RUG-IV vs PDPM: What’s the Difference?

Apr 2, 2019 | Industry Insights

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    Best of Breed vs. Single-vendor Integrated Solution for Your EHR & RCM
    RUG-IV vs PDPM: What’s the Difference?Apr 2, 2019 | Industry Insights Sure, it sounds easier, maybe even cheaper, to purchase clinical (EHR) and revenue cycle management (RCM) applications from a single vendor. Most vendors will even require you to do so, holding your practice hostage to an EHR developed either in-house or by a preferred partner. While this approach may simplify your decision making and support processes, what happens if these all-in-one solutions don’t meet the needs of your patients and staff? Here are three important questions to consider when making your decision: Is it better to hire multiple RCM consultants, or a single interface expert?There’s an old saying that applies to these situations: A penny wise, a pound foolish. A single vendor approach could make sense if an EHR and an RCM were the only two vendor-provided applications in your facility. (Ah… one can dream.) However, since most modern hospitals have hundreds of vendors in place – the average healthcare organization now uses approximately 928 cloud applications – should you really compromise quality simply to reduce your vendor count from, say, 100 to 99? Especially for two of the most important application domains in your hospital? Take your RCM solution, for example. When the RCM solution provided by your best choice EHR vendor is NOT the best RCM choice for your hospital, you will have to contend with lost time-to-value, not to mention the additional costs of hiring even more staff to make a one-size-fits-all solution actually, well, fit your facility. So when making your decision, ask yourself: Are you willing to settle for a less capable RCM solution to avoid a single additional interface? And, is it really cheaper to hire a team of RCM consultants rather than a single interface expert? Is it worth it to prioritize the needs of one department over another in the long run?Continuing with our RCM example, the result of prioritizing the needs of your clinical staff over those of your business staff will be unnecessary tension between your two most important departments. In a single-vendor situation, your business team will be tied to an application selected primarily to solve the needs of clinical staff. Your business team will then be charged with “making it work,” inevitably leading to a slew of consultants, additional hires, and, inevitably, resentment. This can be harmful to your hospital’s performance in the long run, especially as the rise of big data continues to require stronger bonds between clinicians and business staff. Be sure to ask yourself what you are compromising in the long run when you conform to the demands of a single-vendor during system selection and negotiation. Or, in the single-vendor case, lack of negotiation. Will your RCM choice breathe life into your hospital, or will it stifle growth?A good EHR is necessary for improving diagnostics and patient outcomes. A good RCM is critical to maintaining the financial performance of your hospital, allowing you to deliver quality care, finance expansion, and increase executive bonus plans, just to name a few. Too many hospitals seem to assume that any EHR or RCM will do – that is, until denials reach the millions of dollars, days in A/R creep into the 50s or 60s, and revenue is negatively impacted through lost reimbursements. Simply put, there is too much at stake for your hospital to compromise on an EHR or RCM solution that does not meet their specific needs, no matter the vendor. Subscribe to our newsletter Share in media: 000 Author’s name Quisque tristique consectetur justo, dapibus dapibus ipsum elementum sed. Sed enenatis dolor in neque hendrerit tincidunt. Aliquam erat volutpat. Cras pulvinar ex est, sit amet bibendum ipsum hendrerit. Phasellus lobortis pretium lacus, eu tempor felis viverra at. Cras vulputate risus lorem. Proin at imperdiet sem. In sodal justo mi, a porttitor lectus egestas at. Mauris lectus nisi, dictum quis hendrerit in, mollis nec nunc. About Solutions
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    Futureproofing: How LTACHs Can Survive and Even Thrive After Medicare Reform
