In 2020, the Merit-based Incentive Payment Systems (MIPS) Cost category weight is 15% . Physicians and their teams are thinking more seriously about how to succeed in the MIPS Cost category. As a post-acute provider, consider these 5 ways to help physicians reduce costs in healthcare.

1. Reduce Unnecessary Use of the Hospital

Hospital costs account for 1/3 of spending in U.S. healthcare. Two best practices have emerged to reduce unnecessary use of the hospital: chronic care management (CCM) and transitional care management (TCM).

#2 Chronic Care Management (CCM)

Chronic care management (CCM) prevents hospital admissions. The purpose of CCM is to empower patients to better understand and better control their condition(s).

CCM prevents exacerbations of chronic conditions that require stabilization in the hospital. Examples of chronic conditions include asthma, cancer, cardiovascular disease, depression, diabetes, hypertension, and HIV/AIDS. The purpose of CCM is to empower patients to better understand and better control their condition(s).

#3 Transitional Care Management (TCM)

Transitional Care Management (TCM) prevents readmissions. TCM prevents relapses or complications that would cause a patient to readmit to the hospital. The purpose of TCM is to prevent a gap in care as patients transition from the inpatient to the outpatient setting. Medicare’s TCM guidelines include 1) interactive contact within 2 days of discharge, 2) a face-to-face visit within 7 or 14 days, and 3) other non-face-to-face services that you would expect. Two of six non-face-to-face services include:

  • Obtaining and reviewing discharge information
  • Identifying and following up on outstanding orders

#4 Prevent Unnecessary Use Of The Emergency Department (ED)

Approximately 30% of all ED visits in the U.S. are for non-emergent causes. Treatment from an ED costs 10X as much as similar care provided in less expensive setting. Prevent non-emergent use of the ED. Develop protocols with physicians, for example with Lasix.

#5  Create a Care Management Solution

Physician practices are responsible for care management beyond their four walls. Engage in conversations about your core capabilities as an extension into the home.

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