As businessmen and women, we have been taught that `time is money”. We determine how and what we do every day by calculating what will generate the most profit in a given time. The volume base model taught us that the more patients seen on a given date, the higher the income. We try to focus our energy and resources to limit the time a patient spends in a room. We hire scribes, train our M.A’s. to do things quickly, which increases the chance of human error. Improper/lack of documentation has been a serious problem in our current healthcare model and it could lead to audits and patient dissatisfaction. Governmental and private insurances are now focusing more on preventative measures. Their goal is to reduce patients visits to the hospital and keep them as healthy as possible by preventing and treating patients' chronic conditions. This reduces the insurances’ costs as well as the patients’. As insurances push for this movement, incentives as well as penalties are given to the providers. There are multiple value based care payment models some of the most common ones are: pay for coordination pay for performance bundle payment (episode of care payment) and shared savings program (upside and downside)Quality Payment Program/ MIPS (Medicare) All these programs have the same goal: Save money by keeping patients healthy and out of the hospitals. The question is how do insurance companies track patient care? The answer is by providing HEDIS/ Preventive Codes. HEDIS/ Preventive codes include counseling, guidance, risk factor reductions and interventions. These codes measure the quality of the service and the care provided to the members of that plan. Based on your own performance incentives or penalties are given to encourage providers to comply with these performance measures. These codes are becoming a major part of everyday healthcare practice requirements and it will become a point where providers scores will be shown to the public. Additional information on COVID-19 updates will also be provided.
Upon completion of this presentation, participants will be able to: