By Clearday Research Team
Currently, there is little association between patient experience and financial performance, but payers are beginning to focus on it more as the shift to value-based care continues. CMS has increasingly established codes for the entire care cycle of chronic diseases – not just diagnosis. These include many non face-to-face activities like reading results, adjusting care plans, etc. Along with these added CMS codes are more related to transition care management – providers are reimbursed for post discharge-planning activities and transition from acute care to home or other facilities.
Hospitals with “excellent” HCAHPs ratings had a net margin increase of 3% compared to hospitals with “low” HCAHPs ratings (Deloitte, 2016). 30% of CMS’s calculation for reimbursement comes from HCAHPs, patient experience surveys, as part of the Hospital Value-Based Purchasing Program (HBVP) program; however, Medicare incentives for higher HCAHPs accounts for only 7% of the correlation between patient experience and financial performance right now. (Deloitte, 2016). These HCAHPs include measures of patient satisfaction with education, training, and disease self-management. Under the Hospital Readmissions Reduction Program (HRRP), CMS is trying to reduce the $26B annual cost burden and statistics show that 82% of hospitals faced penalties for hospital readmission (Healthstream, 2021). Hospital admission is significantly more common in dementia care patients yet entirely preventable.
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