March 9, 2022
Q. Why should I manage “beyond the box” when that's what I'm getting paid for?
A. Patient-focused outcomes are rapidly becoming how home care is evaluated, not just compliance data. In other words, yes, providers may be paid today based on equipment, but they will be selected based upon their ability to document and drive outcomes. CMS plans to have 100% of reimbursement tied to quality and outcomes by the year 2030. This means everyone providing patient care will have to transition to outcome-based models to stay in business. Managed care and ACOs are asking for outcome measures now.
Delivering equipment is the lifeblood of the HME industry, but Amazon will be able to deliver the basics faster and cheaper than anyone in the industry. To stay relevant, providers must transition to developing patient metrics and market data, outcomes and technology. “Value-based” means a provider’s services must lower acute hospitalizations beyond today’s 30-day goal, demonstrating clinical improvement. Partner with hospital outpatient services and physician practices to be their “practice extenders” in the home. That is the definition of “beyond the box” and a strategic advantage over Amazon and a provider’s competition.
HME providers can also use outcomes to create direct contracts with hospitals or physician groups. The first step is creating a reputation for clinical excellence, which means building upon today’s focus of excellent service by understanding the patient's transition to the home. When providers present data that quantify risks and respond with respiratory vs. general home protocols, they can leverage these measures to become a strategic partner with the hospital. Having data and outcomes will get providers a seat at the table because they can solve problems occurring in the home. However, identifying gaps in care, additional co-morbidities and barriers to follow-up physician appointments actually drives revenue and opens doors to the C-suite.