The Patient Experience is an Often-Underutilized Negotiating Point

The smaller the #medicalpractice, the more important it is to come to the negotiating table with as much data and defined value proposition as possible, because a smaller practice has less leverage. A smaller practice must spend more time defining its value and proving its case to payers.

Delivering a positive patient experience which can be operationalized as high Medicare Star Ratings and low historic patient turnover will make the practice more attractive. #medicalpractice #cptcode #payerreimbursement

Understanding the 2023 HEDIS and CMS’ Star Rating measures and what they mean to your practice will help you better comply with the new requirements, boost your ratings and improve your #payerreimbursement (revenue), by #cptcode.

CMS’ Consumer Assessment of Healthcare Providers & Systems (CAHPS)

These surveys ask patients (or in some cases their families) about their experiences with and ratings of, their health care providers and plans, including hospitals, home health care agencies, doctors and health and drug plans, among others.

The surveys focus on matters that patients themselves say are important to them and for which patients are the best and/or only source of information. CMS publicly reports the results of its patient experience surveys; some surveys affect payments to CMS providers.

CMS publishes the Star Ratings each year to measure the quality of health services received by consumers enrolled in Medicare Advantage Plans.

Monitor Those Patient Experience Metrics

It is not possible to suggest that a certain approach or a particular tool is most effective for measuring a patient’s experience. We suggest 10 things for your consideration when planning how to measure changes in patient experience over time.

(1) Consider how patient experience is being defined to inform exactly what needs to be measured.

(2) Think about why patient experience is being measured and how the information will be used.

(3) Assess whether it would be useful to combine approaches so that both qualitative and more quantitative material is collected.

(4) Consider whether to ask everyone using the services or only a sample to provide feedback.

(5) Think about whether the best time to collect feedback is immediately after using the services, when experiences are fresh in people’s minds.

(6) Allocate enough time at the outset to plan and test measurement methods, particularly if these will be used for many years to monitor change over time.

(7) Think about how the end-result needs to be presented for various audiences as this may shape how data are collected. Potential outputs include statistical averages, in-depth quotes or graphs.

(8) Make sure that there is appropriate infrastructure at an organizational level to analyze and use patient experience information.

(9) Make sure that patients, managers and health professionals are all comfortable with why feedback is being collected and how it will be used. Staff need to be on board as well as patients.

(10) Ensure that patient experience measures are seen as one component of a broader framework of measurement and that all of the approaches work well together, without excessive burden for either staff or patients.

There is an increasing focus on improving patient experience and outcome (quality of healthcare), through value-based care. Your practice’s reputation will be significant in negotiating future insurance contract rates.

Have a system for conducting regular patient satisfaction surveys. Gather feedback on your practice’s reputation through hospital administrators and referring physicians.

Summary

Reimbursements are down. Costs are up. Patients want more attention and convenience than ever. Yet through it all, your practice has continued to deliver great care and patients have a high rate of positive-outcomes and give you good reviews.

But payers have not recognized this. Reimbursement rates are stuck where they were before COVID-19, and in a high-inflation environment, that can push a practice into a financial crisis.

Why don’t payers recognize the great work your practice has done and offer you better reimbursement? Because you have not asked, or when you did, you were not effective. We understand, we’ve been doing this for decades. If you want to renegotiate a contract, you need to be extremely persistent and well prepared.

Do You Lack the Time and/or Expertise?

At CodeToolz, our goal is to help physicians to succeed in the business of healthcare. We can determine if you are getting fairly reimbursed from the payers, or if there is potential for better rates and contract language.

Our team, skilled in contract negotiation strategies, will handle all of your managed care contract negotiations. You maintain complete decision-making control throughout the entire process while we do all of the work.

Let the experts at CodeToolz take your contracting efforts from burden to competitive advantage. The bottom line is that in negotiations, knowledge is power and planning is essential. Contact Us Today! (512) 787-1852