Changes in reimbursement models are driving changes in operations, including data collection and reporting. Providers are being encouraged and incentivized to implement value-based care (VBC) that emphasizes cost savings and quality outcomes instead of the traditional fee-for-service (FFS) reimbursement model that pays according to the number of procedures performed. The idea is that when hospitals have financial incentives to be accountable for patient outcomes, then the comprehensive focus on quality will result in overall lower costs. Transitioning from FFS to VBC may be especially difficult for ORs with their high costs of procedures, but several strategies can help clear the path to progress.
From a healthcare perspective, the only thing we can be certain of in 2017 is that there will be uncertainty. For healthcare administrators, there is uncertainty around how to manage changes in provisions of the Affordable Care Act, Bundled Payments for Care Improvement (BPCI), and the Medicare Access and CHIP Reauthorization Act (MACRA). Restructuring Medicare and Medicaid could have a significant impact on planning, implementation, and payments for providers. But, regardless of the new format, healthcare providers like SpecialtyCare will always have an obligation—both to their patients and their customers—to improve value by providing high-quality care while containing costs.
Sylvia Burwell, Secretary of the Department of Health and Human Services (HHS), is tasked with transforming our healthcare system from a fee-for-service model to a value-based system driven by the goals of access, affordability, and quality. Initiatives and legislation linked to Medicare, Medicaid, and other programs, such as the Health Insurance Marketplace and the Patient Protection and Affordable Care Act, have all but upended our healthcare system, sending providers, payers, and patients scrambling to understand and manage the changes.
Today, the need for continuous improvement is a given. How can we do more with less, but not sacrifice quality? Ultimately, how can we deliver greater value? That is the core idea of value-based payment models now being tested across the country and lies at the heart of the mandatory cardiac bundles recently proposed by the Centers for Medicare and Medicaid Services (CMS). Getting the highest quality from all components of a bundled service is paramount. One such component, cardiovascular perfusion, can have a significant impact on outcomes, recovery, and readmissions. But, how do you know that the perfusionists in your OR are capable of driving value and helping you achieve your quality goals?