5 Things Healthcare Managers Need To Know About The Hospital Value-Based Purchasing Program

Value-based purchasing programs are here to stay. Hospital healthcare managers have a great deal of responsibility to maximize their knowledge and skills for using VBPs. As Healthcare Data Works points out, how healthcare managers use these systems has a direct impact on the facility’s bottom line. These are some important things to know about VBPs.

1. Changing Regulations Affect Operations

As regulations continue evolving, it is important for healthcare managers to pay close attention to how the changes affect their care communities. Some changes are beneficial for improving network management in this setting. For example, the IMPACT Act created a standardized method for measuring data quality among various post-acute providers. Some of the new regulations also allow patient incentives for those who stay within the network, and they also allow ACO pre-assignment for patients.

2. Goals Should Include Clinically Integrated Networks

Healthcare managers must make sure that they are working toward CINs at all times. These networks are vital for sharing information and metrics with others in the network. For care transitions, CINs are very important. Every healthcare manager should take steps to identify and work toward what they need to improve their CINs. In addition to this, they must make sure that all others in the network are working toward the same goal. Although fee-for-service models focus on care within the facility, value-based purchasing focuses on the community beyond the facility’s walls.

3. New Codes For Volume-Based Payment Systems Must Be Embraced

New codes come with the value-based payment system. Although it may seem challenging to learn them, it is worth the time. They are helpful in working with expensive high-risk patients. When it comes to chronically ill patients, chronic care management codes can be used to receive reimbursement for their care through ACO initiatives. While care professionals and managers have mixed feelings about working toward bundled payments, it is important to know that payment division will become simpler. According to The Advisory Board Company, January 2016 rulings from CMS show that the challenges will be addressed and solved over time.

4. An Efficient Solution Is Necessary For Analyzing Data

This is one of the best ways for facilities to score better under the CMS regulations. Healthcare managers must track and monitor their scores to carefully develop improvement plans. More Medicare reimbursement can be secured this way. There are 20 performance measures that are critical to improving scores, and they are all centered around the quality and process of care and patient satisfaction. Everything from the food quality and how clean rooms are to whether care procedures are followed for different medical conditions is considered. Healthcare managers must identify weaknesses in every department and develop plans for improvement.

5. A Strong Workplace Success Culture Is Vital

It takes a strong commitment from the entire staff and organization members to consistently follow CMS regulations and improve performance measures. One of the best ways for healthcare managers to build a stronger success culture is to use positive reinforcement. When scores improve because of one specific department or individual, they should be rewarded. Organizational meetings should be held regularly to plan and discuss goals. Since teamwork is vital to success with CMS regulations, improvements on teamwork should also be rewarded.

By following these tips, healthcare managers can protect their facilities, their bottom line and their Medicare reimbursements. Better overall quality also means a higher hospital ranking. These are also important tips for students and prospective students to learn ahead of time in preparation for successful careers as hospital healthcare managers.

Additional reading: 50 Most Affordable Healthcare MBA Degree Programs 2015

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