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Written by: Darlene D'Altorio-Jones (1959-2015) on Tuesday, September 20, 2011 Posted in: Inpatient Rehab

A release from the Health and Human Service Press Office just hit my desk. I’m rather amazed by the headlines; therefore, I feel it’s newsworthy and enlightens expectations for the future.

Medicare is announcing Advantage Plan early open enrollment for beneficiaries this year and that overall prices are down 4%  with an expected increase of 10% enrollment.   In addition, persons will receive greater benefits (wellness visits) and cheaper prescription plans! More for less … how novel! Why is this newsworthy? Because many private companies don’t seem to share that same excitement and many employer plans being told premiums are rising, not falling and that we should beware as costs can creep up more than 10 % annually.  I am sure these plans use the same health care facilities.  Why the disconnect?

How can Advantage Plans with persons predominantly aged make such bold advances when plans of mixed populations are less apt to do so?  Fiscal responsibility and holding costs low is just beginning to rear debate! But wait, there’s more.

Just like all other insurance plans, for Medicare, there is an open enrollment time frame. Often strict rules govern when you can move in and out of those plans. Yet, as stated in this release, “For the first time in 2012, CMS will provide financial rewards to those Medicare Advantage plans with high quality scores, under its Five-Star rating methodology. CMS is also allowing Five-Star Medicare Advantage and Part D plans to continuously market and enroll beneficiaries throughout the year as an extra incentive for high quality performance.”

Medicare is adding information to the Five-Star rating to further define recommended plans by adding a gold star icon to high performing plans. Ratings are in step with a digital society. Businesses now bank on the ability to gain favor and followers through ratings; just look at the number of businesses asking you to follow them on Facebook, Twitter and the like. Your service and outcomes must rate top end, in this case Five-Star to gain extra privileges and improved access. It is the future.

The freight train has left the station and the message is to get on board.  Lead, manage or retire – it’s pretty simple. There will be less room for under performers in healthcare staring now.

Medicare is giving rewards, incentives and non-traditional exceptions to rules when quality is accomplished. Effectiveness and efficiency are proven value outcomes both clinically and financially, this announcement is another mounting example of the benefits that will come with those traits. It’s a win for Medicare when they can move covered lives to plans that hold the risk.  How much pressure will those plans place on facilities like yours to deliver quality? Lots!

More than ever before, hospitals will have to become lean process managers of time, resources and outcomes; defending value to gain share in volumes or get written out of the preferred rating altogether. Are you able to demonstrate through discrete data elements that your patients get great quality and outcomes for comparable or less costs?

If you haven’t thought of how you will capture, report, and continuously improve the outcomes you provide, you might want to start because pretty soon it won’t be an option. Get on board! Data is your future.

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