    RUG-IV vs PDPM: What’s the Difference?Apr 2, 2019 | Industry Insights Medicare accounts for an increasingly large portion of all long-term acute care hospital (LTACH) discharges, with current estimates indicating that approximately two thirds of all LTACH discharges are Medicare discharges. Between 2004 and 2013, Medicare spending on patients in LTACHs increased from $3.7 billion to $5.5 billion.These rising costs have not translated to improvements in patient outcomes. For example, though Medicare pays for 2,000 days of post-acute care (PAC) services for every 1,000 patients, roughly one fifth require readmission to hospitals, often for preventable conditions. By contrast, Kaiser Permanente averages just 600 days of PAC services per 1,000 patients, and enjoys much lower readmission rates.Medicare ReformIn an effort to contain these rising costs, Medicare dramatically altered its LTACH payment model with the Pathway for SGR Reform Act of 2013. This change, implemented in fiscal year 2016, aims to reduce the payment rate for certain discharges and will significantly impact LTACHs and the healthcare industry as a whole.The most important change is the shift from a prospective payment system (PPS) toward a “site-neutral” payment model. Rather than prospectively defining reimbursement for groupings of patients with similar characteristics, Medicare will calculate payments as the lesser of two rates based on tighter patient characteristic criteria. The resulting payments will be similar to what Medicare pays in the acute care setting, and will either be calculated as an inpatient PPS (IPPS) comparable per diem amount, or the estimated costs of the case.Bracing For ChangeIn an attempt to mitigate negative effects on the industry, the rollout of these changes has been gradual. The full force of the changes are expected to hit LTACHs this year, and will have serious implications for LTACHs across the country, particularly those in the New England and West South Central regions. Research by Berkeley Research Group indicates that LTACHs in Texas, Louisiana, Oklahoma, and Mississippi will see a 19% drop in Medicare payments, while New England states could see drops as high as 38%.A recent report by Standard & Poor offers a bleaker outlook: “We expect a material portion of the approximately 435 LTACH facilities nationwide to close over the next few years amid the phase-in of lower reimbursement.” With the second phase of payment changes still on schedule to roll out in 2018/2019, we must begin asking ourselves if we are truly prepared.Futureproofing the LTACH IndustryThere are many strategies LTACHs could employ to offset the effects of the recent Medicare reform, such asChanging year-end reporting datesDiversifying through acquisitionsPortfolio optimizationCutting costsShutting down unprofitable facilitiesAttracting patients still eligible for the attractive LTAC-specific rate.These strategies help optimize your census to maximize profitability.Another strategy that can positively affect the survival of LTACHs is one you’ve likely already heard of: dedicated care coordination from pre-admission to post-discharge.Historically, LTACHs have been slow to improve care coordination and reduce readmissions, content to wait for the emergence of third-party companies that will specialize in care coordination… for a hefty fee. This is a mistake. Only aggressive action towards in-house care coordination will ensure the long-term survival of your business while significantly improving outcomes for your patients.—To find out how to build a strategy for your LTACH, be sure to read the second installment in theLTACH Futureproofing series! Subscribe to our newsletter Share in media: 000 Author’s name Quisque tristique consectetur justo, dapibus dapibus ipsum elementum sed. Sed enenatis dolor in neque hendrerit tincidunt. Aliquam erat volutpat. Cras pulvinar ex est, sit amet bibendum ipsum hendrerit. Phasellus lobortis pretium lacus, eu tempor felis viverra at. Cras vulputate risus lorem. Proin at imperdiet sem. In sodal justo mi, a porttitor lectus egestas at. Mauris lectus nisi, dictum quis hendrerit in, mollis nec nunc. About Solutions
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    Futureproofing: The Key to LTACHs and Coordinated Care
    RUG-IV vs PDPM: What’s the Difference?Apr 2, 2019 | Industry Insights In my previous blog, I discussed how LTACHs have been slow to improve care coordination and reduce readmissions. I said that only aggressive action towards in-house care coordination could ensure the long-term survival of your business while significantly improving outcomes for your patients.But what, really, is care coordination? And how do you achieve it?The term is used frequently, but very few can offer a clear definition, or describe discrete steps to accomplish it. Without a clear understanding of the term, it runs the risk of becoming just another meaningless buzzword.The official definition of care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities and is often managed by the exchange of information among participants responsible for different aspects of care.Translation: coordinated care is really just a fancy term for improved communication.The key to coordinated care is improved communication across the care continuum. When caregivers at different points of care have access to detailed, complete documentation, they are able to make more effective clinical decisions. On the other end of the spectrum, this detailed