Virtual care delivery continues to gain prominence and acceptance post-pandemic due to its convenience, immediacy, equity and alignment with our digital, mobile, modern way of life. Yet, the Centers for Medicare and Medicaid Services (CMS) continues to tinker with reimbursement models, causing wariness among healthcare providers about how they can financially afford to adopt virtual care.
In its simplest terms, there are three ways to do so:
Replicate the fee-for-service office experience with a fee-for-service virtual experience.
Adopt new ways to provide care within a virtual environment and leverage new codes that align with these care delivery methods.
Transition out of a fee-for-service model and adopt a value-based approach to care.
Revenue Option 1: Replicating A Fee-For-Service Office Experience With A Fee-For-Service Virtual Experience
The global pandemic forced healthcare organizations to adjust to a very basic model of virtual care seemingly overnight. The easiest way to quickly get up and going was to replicate the in-person office experience via telemedicine.
At first, there was concern that payors would reimburse telehealth and telemedicine visits at reduced rates. Due to necessity and outcry, payors adjusted reimbursement models so that virtual care was reimbursed equitably within a fee-for-service environment.
Post-pandemic, the industry is again at odds. Shifting policies, varying messages, and the proposed 2023 Medicare Physician Fee Schedule are creating confusion and concern about whether fee-for-service reimbursements for virtual care will bring in sustainable revenue.
This industry fickleness seems tone-deaf to public sentiment and persistent demand for virtual-first care. Just as people appreciate the convenience of and choices within virtual banking and shopping, they want the same experience in how they access their healthcare.
Revenue Option 2: Adopt new ways to provide care within a virtual environment and leverage new codes that align to these care delivery methods
As the saying goes, necessity is the mother of invention. As virtual care delivery gained momentum and popularity, new virtual first modalities emerged such as remote patient monitoring (RPM) and remote therapeutic monitoring (RTM). CMS followed suit and established corresponding CPT codes.
The ability to provide location-agnostic monitoring outside of practice walls and from within a person’s real-life advanced revenue opportunities beyond a fee-for-service code.
With technology doing what it does best – collect and aggregate large amounts of data – care teams are freed from rote, time-eating data collection and, instead, can work at the top of their licensure within each patient’s care journey. This directly affects clinical and workforce efficiencies.
In addition, when care teams have a line of sight to health data from within real life, especially when paired with intelligent automations for notifications and alerts, they can quickly respond and intervene so that costly escalations and ER visits are avoided.
Revenue Option 3: Transition away from a fee-for-service model and adopt a value-based approach to care.
Healthcare organizations that step away from traditional fee-for-service models and adopt population-centric, value-based arrangements have the greatest potential to maximize revenue and deliver exceptional care quality. Let’s review.
A value-based model is capitated, meaning it assumes a set care cost per person, adjusted according to the level of risk (care) needed to manage that person’s unique health needs. A healthcare organization’s ability to deliver that care within established care quality standards, without incurring unaccounted for expenses, is the revenue margin.
Highly successful healthcare organizations who excel in driving revenue within a capitated, risk-adjusted model of care, know that high-quality care is an essential nexus for success in patient satisfaction, care team satisfaction and revenue growth.
Clinicians and care teams must be skilled and united in the following three behaviors:
Conducting thorough annual wellness visits so that every patient is accurately represented within the system through appropriate, well-documented codes.
Maintaining trusted, connected relationships with patients so that costly escalations and exacerbations are prevented or mitigated.
Adopting comprehensive technologies that enable whole-person care and encourage guided self-management of health.
Healthcare organizations that can deliver on these three approaches are well-poised to optimize operational and clinical performance in outcomes, patient experience, care team well-being and cost reduction – all of which affect revenue potential.
Recommendations
The following five recommendations can guide a healthcare organization’s playbook regarding the right path to delivering quality care and maximizing revenue opportunities within the future of healthcare.
Create a comprehensive plan that considers new payment models and any specific populations you serve.
Educate yourself on virtual care solutions and the range of functionality that they offer. Then, select technology solutions that promote and advance your goals for your business and your patients. Instead of looking at solutions like ad hoc menu choices, consider a wholistic, platform approach.
Take time to understand recent changes to regulations. We see many organizations get scared by the fraud and abuse regulations because they believe it's a barrier to implementing innovative models. However, there are a lot of newer exceptions and safe harbors designed to open the doors for success with value-based arrangements.
Recognize that you need to cultivate different types of relationships with patients than you may have in the fee-for-service world.
Avoid simply translating what you're doing in person and trying to make it a one-for-one change into the virtual space. Understand how those different modalities operate and look for opportunities to provide care in new ways.
Now is a great time to unshackle yourself from the “old way” of doing things and drive the future of healthcare. Let’s chat about how you can do that with our Care Experience Platform.
