It’s not just an accounting change, it’s a mindset change

This post was originally published on MedCity News.

While the ongoing change from fee-for-service to fee-for-performance healthcare is rooted in providing better and more efficient care to patients, plenty of providers remain skeptical about the transition and what it means for their already, in some cases, razor-thin margins.

“What we hear from clients is fee-for-service isn’t just a reimbursement model but a mindset,” says Amber Thompson, VP, Coordinated Care Solutions. “The ‘bundled’ model is completely different.”

As she explains, fee-for-performance healthcare means that the cardiologist, PCP, pharmacist and home care worker are all responsible for coordinating quality care for a heart disease patient. “In the past,” Thompson points out, “these chutes have been exclusive.”

And it’s certainly not a bad thing that patient satisfaction is driving everything. It’s only right that providers who offer the most successful, patient-oriented care reap the rewards, but the fee-to-performance model is driving a change in thinking among providers who have long kept their heads in the sand when it comes to accounting.

“The real issue,” Thompson says, “is we’re all in this together now.” Every care provider who sees that heart disease patient now needs to be on board with giving him or her the best care possible with the least chance for hospital readmission.

What are providers’ top concerns? We’ve got the rundown:

Medicare and Medicaid

“In some states,” Thompson explains, “payments are 50 percent lower than commercial health plan reimbursement for the same services rendered.” Nevertheless, she adds, providers have “an ethical responsibility” to provide those patients quality care. Doing so is hardest for rural and small community hospitals where margins are especially thin.

How do you prevent Medicare and Medicaid from draining profits? “It’s all about the time of intervention,” Thompson says. “Make sure those patients don’t show up in the ED every week.” Follow-up, follow-up, follow-up.

Understanding accounting

In the past, it’s been easy for healthcare providers to focus on treating patients while leaving accounting to the back office staff. Not so anymore. “Providers really need to be involved in the payer world,” Thompson says. “It’s the people delivering care who need to drive change.”

That means if you’re a PCP, make sure you understand what your patient’s pharmacist and social worker are doing and how well they’re doing it.

Don’t put the burden on the patient

“If you do what you’ve always done, you’re not going to make it in this new world,” Thompson warns. She advises providers to be open to the technological tools that enable them to better treat their patients.

For example, if you’re asking your patient to fax radiology results or immunization records instead of taking it upon yourself to collect those records, you’re not behaving as part of the solution. “Don’t put it back on the patient,” Thompson advises. “Be part of the solution.”

Promote clearer partnerships between providers and payers

Thompson says payers could definitely stand to do a better job of making their reimbursement models more clear. This is especially the case for CMS, where margins tend to be incredibly thin.

Another issue is the disconnect between in-patient provider standards, where patients typically need to be seen by a PCP within seven days of discharge, and the PCP model, where providers see a given patient every 90 days or so at best.

Be on your patient’s team

“Think about the consumer’s perspective,” Thompson advises. “If I know my healthcare providers are plugged in with my payer, I’ll have brand loyalty.”

She reminds us that healthcare providers’ most common avenue for earning new business is through referrals from existing patients. Plus, providers will benefit when it comes to getting compensation from payers when patients provide positive feedback.