documentation then has positive impacts on reimbursement processes, reducing AR days and increasing overall revenue.The business team – coders and billers – must be able to provide feedback if documentation is missing or incomplete. When they are dealing with a stack of paper forms with multiple serious errors – or, worse, a stack of paper forms with only one serious error – they then must trace down the clinician to have them correct the error(s). This may involve a series of emails, scans, faxes, or phone calls, each of which take significant amounts of time. And then the claim gets denied by Medicare. Lather, rinse, repeat.This feedback loop shrinks dramatically when coders, billers, and practitioners all fully understand guidelines, processes, and procedures.  Except that there are mountains of procedures, not to mention the many thousands practitioners don’t have the time or the bandwidth to follow them.Unsurprisingly, the secret to coordinated care is integrated health technologies that facilitate and improve communication between teams.I know. Shocker. But bear with me. Source:  2016 CAQH INDEX: A Report of Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings.Let’s use LTACH pre-admission screening as an example. At Cantata Health, spent over five years developing a pre-admission screening portal in partnership with our clients, ensuring that the technology was tailor-made to the needs of LTACH pre-admission procedures.But you don’t have to use Cantata Health products to achieve coordinated care (don’t get me wrong, we would certainly like it if you did). But there are some features you should look for when evaluating an electronic health solution that will actually facilitate coordinated care.Coordinated Care Solutions Should Be Web BasedWeb based electronic health solutions allow practitioners to conduct screenings and complete documentation in real time. Returning to the pre-screening portal example, our web based screening documentation can be ready for financial review in three easy steps on a tablet or laptop as your liaisons go about their tasks. This allows them to focus on the relevant conversations, data, and metrics that they need to complete their documentation.While the increased mobility is a huge benefit, web based solutions are becoming increasingly more common with the steady migration to cloud-based technologies. And as demand for healthcare continues to increase, this transition will only accelerate in the coming years.Coordinated Care Solutions Should Be IntegratedI know I said “integrated” before, but I really mean it. There’s no reason to fill out the same information multiple times on electronic forms. That’s why our pre-admission portal integrates seamlessly with our EHR and RCM software. Any demographic information entered during the pre-admission process is automatically compiled and uploaded into your EHR and RCM tools, not only ensuring that any and all forms are completed correctly, but also eliminating redundancies in a practitioner’s routine.Integration also prevents mistakes or inaccuracies across forms that may impede payment processes or, worse, compromise patient care. Which brings me to my next point.Coordinated Care Solutions Should Be Real TimeIf a pre-admission liaison completes a the pre-admission process, the resulting forms should be available to the coding and billing team for immediate review. This way they can identify and flag inconsistencies and then… wait for it… communicate them back to the liaison so that they can address these concerns, often prior to leaving the acute care facility. Closing this feedback loop rapidly accelerates the admission process, getting patients to the care they need faster.Coordinated Care Solutions Should Be Data CentricNot only should coders and billers be able to access pre-admission forms in real time, they should also have detailed analytical history about the referring physician, clinical indicators, and number of referrals. That’s why our product includes an analytics dashboard, allowing a broader view to improve high-level business decisions that in turn improve the overall function of your organization.These types of data based decisions are extremely important now, but will become even more essential as the healthcare industry transitions to payment for care quality and overall cost effectiveness. Subscribe to our newsletter Share in media: 000 Author’s name Quisque tristique consectetur justo, dapibus dapibus ipsum elementum sed. Sed enenatis dolor in neque hendrerit tincidunt. Aliquam erat volutpat. Cras pulvinar ex est, sit amet bibendum ipsum hendrerit. Phasellus lobortis pretium lacus, eu tempor felis viverra at. Cras vulputate risus lorem. Proin at imperdiet sem. In sodal justo mi, a porttitor lectus egestas at. Mauris lectus nisi, dictum quis hendrerit in, mollis nec nunc. About Solutions
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