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800 Hospitals Forfeit 1% of Revenue to CMS For Poor Performance


Last week, CMS reported that 800 hospitals will be required to forfeit 1 percent of their reimbursement for missing the mark on reducing hospital-acquired conditions (HACs). The race to eliminate preventable patient harm has always been a top hospital goal, but now it’s one tied to their reimbursement through the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program (HACRP). No matter how hard hospitals work to improve their performance, CMS will penalize the lowest performing quartile (25%) of hospitals annually.

At a time when hospitals are fighting harder than ever to maintain profitability, forfeiting millions of dollars in revenue can make all the difference in a hospital’s ability to remain sustainable. We all know running a hospital has become increasingly complex in recent years. The entire healthcare system is facing pressures to reduce cost, while reimbursement remains on a steady decline. Operating costs have increased as health systems are spending millions annually on relatively new expenses such as EMR technology and physician employment models. The shift to value-based care is causing uncertainty and requires the development of new strategies and innovative care delivery models – all of which involve intensive time and resources.

Is Outsourcing the Key?

How can hospitals possibly respond to these mounting pressures, while remaining profitable and maintaining their mission? While it sounds simple and it’s certainly easier said than done – it’s time for hospitals get back to the basics. What does this mean exactly? One would argue that the hospitals who focus on their core mission by placing the majority of their resources on directly serving their patients are the ones that will come out on top when the shift to value-based care becomes a reality. This means outsourcing other critical functions – when and where it makes sense.

Specifically, outsourcing highly specialized business and administrative functions such as revenue cycle management (RCM), clinical documentation improvement (CDI), call centers and collections services, as well as other core functions will allow hospitals to reduce overhead costs associated with hiring, training, salaries/benefits and turnover. While outsourcing has gotten a bad rap in the past – hiring highly specialized experts who focus on narrow niche fields such as these has proven its ROI time and again for health systems, both small and large. The key is to find the right outsourcing partner and empowering them to do what they do best on your behalf. What happens next? Hospitals get to focus on what they do best and why they got into healthcare in the first place – delivering exceptional patient care and improving the health of the communities they serve.

For nearly 15 years, GeBBS Healthcare Solutions has been helping health systems improve financial performance, compliance and patient satisfaction by delivering industry-leading solutions for revenue cycle management (RCM), health information management (HIM) and patient contact services. They are praised by their customers for establishing a true partnership model and delivering exceptional ROI. To learn more, visit www.gebbs.com

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