Seasonal Discharge Rates for Hospices

As we discussed in my last article, the ACA has allowed CMS to explore new payment models that might more accurately reflect the value or cost of the services rendered by healthcare providers.  For acute care facilities, we are experiencing the beginnings of value-based payments intended to blend outcome data with billed services to determine fair compensation.

For hospices, new payment models have been introduced this year that are an attempt to more accurately reflect the cost of treating these patients at various stages of care.  The hospice payment changes are an attempt to match the “cost curve” where patient care costs more in the early days of treatment and the final days of life compared to the days in between.  This study was used to document these “curved” resources and provide the basis for the current payment model:

Cost Curve Study

Seasonal Blog Picture

Continue reading

Value-Based Payments Can and Will Break Traditional Patient Accounting Systems

The Affordable Care Act includes many healthcare regulations unrelated to the distribution of insurance and expanding Medicaid. One important part of this legislation allows the federal government to explore new payment methodologies that they believe more accurately compensate providers for their services.  For acute care facilities, the term used for these new payment models is “Value-Based” payments where data previously considered to be unrelated to the billed services is used to determine the compensation for providers.

For hospitals providing services covered by this model, post discharge data is used to determine the outcome of the service.  This outcome will then have an impact on payments for these services.  In this new model, discharging a patient is no longer the “end point” of a billed service.  The service is expanded to include post discharge services and results.  This is a revolutionary concept and as it applied to other services, it will have major impact on the hospital industry in many ways that are both intended and unintended by this model.  Regardless of your point of view regarding the fairness of this payment model for this service and others like it, there will be problems with existing patient accounting systems in dealing with this new reimbursement model.

Continue reading