Reimbursement for traditional medical services are down due to to COVID. Is it time for practices to embrace new care delivery models like remote patient monitoring?
When 100 healthcare executives were surveyed by Porter Research in December 2018, 62 percent of respondents listed declining reimbursements as a key problem area for them. Likewise when several thousand mid-size medical practices were interviewed around the same time, getting compensated has become more challenging as these practices see declining reimbursements from third-party payers (62% of respondents agreed) and increasing patient payment responsibility (63%).1
As demonstrated, declining reimbursement is pain for both large healthcare systems and small practices. But this move aware from fee-for-service reimbursement is intentional. The Center for Medicare and Medicaid Services (CMS) has made a focused effort to move the healthcare industry toward a value-based system over the last several years. Value-based care is payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. The intent is to improve outcomes of patients while cutting waste. CMS administrator Seema Verma has explicitly mentioned that “Value-based payment … is the future, So, make no mistake — if your business model is focused merely on increasing volume rather than improving health outcomes, coordinating care and cutting waste, you will not succeed under the new paradigm.”2
As a medical practice we recommend the following three actions to move your organization toward this new payment paradigm.
Educate
Start with educating yourself and your staff on the reimbursement models currently out. Some new models like Transitional Care Management (TCM) and Chronic Care Management (CCM) have been around for over 5 years. Recently, CMS has introduced new models like remote physiologic monitoring (RPM) that allows physician reimbursement of up to $170 per patient per month for patient communication outside of the clinic or hospital. Attend conferences and find vendors who can accelerate you and your staff learning on the regulations behind the reimbursements. The more you truly understand the rules, the better you can ensure revenue attainment.
Experiment
Next, you and your team will have to start to implement these new models in your existing practice. However, the work to understand how to integrate it into your current workflow will take experimentation. For example, RPM requires several criteria to be met in order to bill officially for the codes. The first CPT code, 99053, pays for training of patients with remote monitoring equipment. In your practice, who will do that? Do you want it done remotely or in the clinic? Do you want to do it yourself or work with your vendor? Once you figure this one code out, there still have 3 other codes (99054, 99057, 99058) that need consideration. Experimenting to fully understand how to incorporate into your practice workflow will take time and focus before you can begin to scale.
Execute
After extensive experimentation, it is time to execute at scale. This is where you take all your learnings and implement across your medical group or large healthcare system. This is also where you consider how to incorporate these reimbursement models into your E H R. You want a seamless workflow between the patient charts to the regulations for payment. This is also were you evaluate effective vendors who can meet your needs across your entire patient population.
Ultimately, declining reimbursements for your current medical services are an opportunity for forward thinking practices to begin the journey toward new models. The ones who do will find the new models are more lucrative and, most importantly, better for the patient.
To learn more about how SynsorMed can help with your CCM, RPM and Virtual Care options please reach us at info@synsormed.com
- https://www.medicaleconomics.com/news/top-challenges-independent-practices-are-facing-2020
- https://www.modernhealthcare.com/payment/americans-fed-up-high-healthcare-costs-surprise-billing-verma-says
Reimbursement for traditional medical services are down and it is time for practices to embrace new care delivery models like remote patient monitoring which are seeing increases in reimbursement.
When 100 healthcare executives were surveyed by Porter Research in December 2018, 62 percent of respondents listed declining reimbursements as a key problem area for them. Likewise when several thousand mid-size medical practices were interviewed around the same time, getting compensated has become more challenging as these practices see declining reimbursements from third-party payers (62% of respondents agreed) and increasing patient payment responsibility (63%).1
As demonstrated, declining reimbursement is pain for both large healthcare systems and small practices. But this move aware from fee-for-service reimbursement is intentional. The Center for Medicare and Medicaid Services (CMS) has made a focused effort to move the healthcare industry toward a value-based system over the last several years. Value-based care is payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. The intent is to improve outcomes of patients while cutting waste. CMS administrator Seema Verma has explicitly mentioned that “Value-based payment … is the future, So, make no mistake — if your business model is focused merely on increasing volume rather than improving health outcomes, coordinating care and cutting waste, you will not succeed under the new paradigm.”2
As a medical practice we recommend the following three actions to move your organization toward this new payment paradigm.
EducateStart with educating yourself and your staff on the reimbursement models currently out. Some new models like Transitional Care Management (TCM) and Chronic Care Management (CCM) have been around for over 5 years. Recently, CMS has introduced new models like remote physiologic monitoring (RPM) that allows physician reimbursement of up to $170 per patient per month for patient communication outside of the clinic or hospital. Attend conferences and find vendors who can accelerate you and your staff learning on the regulations behind the reimbursements. The more you truly understand the rules, the better you can ensure revenue attainment.
Experiment
Next, you and your team will have to start to implement these new models in your existing practice. However, the work to understand how to integrate it into your current workflow will take experimentation. For example, RPM requires several criteria to be met in order to bill officially for the codes. The first CPT code, 99053, pays for training of patients with remote monitoring equipment. In your practice, who will do that? Do you want it done remotely or in the clinic? Do you want to do it yourself or work with your vendor? Once you figure this one code out, there still have 3 other codes (99054, 99057, 99058) that need consideration. Experimenting to fully understand how to incorporate into your practice workflow will take time and focus before you can begin to scale.
Execute
After extensive experimentation, it is time to execute at scale. This is where you take all your learnings and implement across your medical group or large healthcare system. This is also where you consider how to incorporate these reimbursement models into your E H R. You want a seamless workflow between the patient charts to the regulations for payment. This is also were you evaluate effective vendors who can meet your needs across your entire patient population.
Ultimately, declining reimbursements for your current medical services are an opportunity for forward thinking practices to begin the journey toward new models. The ones who do will find the new models are more lucrative and, most importantly, better for the patient.
To learn more about how SynsorMed can help with your CCM, RPM and social determinant of health needs please reach us at info@synsormed.com
