Preparing for Alternative Payment Models, Part 2

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By Michael Mayer, CIO, The Americare Companies and Michael Zucker, VP Patient Accounts, The Americare Companies
Taking steps to prepare for alternative payment models in home health. (2)

In our last post, we looked at five alternative payment models currently being tested. Although the models differ in their approach, they all depend on data to work. So in this post, we’ll take a deep dive into the changes home health agencies must make to succeed in the value-based healthcare era.

Adjust your attitude

The Centers for Medicare & Medicaid Services (CMS) is demanding a lot of data, with no signs of letting up. It’s easy to feel annoyed or overwhelmed by this. But let’s step back and look at the big picture: CMS wants us to take better care of patients at lower cost by sharing risk. Sounds like a goal worth working toward, even if it involves significant change from the way we now do things.

Appoint an operations czar

The one thing few home care organizations have—and all of them will need—is someone who is fully responsible for operations across all departments. This person eats, breathes and sleeps operations, from the tiny details to the big picture. He or she understands that problems with intake affect what happens in the field and that finding root causes for information missing on documentation is the only way forward.

Own your productivity

Start by admitting that paper-based systems are not efficient. At the very least, scheduling, intake and missed appointment follow-up must be electronic to ensure front-office productivity—and it all starts with the front office. Next, take a careful look at documentation. Yes, your policy states that documents must be submitted within 72 hours of a visit, but what percentage of the time is this rule followed?

Find mistakes and fix them for good

Sit down with your QA staff to understand their process. Do they have a checklist of items they look for so each document is reviewed in exactly the same way? Is the checklist complete? When they find errors, are they just fixing them or are they going to the clinician to help resolve the problem this time and all the next times?

Revamp your reports

Reports are critical to running your business profitably and efficiently—so why do so many go unread? Don’t fall into this trap. Every report your organization uses should be easy to read and understand, and someone should be responsible for not only reading it, but acting on the information as needed.

Understand where documentation is headed

Uniformity is the name of the game here. All data in your organization needs to be in a format that can be pulled into a report, merging with other data as necessary. That means no free text and no customized forms. Start getting rid of them now, before you are mandated to do so. Where additional training is required for clinicians, provide it. Your patient records must be 100% standardized and consistent across all departments.

Come clean

Now that outcomes are public, patients no longer have to rely on word of mouth or an agency’s marketing information when they choose a provider. To understand the type of care you are actually providing, conduct your own patient surveys and share the information with your staff. Don’t be afraid to compare one team with another and to be honest with individuals about what they’re doing well and areas that need improvement.

Invest in IT

If complying with CMS data requests related to new payment models seems like a herculean task, you don’t have the right IT resources in place. You need robust back-end support along with someone to create the necessary reports, run them and explain them. Savvy agencies are willing to spend the money on external audits to expose security issues and data management issues. They also realize the value of having a strong working relationship with their IT vendors.

With the right tools and the right attitude, your agency will be ready to face whichever of the new payment models is coming your way.

Check out our post on 5 Alternative Payment Models and what you need to know to prepare for a world of value-based home care.

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