A Shift From Fee-For-ServiceRead Time: 4 minutes
With upcoming changes in the way the Centers for Medicare and Medicaid Services (CMS) provides reimbursement, rural hospitals are forced to shift focus from fee-for-service to value-based care. The new policies reward institutions that have high-quality data reporting. However, given the lean resources that rural hospitals are often working with, providing low-cost, high-value care can be challenging.
Skewed quality results
While value-based models sound beneficial at first, smaller institutions can struggle under these payment structures. Lower patient volumes can sometimes skew quality results and disqualify rural hospitals from reimbursement programs. For example, if a small emergency department has 2 admits for the day, and one of these patients falls, the fall rate suddenly jumps to 50%.
Smaller hospitals also face staffing struggles. For example, community hospitals often lack the robust staff that is needed for proper documentation of quality procedures. These low volumes, combined with being in remote locations, can also pose challenges to rural hospitals in joining accountable care organizations (ACOs). This means that these hospitals lack the care coordination needed for proper documentation.
Reimbursement is crucial
By definition, rural hospitals are often in areas with a smaller population. Commonly, these regions of the country have a community made up of a large amount of Medicare and Medicaid patients. As a result, rural hospitals lack an adequate payer mix. Additionally, this reality underscores the need for these institutions to achieve strong quality outcomes so CMS will provide reimbursement.
Many rural hospitals find success with remote case management services. These trained professionals help to triage patients, answer questions and coordinate care during off-times or when staffing is low. This can lead to increased patient experience, more efficient care coordination, cost savings, and improved outcomes.
Focusing on preventive care
One aspect of reported outcomes is readmissions. Rural populations commonly lack relationships with primary care providers, leading to higher emergency department readmissions due to a lack of adherence to the care plan. Thus, preventive care is key for small healthcare institutions. However, in these smaller communities, there is often a significant strain on primary care providers who both run an outpatient practice and round on patients in the emergency department. One solution for improving efficiency and preventing burnout can be hiring hospitalists. These physicians are specially trained to coordinate care for patients in the hospital. Hiring hospitalists has been shown to decrease costs and improve retention of primary care providers.
Value-based care is the future
While many urban areas have already made the shift to value-based care, rural areas can face some specific barriers. But there are solutions, including utilizing remote call centers and hospitalists. Starting the conversation early can lead to higher quality data reporting, and, thus, a better reimbursement rate.