As the healthcare industry is transitioning from a volume-driven to a value-based model of reimbursement, a significant challenge has been created for healthcare executives: Managing the Gap.
And just what is the gap? It’s that period of time when your organization is being paid on a fee-for-service basis, while also diligently working to improve quality and lower costs in preparation for value-based reimbursement. Everyone must learn to work under both the old and new reimbursement models simultaneously in order to successfully manage the gap. There is no light switch that will trigger the end of fee-for-service as we know it and immediately transition to value-based reimbursement models. In fact, it is highly likely that we will see both reimbursement models in place for the foreseeable future.
We are challenged to manage the use of healthcare dollars effectively while also measuring quality outcomes. It is vitally important for health care executives to address the financial viability of their organizations while simultaneously managing patient care in a much broader way than in the past. Transitioning from a Volume-Driven to a Value-Based Model without loss of revenue and reimbursement can be a daunting challenge.
It is imperative that revenue capture for your fee-for-service component be accurate and compliant, while also addressing ways to eliminate waste and manage the entire continuum of care. This requires accurate diagnosis coding to address risk-adjustment factors, case mix index, and other indicators that are used in ACO and other value-based reimbursement models as well. Successful healthcare organizations will be the ones that are adept at managing the gap to ensure success regardless of the reimbursement model (volume-based or valued-based).
Regardless of the compensation model, your coding and documentation practices must accurately reflect the care being provided.