Case 3: Boosting Your Bottom Line
As we enter a new year, senior living services face an increasingly complex landscape of reimbursement models and regulatory requirements. Terms like ACOs, MCOs, PDPM, and VBC can be overwhelming. With a growing array of payer options, senior living executives must navigate these complexities while ensuring the well-being of residents. The key to success lies in strategic planning and the adoption of effective tools that align with organizational goals, enhancing quality of care, revenue, and resident satisfaction.
Identifying the right solutions begins by recognizing the industry’s pressing challenges. Issues such as lawsuits, regulatory changes, and rising operational costs are ever-present. While various agetech innovations are emerging, the most impactful solutions are those that directly affect a provider’s bottom line.
One promising solution is eBrief™, a first-of-its-kind intelligent incontinence monitoring system. eBrief offers real-time incontinence alerts for staff while also collecting valuable data that can enhance both regulatory compliance and revenue opportunities. This groundbreaking data is crucial for senior living communities looking to optimize their financial performance.
Understanding how incontinence impacts reimbursement is vital for maintaining healthy margins. Incontinence products represented a staggering $5.3 billion in costs for senior living providers in 2014, according to CDC reports. Moreover, incontinence is a critical factor in assessing quality of care, as it is linked to chronic conditions that can adversely affect residents’ mental and physical health.
The Patient-Driven Payment Model (PDPM), introduced by CMS, is still in its early stages but already shows potential for improving financial outcomes for providers. PDPM reimbursement rates are influenced by functional assessments, restorative programs, and chronic condition management. For example, implementing two restorative programs can increase reimbursement by up to $11.48 per resident per day.
To maximize these opportunities, it’s imperative to accurately document the full extent of care provided during the assessment process. Incontinence significantly impacts initial admissions and ongoing care, making it essential for providers to ensure the accuracy of Section GG assessments, which are critical for functional scoring.
eBrief not only alerts caregivers in real-time to a resident’s incontinence needs but also collects essential metrics such as voiding frequency and patterns. This information aids in creating more effective toileting programs and maintaining an automated bladder diary, which collectively support care plan interventions related to incontinence.
The positive effects of eBrief on reimbursement extend beyond immediate gains. As CMS gradually rolls out Value-Based Purchasing (VBP) programs, the benefits of effectively managing incontinence will lead to improved quality metrics, impacting both financial and clinical outcomes well into the future.
For the 63% of residents covered by Medicaid, incontinence management directly influences state-level reimbursements. Many states are implementing quality payment programs that reward providers for meeting specific quality metrics, many of which relate to incontinence complications like falls and hospital visits. In Texas, for instance, providers participating in the Quality Incentive Payment Program (QIPP) can earn significant bonuses by achieving goals such as reducing antipsychotic medication use and improving bladder and bowel control.
By leveraging innovative technologies like eBrief, senior care providers can take proactive steps to enhance outcomes, optimize reimbursements, and ultimately improve the quality of life for their residents.
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About etectRx:
etectRx is a leading digital health sensor platform company offering a unique combination of wireless sensor technology, intelligent software, and services through our novel eBurst technology. This technology supports remote monitoring of multiple health conditions – enhancing patient engagement and healthcare outcomes across stakeholders including patients, providers, and payers, by promoting accountability and awareness.