Measuring your worth
By Bill Goulding, National Director, Outcomes and Reimbursement, Aegis Therapies
Outcomes measurement is the key to being accountable to patients, payers and physicians for rehabilitation therapy services. Yet the long-term care industry lags behind other healthcare sectors in applying outcomes measurement to its therapy services.This is unfortunate, because reliable outcomes measurement can make two significant contributions: It can help improve the quality of the care you provide to your patients and it also can prove that the type of care you are providing is effective.
It's time for long-term care providers to step up and put rehabilitation outcomes measurement into practice.
Measuring up for payers
Regulatory standards currently being discussed will require skilled nursing facility operators to demonstrate that they are providing value-based services to their patients. When these standards are enacted, will you be prepared to respond?Capturing the relative cost of healthcare as it relates to positive outcomes is referred to as “value-based purchasing,” and is at the forefront of payer priorities. Currently, there is increasing regulatory pressure to use performance measurement tools for value-based purchasing.
With the arrival of CMS' policy directives — such as Medicare's Transmittals 60 and 63 — it is more important than ever to support the value of services you provide with proper documentation. The skilled nursing industry hasn't endorsed a consistent outcomes measurement process yet, but there are excellent measurement tools in use and available now.Data compiled using these tools tracks the impact of treatment from admission to discharge, creating a streamlined, before-and-after picture of patient progress. This concise snapshot is appreciated by reviewers, especially by those who might not be familiar with industry-specific details, such as administrative law judges, who may need to render a decision on denied therapy services at the third level of appeal.
Creating confidenceOutcomes measurements enable you to demonstrate to patients, their families and their physicians that your services improve the quality of life for those in your care. In addition, patients benefit when they are shown outcomes data that applies to their specific condition, such as the average length of rehabilitation to expect after experiencing a hip replacement or fracture.
Patient fears, such as not improving enough to be discharged from a nursing home or inability to regain premorbid mobility, can be overcome by learning about positive outcomes of previous patients who experienced similar conditionsEffective communication with referral sources is necessary in a market of aggressive competition for certain types of patients, such as those requiring therapy following joint replacement. Providing measurable outcomes data can favorably position a skilled nursing facility as providing the same or better quality therapy and clinical outcomes at lower costs than other settings.
Demonstrating the effectiveness of therapy programs by showing individuals successfully returning to their homes allows the skilled nursing industry as a whole to address negative stereotypes. It dispels the fear that no one ever gets discharged from a nursing facility or the inaccurate generalization that nursing home patients are less able to improve their function.Demonstrating value
Using outcomes measurement allows you, as a therapy provider, to show an open ledger of the positive impact you have on you patients. Regulators, referral sources, physicians, patients and their families will be able to clearly see the value of your services.The days of simply submitting a bill that lists “services rendered” and expecting to be paid with no further documentation are quickly disappearing. If therapy providers don't have a reliable, consistent system to show expected costs, probable length of stay and anticipated outcomes, a patient may go to another provider.
With tighter competition and stronger regulations around payment, outcomes measurement programs will become increasingly important to healthcare consumers and providers.It's a powerful tool that can demonstrate your community's commitment to quality care.