Businessman knocking at a door
30th May

With the multitude of value-based purchasing changes emerging from the Affordable Care Act it is easy to miss some. Most of you know that in October new conditions will added to the hospital re-admissions penalty program. What you may have missed in all of this is that the Centers for Medicare and Medicaid Services (CMS) are going to initiate financial penalties on hospitals with high episodic spending, and here is the interesting part, it could involve thirty days of post-acute care.

You may be asking yourself, what does this mean to me? It means there is opportunity looking you squarely in the eye.

In their on-going effort to shift providers’ efforts to value from volume CMS is implementing the Medicare Spending per Beneficiary (MSPB) as part of the Value-Based Purchasing Program (VBP). This will increase hospitals’ responsibility for care after discharge. Because CMS is looking at spending across an episode of care, hospitals and post-acute providers now have reason to work together. Since spending is being tracked during the thirty days after a hospital discharge, post-acute providers will have an impact on the MSPB scores either positively or negatively.

Now that you see the opportunity it is time to chart a course on how to approach a hospital about working together. Hospitals are under more intense scrutiny every day and you need to demonstrate your understanding of this.

First you should know the hospitals’ MSPB score which you can obtain from the CMS website. This is extremely important for you to know as it shows you are paying attention to the hospital as well as yourself. Secondly you need to know that that rehospitalizations, length of stay of a SNF and cost associated with all post-acute providers. Lastly you must be able to articulate your outcomes and how they can be helpful to that hospital.

I have talking for a long time now about metrics and how you must be aware of your own. This is a perfect opportunity to use those and become a true partner with a hospital. You help them and they reward you with referrals. That my friend is answering the door when opportunity knocks.

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