PATH ALONG and Hospital Service Changes

The PATH ALONG model encourages community members to watch as hospital service changes begin to unfold.  With Medicare and Medicaid altering reimbursement (lowering) for readmissions hospitals will develop compensatory strategies to make up for the loss in revenue.  Hospital systems understand private health insurance providers often follow Medicare and Medicaid guidelines to communicate a similar standard of delivery.

An immediate strategy will involve clinical staff meetings to help monitor supply utilization, length of patient stay, inpatient drug cost, readmissions within the 30 day window, and the use of outside diagnostic test providers.  This is administration informing the staff everyones help is needed to compensate for this expected loss of revenue.

Documentation and delivery of care is the core activity of a hospital.  Analysts will review claims and service records to understand margins of profit .  How does a patient diagnosis  receiving physician service generate a claim with a pay source (Medicare) resulting in a margin of profit for the hospital.

The analyst wants to know which physician inpatient services have an expense that is higher than the actual reimbursement.  The data should indicate which physician service is performed most (highest volume), which physican service generates a large margin (highest profitability), and which physician service is costly to deliver (highest loss). 

The analysist will communicate the derived values in a printed form and share the findings with the hospital administration.  This helps participants comprehend factors of causation contributing to the profit and loss of the hospital location.  Administrative leaders will form a working commitee with scheduled meeting times to devise a plan with specifics to improve the lower performing areas of physician delivered service.  

The public relation marketing arm of the hospital will be assigned to develop communication that will capitalize on the defined high performing areas of service.  Informing the community of the availability of (highly profitable) competent providers to deliver a much needed service.

One working commitee will be assigned to review Medicare and Medicaid clinical denials of payment.  From this commitee will flow a hospital staff training focused on medical necessity and ICD-10 coding to help prevent future denials of reimbursement.

This essentially outlines the means a hospital will employ to better comprehend the change required to continue to care for the existing service area.  This is the hospital using an evidence based approach to maintain the fiscal reserve required to deliver the needed service. 

The PATH ALONG model connects inpatient providers to community staff who support the person during transitons of care.  Simply call 608-432-4286 or email lkutzke@homecarepath.onmicrosoft.com to schedule service.  Wisconsin's PATH ALONG model is designed to reduce hospital readmission rates.  For more information please click on the site below with free access

The PATH ALONG app http://appsmakerstore.com/appim/j6kcdet8xvwk4s


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