Latest / The Shift Ahead with Ken Bell / Why Good Care Still Loses Revenue with Becca Smith
Transcript
- speaker-0: really that's about maximizing reimbursement. It's actually about minimizing missed opportunities. speaker-1: I'm Ken Bell with Careability, and this is the shift ahead. Five minutes, three questions, and one expert, helping operators and clinicians prepare for what's coming next. Let's get into it. Where do SNFs most often lose reimbursement when clinical, MDS, or operational teams are not aligned? speaker-0: Organizations most often lose reimbursement ⁓ well before the end of the process. When I think about clinical reimbursement, the finance, the rates, ⁓ the coding, we've got nursing, MDS, TRB, operations, all working together. And when everyone works independently, you know, we don't reach the field's true potential. So we have the care that happened, you know, documentation may happen, coding happened, but they don't happen together. And that's really when you have missed opportunities for reimbursement. A few examples could be clinical changes that aren't communicated about a resident. Perhaps diagnoses aren't making it through from one facility to another, or even hospital treatments that aren't captured. Perhaps IV fluids were given. Interviews may be missed. So many things that really have to do with the operational workflows. I think the biggest reimbursement losses are usually process failures more than failures of. speaker-1: Okay. As residents become more complex and payment models continue to change, what should providers be doing now to protect their outcomes and reimbursement? speaker-0: As hospitals have shortened lengths of stays, it has really created a situation where we must in the skilled nursing facility industry accept those residents and adapt to caring for those residents. And and I think that's an opportunity that we've been working to do is updating and and trying to stay pace with that so that we have the right clinical processes to take care of those residents and and not have them readmit to the hospital, but also to capture that care. So really moving from just a mindset of correcting mistakes to preventing missed opportunities. I believe the biggest mistake a provider might make when trying to improve reimbursement is just a focusing on the end result and the one person. You know, really it's not just the MDS coordinator that's owning reimbursement. And it's not just owned by nursing and it's not just owned by operations. It's really how everybody works together and contributes is what then creates that reimbursement. ⁓ Great farmer will ask, what does this field need today? Is the same thing that in a facility, we need to be asking, what does this resident and the system, what do we need to do today to make sure that we're doing all those right things? If you're not paying attention to your documentation, you won't have it to support the coding. Or you could have all the documentation, but perhaps you're not staffed appropriately to complete the MDS. And perhaps it takes two weeks to create complete an MDS when really you could have started at that appropriate higher level. you know, 12 days before. And so really with clinical reimbursement, we just need to, if we align our systems to support excellent care and we're have the processes in place to document it, then the financial outcomes, great financial outcomes, just naturally reflect all that value we're creating. So it it makes it more of a creating and harvesting, like we were talking about. And by doing that, you're not just focusing on anything that could be construed as artificially trying to inflate your rates, just giving excellent care and getting paid for that care. speaker-1: Becca, what's the next big shift healthcare leaders should be preparing for right now? speaker-0: I believe the next big shift that healthcare leaders need to prepare for is really that the concept of instead of looking backward, predicting forward. So I think healthcare is moving towards using more predictive analytics, artificial intelligence, early risk identification, and having constant clinical monitoring so we know what's going on. So we can we're moving away from, you know, what happened to what's about to happen and how can we intervene sooner. You know, not waiting till we have, let's say, our monthly rates for reimbursement or our quality measure reporting, but really working on, you know, in real time to drive those outcomes that we want to see. Because really reimbursement doesn't begin with the coding. It's all the clinical care. And if we don't have the information about the clinical care, about the documentation, then we can't validate that it's been provided. Highest performing organizations don't focus on harvesting more, but really Focus on cultivating value better.