How to Break Even on Medicare Reimbursements
There isn’t a quick fix on this, you’ll need to do a process evaluation, and that can take four to six months to gather all the data, Gift says.
If you’re not sure where to begin your full-scale roll-out of Lean or Six Sigma, consider looking at your imaging and testing levels, since reimbursement cuts are already in place for these services. And you may be surprised to learn how many of these tests are duplicated.
“Often tests are orders and the lab, or whoever, doesn’t get the results on the chart quickly enough. So another lab is ordered by the physician. Or a test only needs to be performed only once but it is not noted on the record and so it’s ordered and performed every day,” Gift explains. “It’s a system [communication] breakdown.”
2. Instruct on Decreased Utilization. Along the lines of out-with-the-old philosophy, and in with the new, you must train your staff to understand why they must decrease their utilization across the board.
“You have to change the mindset of the physician,” says Gift. “You can have all the data, but what you find is that physicians have been trained to practice a certain way and that’s the way they continue to practice.”
It’s unfortunate, but most people resist change and the hospital employee is no different. However, the time for hesitation has passed and your staff must embrace the new. Reform means healthcare professionals must innovate and improve processes or watch your bottom line get worse with every passing day.
“You have to do a solid analysis of your utilization, because inevitably when you start to present data to nurses and physicians, [they] will challenge it,” he says. “You have to engage these people and get them to understand what’s happening and how they can impact the process.”
Though we all wish that Medicare reimbursements would go up instead of down in the coming years, the fact is, it’s highly unlikely. So, your best efforts will be needed in the coming years to try to at least get your Medicare to a breakeven point.
Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
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