Does the Medicare shift in pay for performance threaten the small hospitals in the U.S.?
In its Spring newsletter, the Center for Rehabilitation Outcomes Research (CROR), reported on its efforts to fund research on patient reported outcomes in the face of changing Medicare reimbursement policies – and how companies like Ortech are providing solutions for health systems.
In the past, Medicare has reimbursed based on the cost of treating patients. Now, we’re seeing a shift towards pay for performance, meaning the quality of care play a bigger role in determining reimbursement than the the cost of care.
Nine to 11 percent of medicare reimbursements are based on equality according to Craig Garner, healthcare consultant and partner in Garner Health Law Corp, and that is growing. This has huge ramifications for independent hospitals and practitioners who can’t afford to lose that 10 percent. Further, The Centers for Medicare and Medicaid Services (CMS) are projected to increase that to 90 percent by 2018.
Hospitals that out-perform their peers will benefit from this, while those who don’t stand to lose a great deal. Overall, it’s a shift to patient advocacy, but data is at the heart of the issue.
According to the article –
As part of the Affordable Care Act, inpatient rehabilitation hospitals, long-term care hospitals and inpatient psychiatric facilities are required to collect and provide quality data to Medicare in order to receive full reimbursement. Although Medicare doesn’t yet have statutory authority to use the data to penalize low-performing facilities by reducing reimbursements, many policy makers are pushing to implement pay-for-performance within a few years.
As Medicare asks for more and more data (from 10 measures in 2007 to 58 measures in 2016), companies like Ortech help health systems satisfy their requirements by helping them collect patient outcome data, track measures like number of corrective procedures needed, to time for recovery and patient recovery time and patient reported data.
Not only can administrators benchmark against their peers and see how individual surgeons are performing, but this allows nurses to spend more time with patients and less time pulling data.
Health systems use our system to collect the information but they can leverage the data any way they want. They can run benchmark reports against other sites. They can compare outcomes among surgeons. They can look at a specific patient population… – Michael Barr, said Michael Barr, Ortech’s vice president of sales and marketing.
The Patient-Centered Outcomes Research Institute (PCORI)’s mission is to fund research regarding the best way to get patient reported outcomes integrated into quality measures that health systems are evaluated on and to improve the quality of comparative clinical effectiveness research.
According to PCORI: “Better information will lead to better healthcare decisions and, ultimately, to improved patient outcomes.”
We couldn’t agree more and thank CROR for including us in the article.You can find the full version in their newsletter here.