Payment reform. It’s not simply theoretical anymore, and it’s not just a trend - it’s the new direction of healthcare. The move from a fee-for-service payment model to value based care represents a radical shift for providers. Now, payments are based on the quality of care provided to the patient rather than the amount of appointments and tests required to treat the patient. Essentially, value based purchasing (VBP) has turned the old system on its head.
While this change should mean positive things for patients, including improved care at a lower cost, most healthcare organizations are worried about the transition. And these worries are not unfounded. You hear reports of healthcare organizations that struggle to meet their aims, incurring financial penalties that jeopardize their success and damage their brand in a highly competitive market place.
What’s different about VBP? Isn’t the goal of patient care still the same? Isn't it to make patients well? Actually, in a value-based world, it’s about more than making the patient well. In the VBP program, CMS evaluates and reimburses hospitals based on a standard set of metrics grouped into domains: clinical process of care, patient experience of care, outcome and efficiency. As you can see, care outcome is only one of four aspects of patient care that matter in this program. It’s not enough to simply make a patient well; hospitals now need to do so efficiently, effectively and in a way that makes the patient’s experience a positive one. Some hospitals even feel as though they should take a cue from the hospitality industry.1
Beginning in 2017, VBP domains will expand to include an increased focus on care coordination, efficiency and cost reduction. Having comprehensive patient information has always been crucial for physicians to provide excellent care, but now it has greater implications.The availability of complete patient health information protects against the ordering of unnecessary tests and the scheduling of unnecessary appointments, achieving VBP’s aim of saving time and money. Sharing information between providers across care settings and specialties supports better care coordination and outcomes measurement. And the better a hospital complies with the program, the higher its reimbursement rate will be.
Unfortunately, sharing information across providers and care settings still has its challenges. Proprietary operating systems of various EHR vendors complicate the delivery of one, true patient health record. Medical images - once used primarily for diagnosis - are now critical components to all aspects of patient care, yet they are difficult to move around and share. These interoperability challenges are further compounded by an influx of healthcare data that shows no sign of stopping and continued M&A activity that brings even more complexity to the IT environment.
Understanding the data challenges facing today’s healthcare organizations involves seeing how a sound data management strategy represents an important underpinning to support the transition to a VBP model. This is why your shift to VBP is an ideal time to examine your data management strategy, shore it up and ensure its ready to support your changes. With greater emphasis on care coordination, efficiency and patient experience coming from CMS, now is the time to ensure clinical information is effectively managed. Learn more about how to get your house in order to prepare for VBP.
1 Happy patient, healthy hospital July 18, 2016