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Analysis

3 Reimbursement Models Nurse Leaders Must Know

By Jennifer Thew RN  
   February 13, 2018

From bundled payment models to uncompensated care, here are developments in the reimbursement realm to keep nurse leaders informed.

It's probably safe to say that nurse leaders' favorite subject is not finance. But in today's healthcare industry, financial incentives and reimbursement have become so entwined with patient care and outcomes, that you cannot have one without considering the other.

Below are recent HealthLeaders Media articles to help nurse leaders make sense out of the dollars and cents attached to patient care.

1. Five Reasons You Can Benefit from the New Voluntary Bundles

Last year the Centers for Medicare & Medicaid Services reined in its mandatory bundled payment models, leaving many healthcare providers concerned that investments they made to prepare for these models might for naught, writes HLM senior leadership editor Philip Betbeze.

But those investments in value-based care models may not go wasted after all under CMS' new voluntary Bundled Payments for Care Improvement (BPCI) Advanced model.

Participants in the new model will be expected to keep Medicare expenditures within a defined budget while maintaining or improving performance on these seven specific quality measures:

  • All-cause hospital readmissions
  • Advanced care plan
  • Perioperative care: Selection of prophylactic antibiotic: First or second generation Cephalosporin
  • Hospital-level risk-standardized complication rate following elective primary total hip arthroplasty and/or total knee arthroplasty
  • Hospital 30-day, all-cause, risk-standardized mortality rate following coronary artery bypass graft surgery
  • Excess days in acute care after hospitalization for acute myocardial infarction
  • AHRQ patient safety indicators

The enrollment deadline in the model is nearing. The BPCI Advanced portal closes March 12.

2. New Uncompensated Care Calculation

CMS is changing its formula for calculating and allocating funds for uncompensated care for hospitals that qualify under its Disproportionate Share Hospital program. This new method presents both opportunities and challenges for organizations.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


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