The need to transition to a value-based payment system has turned the traditional healthcare reimbursement model on its head. In a recent Healthcare Finance article, KPMG—one of the largest professional services companies in the world—announced that 74 percent of healthcare providers are now in the beginning stages of investing in the method.
Joe Kuehn, advisory partner at KPMG’s healthcare & life sciences practice, mentioned this in a statement. “It has never been more crucial for providers to prepare their finance departments to address the demands that new care delivery models, such as accountable care organizations and alternative payment arrangements, will present as the industry moves away from fee-for-service reimbursement mechanisms.
A growing interest The rise in popularity of value-based systems stems from the fact that patients are increasingly opting for providers who offer the best value for the money. This concept alone proves that shifting to value-based models have as much impact on hospital revenue cycle management as much as clinical care. How to get there In a Healthcare IT News article, value-based system proponent Bird Blitch identified three steps for providers to increase financial transparency and enhance patient revenue stream: enhanced enterprise connectivity, consolidation and automation of financial information workflow and delivery of business intelligence. Blitch adds that providers need to “think like a patient” to achieve “a faster and more agile shift to value-based care.” The challenge of a shifting revenue mix The change to a value-based mode of care is long overdue. Unfortunately for providers that can’t make the change, the financial penalties and lower imbursements that result are bound to create a significant burden. Perhaps knowing some of the challenges that you may face will open you up to the possibility of implementing a value-based system in the future. One of the most prominent ordeals that you may face is a shifting revenue mix. It’s been expected that Medicare expenditures will rise as baby boomers age. The unexpected twist is that Medicaid has grown at a faster rate. This trend will likely continue as baby boomers continue to age and the Affordable Care Act is fully implemented. Unfortunately, more Medicaid business can mean less revenue for hospitals. Help with revenue cycle management Third party providers like DECORM can provide for you with services such as eligibility for Medicaid assistance, ACA enrollment and social security disability insurance processing. Along with your in-house efforts, these providers can allow you to transition to a value-based payment system faster. Sources: Finance execs plan tech investments to ramp up value-based payments, Healthcare Finance News, Jul. 1, 2015 The Path to a Value Based Payment Model, Revenue360.net