners will need to implement an electronic health record to effectively participate in the sharing and exchanging of patient data. Additionally, population health solutions provide the ability to identify patients who are at high risk or emerging risk to enable early intervention.
Quality Care - All potential partners will be assessed on the quality of their care. At present, the primary quality outcome is a provider’s rehospitalization rate. Hospitalization is the key driver of healthcare cost; low hospitalization rates are representative of well-coordinated and well-managed care. Other important measures of quality include infection rate, provider-acquired pressure (injury) ulcer rate, emergency room visit rate, fall rate, etc.
CMS’ Medicare Star Ratings - These ratings are currently available for home health and nursing homes and assess multiple facets of care - from quality metrics to staffing.
Patient Satisfaction - Patient and family satisfaction are publicly reported by CMS for home health, hospice, and nursing homes. Because there is a correlation between patient satisfaction and clinical outcomes, patient satisfaction is rewarded in many value-based care models.
Accreditation Affiliations - post-acute providers who have invested time and money to seek accreditation by an industry-recognized accrediting body will be assessed favorably. Accreditation organizations include Joint Commission, Community Health Accreditation Program, Commission on Accreditation of Rehabilitation Facilities, etc.
Survey History - Networks will evaluate potential partners based on federal, state, and accreditation surveys, as these are reflective of an organization’s quality of care.
Cost of Care - As payers move toward more bundled payment initiatives, the cost of care will be an important factor for positioning as a partner of choice. As of 2015, CMS requires hospitals to report their Medicare Spend Per Beneficiary for a time period that spans from three days prior to the hospital admission through 30 days after discharge. Eventually, CMS will require all providers to report this type of data.
How Can Corstrata Help Providers Become Preferred Post-Acute And Chronic Wound Care Providers?
The importance of effective wound care cannot be underestimated. With 6.5+ million people requiring wound care annually in the US at a cost of $25 billion, a quality wound care program is critical. Board certified wound care nurses are scarce and expensive resources. Corstrata can assist post acute providers in becoming a wound care “center of excellence.” We facilitate access to certified wound care experts, evidence based wound care treatments, and cost effective wound supply formularies. Corstrata’s virtual wound management can help you achieve better clinical outcomes, lower spend per patient, and increased patient satisfaction!