Value-Based Purchasing At A Glance

Successfully Navigating the Home Healthcare Industry to Value-Based Purchasing Through Clinical Documentation Improvement (CDI)

 

On April 29, 2011, the healthcare industry changed forever. It’s on that date that the Centers for Medicare and Medicaid Services (CMS) released its Hospital Value-Based Purchasing (VBP) Final Rule, required under the Patient Protection and Affordable Care Act (StuderGroup, 2016).

What is Value-Based Purchasing?
The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries.

How does Hospital VBP Work?
CMS rewards hospitals based on:

  • The quality of care provided to Medicare patients;
  • How closely best clinical practices are followed; and
  • How well hospitals enhance patients’ experiences of care during hospital stays.

Hospitals are no longer paid solely on the quantity of services they provide.

The Affordable Care Act of 2010 established the Hospital VBP Program, which applies to payments beginning in Fiscal Year (FY) 2013 and affects payment for inpatient stays in more than 3,000 hospitals across the country (cms.gov, 2016).

How to improve your Agencies quality?

  • You must build a solid foundation…
  • Great field clinicians are not necessity

How does Select Data improve your Agencies quality?

Through Clinical Documentation Improvement (CDI). Clinical documentation is at the core of every patient encounter (Ahima, 2017). Consider Select Data as a partner in achieving the best patient plan of care for the diagnoses to be coded and the goals needed to achieve those high quality goals and succeed with the CMS quality measures. Select Data improves your clinical documentation and provides a clear picture of your patients health.

Don’t wait, if you are an agency in one of the 41 states not yet officially affected. VBP is here to stay. Payors other than CMS are also looking at patient outcomes by diagnoses and using that factor as a guide as to whether or not they wish to contract with a provider.

For a small Medicare certified agency, a 3% reduction in payment will be painful and a 5% reduction could be unsustainable. You need to be active in VBP education NOW!

You may need to designate a position only for data analytics. You need to have strong partners whether in your EMR, your coding and document review, or in analyzing and providing the best plan of care for the patient in order to meet the VBP outcome level goals. Call Select Data at 1.800.332.0555 for more information.

References

Ahima (2017). Clinical Documentation Improvement: Overview. Retrieved from: http://www.ahima.org/topics/cdi

CMS.gov (2016). Hospital Value-Based Purchasing. Department of Health and Humans Services: Centers for Medicare & Medicaid Services. Retrieved from: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf

Studer Group (2016). VALUE-BASED PURCHASING AT A GLANCE:Fiscal Year 2016 and Your Organization. Studergroup.com. Retrieved from: https://www.studergroup.com/industry-impact/value-based-purchasing

Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555. Click here to contact us.

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