Healthcare Reform – What will the next 2+ years look like?

Providers will need to be able to produce and leverage new CMS outcome information to win over hospital CxOs.

CMS recently put outcome-based data for readmissions out on the Hospital Compare website.  How cool is that!  Pretty cool, when you consider its importance as a sales tool when calling on your local hospital CxO to win more Medicare business.  In any entry-level sales course, we learn to do as much homework as possible before making the first call. Well the government just made it really easy, in addition to a slick mapping tool recently published by USA Today.  

Using the Hospital Compare website, you can dial in a zip code, get a list of local hospitals, and then pick three to compare with respect to customer results, mortality rates, and readmission rates.  The latter two offer a comparison of The Big Three DRGs (pneumonia, heart attack, heart failure) against national averages for the three hospitals you’re comparing.  So what?  When planning a sales call, it’s great to know where hospitals are hurting because if you have or are thinking about specialization programs, you can really position value about how you can impact your local hospital’s bottom line. This is vital because starting in October 2012; total Medicare payments to hospitals with high readmission rates will be reduced 1% followed in 2013 by that number  ratcheting up to 2%, and in 2014, 3%.  For a hospital dependent on Medicare revenue to drive profit, the 1% hit could be a big nut.  I sized each nut by pulling each hospital’s Medicare revenue from Medicare’s Data site.

An example might be helpful.  Let’s say you are a Kansas-based provider with care operations statewide.  Using a cool mapping tool launched by USA Today last month called Compare hospitals on heart attack, heart failure and pneumonia (real-time celebrity makeover of the Hospital Compare data I talked about above) you can quickly pull up the top 100 biggest offenders in the country with respect to readmissions and mortality.  Zooming into Kansas reveals three hospitals with not so pretty readmission rates.  Knowing you can help where they have pain, you now have a great excuse for a hospital CxO to take your call and hear how you can cut their readmission rate in half based on whatever special sauce your rehab program offers.  Prove it over time with hard data and you will win a lucrative and loyal referral source, one you could even woo into a long-term agreement.  Leaders are doing this now, vs. waiting for ACOs to do it for them.

Data driven outcomes will be vital for success in the outcome-obsessed world of healthcare to come.  Walls between providers are coming down, and those who can prove lower readmission rates will be positioned to take share from competitors…including those of a different provider segment.   Long Term Living's November cover story offers 5 ways outcomes will re-shape the industry.

About The Author

Renee’ Flis

National Sales Manager – Independent Owners

VCPI

111 W. Michigan Street

Milwaukee, WI  53203

P: 414-378-1280

rflis@vcpi.com

Renee’ offers 10 years of consultative experience in skilled nursing, assisted living, hospital, and travel healthcare environments.  CxO-level executives depend on Renee to drive results in both strong and volatile markets. Renee is an expert in developing, facilitating, and executing strategic business plans from an entrepreneurial leadership perspective. As a post- acute change agent and certified outcomes educator, she helps providers prepare for 2014 and the outcomes-driven world of Accountable Care Organizations to come. 

Over the years Renee has helped dozens of providers shift their strategic direction to a paperless, outcome-driven business model.  She helps create competitive advantage through improved outcomes reporting, to drive up market share from referring hospitals.

Industry Association Memberships

• AHCA – American Healthcare Association
• AHCA I/O – American Healthcare Association, Independent Owners
• AAHSA – American Association of Homes & Services for the Aging
• ALFA – Assisted Living Federation of America

Education

• Bachelor of Science Degree – University of Wisconsin Stout
• Certified Dementia Care Specialist – Wisconsin Alzheimer’s Association & NWTC

Professional Affiliations

• VCPI - Client Connections
• White House & Healthcare Reform Resource Groups
• Healthcare Executives Network