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What to Expect in 2015

Written by: Mediware on Tuesday, January 6, 2015 Posted in: Inpatient Rehab

How will patient care be managed and billed?

IMPACT Act 2014

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This year, the post-acute care provider will see significant changes leading to how patient care will be paid and managed. Payment reform continues to focus achieving the ‘Triple Aim’ objectives of Quality, Cost and Value in health care for the nation’s population. PAC providers will begin preparing to operate in a delivery system where payment is bundled with other providers, requiring coordination and communication to achieve expected outcomes.

Reform legislation has established the site neutral agenda to align payment of services based on the effectiveness of resources applied, regardless of the setting in which they were delivered. Seventeen conditions (mix of orthopedic, cardiac and pulmonary) are identified for site neutral payment. Stroke treatment is not included in the discussion; however, given the complexities of patient requirements and the considerable variation in treatment and management, stroke will most likely be the prime candidate for bundled payment reform in post-acute care.

Last year, Congress was presented with legislation outlining PAC coordination and payment alternatives. For qualifying hospital discharges, payment will be made to an HHS approved PAC coordinator (hospital, insurer, third-party benefit manager or PAC provider) to oversee and pay for all the services traditionally covered under Medicare parts A and B. This round of reform was referred back to committee for modification. We can anticipate reintroduction of similar bills in 2015 as PAC bundling continues to receive legislative attention to control costs.

In 2015, PAC providers will begin preparing for a common standard of patient assessment data required across all post-acute settings. The IMPACT Act of 2014 will require collection of standard patient assessment data by all PAC providers. These data will enable legislators to better assess the care requirements of patients and determine the appropriateness of PAC providers in meeting them. These reporting requirements are significant game changers for the industry and CMS is anticipating a three year lead-time to perfect the system.

This year, Medicare will focus on care of chronic illness and multiple co-morbid conditions in an attempt to lower the $490 billion spent annually to treat these conditions. The Better Care, Lower Cost Act introduced last year outlined a single payment to identified teams of caregivers to manage the chronically ill patient. This legislation was not acted upon in the last Congress and will most likely appear again on the 2015 legislative agenda as Congress seeks to reduce Medicare spending through better coordination of care for chronic conditions.

All providers will see accelerating investments in cost containment and care coordination as the shift from fee-for-service to fee-for-value necessitates more effective strategies and clinical operations. Care navigation, bundled payment care guidance and monitored care management will receive increased clinical and financial attention.

Enhancing the Care Delivery Model Quality will require greater reliance on community resources to effect care outcomes. Providers will begin to look beyond their individual practice settings to manage chronic conditions for patients within their charge. This will foster PAC’s entry into population health management as a valid participant in healthcare reform and the way it is delivered and paid.

Technology will rapidly advance beyond the EMR to link delivery and management of care. Providers will realize the requirement to be interoperable with providers across the PAC continuum. Communication and coordination of care will extend to payors, patients and employers to influence treatment effectiveness and outcomes. Patient engagement, price transparency, medication/therapy management and adherence, and remote monitoring will see advances in the electronic solutions available to PAC providers to extend the influence of clinical practice.

2015 will begin to fill in the details for implementing the public health improvement strategies outlined by the legislation. PAC providers should anticipate changes in the way care is delivered and valued.

Happy New Year!

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