The Change from Fee-for-Service to Value-based Care and its Impact on Revenue Cycle

Transitioning from a Fee-for-Service to a Value-based Care system is rocking the healthcare industry. With Medicaid patients bringing in less profit and Medicare patients generating margins of minus 5% on average, providers are bracing for revenue to go down further while putting in place methods for tracking patient health and complying with new regulations. In this scenario we look at the most important aspects of value-based care, its impact on revenue and the alterations needed in a hospital or clinic to deal with it.

Improved Customer Service

Collecting patient health information is all important in a value based care system and it starts with staff who will have to ramp up efforts to ensure all details are recorded accurately. This process starts when a patient first visits a hospital, and involves face-to-face interaction from then onwards to track all their details and services provided accurately to recover costs. Better customer support also results in recurring patients understanding details of their illness and managing it efficiently, leading to fewer hospital visits and more revenue for the provider.

Dealing with Short Term Revenue Fall off

Moving from fee-for-service to value-based care is expected to result in revenue dropping for hospitals and clinics. In this period as services and procedures provided to patients reduce, hospitals will have to supplement lost revenue by lowering operating costs through outsourcing revenue cycle management, ensure accurate medical coding is done to recover cost of each visit, and try to attract more patients by improving quality of care.

Efficient Capturing of Patient Data

Capturing patient medical data, including history and treatment provided in EMR/EHR software is an important part of value based care. Managing this data and ensuring it is easily accessed in future ultimately ensures that the most amount of revenue is generated through value based payments that occur down the line.

Data Collection and Analysis

Continually collecting data from patients means that it has to be securely stored, and hospitals need to access it whenever needed. Outsourcing here can help reduce spending on data storage facilities, while providing a robust healthcare IT infrastructure that is secure and meets the latest regulatory guidelines. Data once collected also needs to be analyzed using IT solutions. Efficient analysis of data using healthcare software also means that hospitals can find problematic areas on the fly and put solutions into place to rectify them, improve quality of care delivered to patients and reduce readmission rates.

Shifting Focus to Prevention of Illnesses

Operating under the value-based care system means that providers will have to try and limit the number of times a patient is readmitted, reduce mortality rate, and improve customer satisfaction. All of these goals have to be met while minimizing the costs associated with each care episode and improving the overall health of the patient and preventing illnesses.

OutsourceRCM has the experience and technologies to ensure that your hospital or clinic is ready to meet the demands of a value based care system. With expertise in medical billing, medical coding, medical record indexing, healthcare analytics and healthcare IT, our company is a one stop shop for your hospital’s needs. Contact us to learn how we have helped hospitals put in place processes and data collection to improve their revenue under the value-based-care system.

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