Since the Affordable Care Act (ACA) was signed into law in 2010, there have been many changes to the healthcare industry. As the Act continues to rollout, healthcare providers are considering how it will affect the care they give, their reimbursements and how their clinicians will practice.
One major change is the U.S. Department of Health & Human Services’ (HHS’) effort to link provider payments to improved performance through value-based purchasing (VBP). HHS plans to move one-third of all Medicare payments to value-based care models by 2016 and by 2018 require half of all Medicare payments move to alternative care models such as Affordable Care Organizations (ACOs). This shift stresses quality and value over volume, continuing the move away from fee-for-service reimbursements. This article focuses on the VBP component.
Highlights of VBP include:
- Holds healthcare providers accountable for both the cost and quality of care they provide.
- Attempts to reduce inappropriate care.
- Identifies and rewards the best-performing providers through public reporting, enhanced payments through differential reimbursement and increased market share through purchaser, payer and/or consumer selection.
Currently, home care clinicians work in an environment where the more patients the agency sees, especially those with Medicare as primary payer, the more the agency gets paid. Clinicians are all familiar with tracking episodes of care, visits per episode, case mix weights and other factors that predict expected reimbursement.
Entering into value-based contracts means that some rules and regulations we have now will remain while others will no longer be applicable. Currently, it’s unknown what those will be. As we begin to look at clients as a population group with home health caring for patients’ long-term needs rather than short care needs, our clinical strategies must change.
Clinicians will need a new set of skills to include:
- Assessing patients not from a head-to-toe model but from a model focused on identifying patient priority needs as quickly as possible.
- Identifying critical focus areas. Medication reconciliation is so critical to preventing rehospitalization that it could be the only focus of an entire visit.
- Implementing patient engagement, motivational interviewing and strategies that foster patient “buy-in,” so they can see themselves as partners in improving their health.
- Understanding one size won’t fit all. Currently, many agencies use one set of educational materials for all patients. Clinicians will need to identify and work with materials that are tailored to the patient’s literacy and learning styles.
- Using different time ranges for the episode of care. Successful care outcomes will be measured by 60, 90, 120 or more days of reducing emergency room visits and hospital readmissions.
- Adopting new skill sets. Agencies will need to increase the services offered to include non-skilled care, private pay, private duty and other support services to assure the best outcomes for patients.
Home care has always been an ever-changing business. However, while regulations and reimbursement have required administrators to constantly adapt, clinical practice has been minimally affected — excluding the Outcome and Assessment Information Set (OASIS). Currently, clinicians’ case loads are usually assigned based on payer type, practice specialties (wound care, cardiac, mental health, etc.) and geographical considerations.
In a VBP environment, clinicians need to build on current expertise while learning to use new strategies and techniques, so that care is focused on successful patient outcomes.