In recent news, the National Association of ACOs announced it is pushing Center for Medicare and Medicaid Services (CMS) to rethink its positions on what qualifies a patient for home health services. While home-based care is rising at a staggering rate, there are still a few monkey wrenches in the way of this kind of care reaching its full potential, particularly for Medicare and Medicaid patients. Accountable care organizations are interestingly leading the charge on what they think CMS needs to change to meet the demand for home-based care, help home care services overcome new billing challenges with CMS, and allow more patients to be able to take advantage of home-based care services.
While it’s great that someone is working on behalf of home health services and everything that entails, what makes ACOs so excited to see them succeed? What is in it for an ACO to want home health services to grow more than ever before?
ACOs Want Better Patient Care From Home Health Services
An ACO’s job is to control costs while increasing quality patient care. They work very closely with CMS to ensure that the government is receiving the kinds of services it expects for its members while making sure that taxpayers are not being overcharged for patient care. This type of organization walks a tightrope of cost-effectiveness with its participating members.
Why do ACOs need to make sure that home healthcare services succeed? The answer is easy: cost control. From the patient care end of cost control, it’s all about avoiding hospital admissions and readmissions. No one likes to see hospital readmission that could have been avoided if better patient care were delivered, especially the hospital itself. The best way to head that off is exceptional patient care post-discharge. This kind of care is always provided by home health services if it is not being done by a family caregiver.
Home health services with well-trained staff are poised to be the final eyes and ears of the ACO model, signaling when and if patient discharge orders are not being followed by the patient or the family caregiver. This strategy is a pivotal point in cost-control, allowing other members of the medical care team to step in and make adjustments to the patient’s treatment plan when necessary.
Another driver for the ACOs wanting to see changes is a simple rule CMS regulations have around what qualifies a patient for home health services. Under the current rule, patients must be eligible for what CMS considers a homebound patient to receive in-home care. This creates a conundrum for medical care providers and patients when in-patient care is deemed unnecessary for the sole reason that the patient can leave their home.
This intersection of mobility and care needs unnecessarily drives up the cost of treating the patient. National Association of ACOs says the cost of care will decline if this rule is rethought and rewritten to include patients who can leave their home but have mobility issues.
Controlling Costs Is What ACOs And CMS Is All
The two entities most interested in watching out for Uncle Sam’s dollar are ACOs and CMS. Their very existence was created to control the costs of healthcare overall for Medicare and Medicaid patients. What would it look like if home health services, ACOs, and CMS could all view, audit, and report on the same patient receiving home health services? What would billing approvals be like if they were able to seamlessly read home health service reports and care notes from professional caregivers and even family caregivers?
The new CMS rules around billing, reporting, and reimbursement have home health services in a tizzy about how to avoid reimbursement reductions and denials when it comes to value-based reimbursement. Patient care records and exceptional care notes will have to be at the forefront of every home health service provider’s mind to avoid costly reimbursement rejections and painstaking Medicare and Medicaid audits.
eCare Vault joins cost-control and efficient patient care strategies to be the first of its kind care coordination platform suitable for such a task. Patient-centric care is what eCare Vault is all about. If you’d like to know more about eCare Vault can help home health services control costs, monitor patient care and make new CMS rules on value-based reimbursement less of a burden, contact us today for more information about what eCare Vault can do for you.