Wound Care Articles and Insights
April 29, 2011

Value Based Purchasing and Wound Care

Mike Comer

Holy Mackerel!Do you realize that in less than two weeks, two "final rules" have been released by the US Department of Health and Human Services which will have more of an impact on the entire hospital industry than all of the final rules released in the last ten years combined?OK, that could could possibly be an exaggeration, or, it could also very possibly be a gross understatement! Today, HHS released the final rule on the implementation of "Value Based Purchasing". In a nutshell, this is a historic change of how over 3,500 hospitals will be reimbursed starting in 2013. Acute care in-patient Medicare Reimbursement will be based on meeting certain quality measures rather than just fee-for service.Hospitals will continue to receive payments for care provided to Medicare patients based on the Medicare Inpatient Prospective Payment System, but those payments will be reduced across the board by 1 percent starting in fiscal year 2013 to create the funding for the new value-based payments. In federal fiscal year 2013, this amount is estimated to be $850 million, which will then be used for incentive payments.These measures will change each year, (much like the Joint Commission National Safety Goals)For 2013 the quality measures include:

  • Ensure that patients who may have had a heart attack receive care within 90 minutes;
  • Provide care within a 24-hour window to surgery patients to prevent blood clots;
  • Communicate discharge instructions to heart failure patients; and
  • Ensure hospital facilities are clean and well maintained.

These measures will most likely be much broader over time. What this signifies is an important paradigm shift in where the focus will need to be for hospitals. My take is that the following points will be paramount:

  • Patient satisfaction
  • Reduced Readmissions
  • Better than average outcomes
  • Trackable outcomes
  • Early identification of both clinical and financial issues
  • A renewed focus on cost reduction for hospital operations
  • Strong utilization of outpatient service lines to support the inpatient mission

Hospital reimbursement is going to be a wild ride for the next few years. It will be vital to have service lines that not only bring in strong revenue to the bottom line, it will also be imperative to retain as much of that revenue as possible, be certain that you are meeting the ever-expanding regulations for that service line, and use that department to help save money for your inpatient operations.I am sure it will come as no surprise to you that I feel a well run, cost effective wound care program will meet these criteria well.

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