By Daria Byrne, Vice President, Clinical and MedSurg Solutions Consulting, Intalere
We live in a consumer-driven healthcare society. Outcomes affect reputation and reputation affects the bottom line. Good outcomes depend on processes that are continually assessed and improved. On average, healthcare providers receive government payment of 88 to 90 cents for every dollar spent caring for Medicare and Medicaid patients. In order to effectively maximize reimbursement potential, organizations must have the foundation for regulatory readiness and continually focus on patient quality to drive positive outcomes.
Any hospital that receives Medicare or Medicaid reimbursement for services must meet the federal requirements outlined by CMS called Conditions of Participation (CoP). In order to effectively maximize reimbursement potential, an organization must have the foundation for regulatory readiness and continually focus on patient quality to drive positive outcomes.
What are some of the key focal points to accelerate organizational performance improvement and accreditation strategies for your organization?
- Compliance with federal, state and local laws – Your facility must understand and meet minimum standards and guidelines provided by various domestic and international quality boards. In the case of CMS, that involves making sure your readiness plan parallels with CMS requirements that impact reimbursements.
- Education – Make sure staff are appropriately trained in terms of following standards for reducing chances of error, infection or negligence. This should incorporate every department in healthcare facilities including lab, pharmacy, infection control, HR, IT, etc.
- Policies/Procedures – Your organization should have policies to support a culture of safety and reporting (including unsafe conditions) and a risk-based approach to determining human and system errors. Transparency and learning from reporting events is key.
- Quality assessment and performance improvement – Ensure you have mechanisms in place to assess strengths and vulnerabilities in order to prioritize and address any areas of concern. Does your policy include baseline measure of safety culture, and identify and address identified quality and safety matters? You should also include development of unit-based improvement initiatives to improve culture and recognition of those that report, catch mistakes or possible issues, and make suggestions for improvement.
- Staffing – It can be an overwhelming process to internally identify areas of weakness and provide specific recommendations on how to mitigate potential deficiencies. Your facility has to consider what that endeavor would take in terms of time and resources. Is it worth bringing in outside resources to assist, so your staff can concentrate on direct patient care?
As accreditation and regulatory agencies continue to set standards, it is imperative to change the focus from just meeting requirements to always improving performance and processes in order to maximize reimbursements and avoid Medicare penalties. Most important is empowering staff to promote safe, timely, effective, efficient and patient-centered care through processes and systems committed to exceptional patient outcomes.
Intalere offers an Accreditation Readiness Consulting Solution designed to help organizations improve pre-survey, survey and post-survey experience to enhance patient safety and positively impact their reimbursement. Contact us if you’d like to learn more.
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