Discharges and Readmissions: The Impact of Alternative Payment Models

presented by Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN and Nancy Skinner, RN, CCM, CMGT-RN, ACM-RN, CMCN, FCM

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Disclosure Statement:

Financial: Colleen Morley receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Nonfinancial: Colleen Morley has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Financial: Nancy Skinner receives compensation from MedBridge for this course. She is a consultant/educator at Encompass. There is no financial interest beyond the production of this course.

Nonfinancial: Nancy Skinner has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 37 Minutes; Learning Assessment Time: 34 Minutes

The Centers for Medicare & Medicaid Services has indicated that 100% of traditional Medicare reimbursement will be value based by 2025. Healthcare professionals may not possess a clear understanding of value-based reimbursement strategies and the regulations adopted to support those strategies. Any gap in that knowledge and/or execution related to current healthcare reimbursement initiatives may negatively impact the financial viability of an organization and/or compromise the status of that organization within the community of practice.

This course will provide a review of associated quality metrics and the strategies under value-based purchasing introduced by the Centers for Medicare & Medicaid Services. The discussion centers around the various alternative payment models and structures that have been implemented to put the focus on quality of care rather than quantity of services. Obtaining an understanding of these initiatives is important as reimbursement in the form of both incentives and disincentives is associated with both provider and payer accountability for the quality as well as the cost of provided care. This course is applicable to physical therapists, occupational therapists, speech-language pathologists, nurses, social workers, and case managers.

Meet Your Instructors

Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN

Dr. Colleen Morley has held positions in acute care as director of case management at several acute care facilities and managed care entities in Illinois, overseeing utilization review, case management, and social services for more than 12 years and piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication, and population health…

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Nancy Skinner, RN, CCM, CMGT-RN, ACM-RN, CMCN, FCM

Nancy has, for the past 30 years, served as a case manager, director of case management, and international case management educator. In her current role as principal consultant for Riverside HealthCare Consulting, she advances programs that promote excellence in care coordination and other transitional care strategies. She has presented more than 400 on-site programs and…

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1. The Transitional Care Team

In this chapter, we explore the evolving role of the transitional team as the patient moves through the care continuum. We discuss the fundamental shifts from length of stay to effectiveness of the plan, from provision of discharge instructions to advancing an understanding and engagement in the information for patient self-management, and the balancing act of financial stewardship and patient advocacy.

2. Value-Based Payment Models

We continue with a review of the shifting focus of healthcare from volume to value through a discussion of current alternative payment models and healthcare delivery systems. Concepts including value-based purchasing, bundled payment models, patient-centered medical homes, accountable care organizations, and transitional care management are examined.

3. The Impact of Transitional Care Management

Join us for a discussion between the instructors on key transitional care management topics reviewed in this series. The impact of each element is discussed within this lively Q&A.

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