Murer Consultant’s Geriatric Services Team Partners with Providers to Drive Medicare Market Share

The graying of America presents powerful opportunities for healthcare providers to build Medicare market share while better serving their communities and enhancing the bottom line. When properly planned, geriatric service lines offer exciting opportunities for those willing to innovate in order to maximize Medicare market share and achieve a desirable payor mix. Now that Medicare and its future are being both protected and assaulted, healthcare organizations have enhanced reasons to strive to realize the full potential of the federal program to create a more stable and predictable marketplace. Such a market would be of benefit to patients and providers alike. The idea to launch or expand geriatric programs is not new. In fact, healthcare providers have been reacting to increasing volumes of elderly patients for years by launching or expanding their existing geriatric programs. But many of these programs have been net drains on the bottom line because of low reimbursement rates and an adverse selection of frail elderly. That’s where attention must be focused.

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Solutions are possible.

Comprised of experienced healthcare practitioners, reimbursement and financial experts, hospital leaders and attorneys, Murer Consultants’ has formed its Geriatric Services Team to partner with providers to develop new or to modify existing integrative geriatric service lines. This Murer team, with years of experience working with geriatric service lines, offers solutions that align with value-based payment models. The team’s focus is on all aspects of the care continuum, including pre- and post-acute care. Murer formed its Geriatric Services Team in response to the need for quality service lines that cater to the growing elderly population as well as healthcare providers’ ever-present need to find new and growing sources of revenue. Murer works with healthcare providers who already have geriatric service lines as well as those interested in launching them. The guiding principles are the same for both: Develop quality and sustainable programs that produce meaningful revenue for the healthcare provider. As the needs of the elderly population increase, the possibilities for how healthcare organizations may choose to address them are endless and range from Geriatric Immediate Care Centers to Multi-Disciplinary outpatient “one-stop-shop” facilities to specialized inpatient units. A hospital’s survival and growth strategy is enhanced by planning its larger organizational strategy with post-acute care in mind. Given the full spectrum of possibilities, hospitals should consider defining their strategies sooner—whether, shoring up current post-acute relationships, establishing new formal relationships, or acquiring a post-acute provider, as opposed to later as revenues continue to flat line or decline. The next alignment wave is starting now. Acute-care hospitals and health systems cannot afford to miss this opportunity. Post-acute geriatric services have the potential to positively impact the margins of acute-care hospitals and are especially attractive vehicles for those looking for diversification strategies. Recent statistics show that more than 45 percent of Medicare acute patients were discharged to a post-acute setting. This number represents a statistically meaningful percentage of a hospital’s population. It requires that more services and health care facilities have a robust set of pre- and post-acute care service lines to maintain their existing relationship with the patient.

For More Information, contact Beth Hughes, the Murer Lead for Geriatric Services

Bhughes@murer.com • (708) 478-7030

Elements of a successful Geriatric Service Line

Several factors govern the success of geriatric programs and reimbursement rates under these circumstances:

Service Line Design

The services offered must be competitive within a particular market while managing a tolerable level of risk.

Revenue Management

Coding must be accurate to capture and achieve competitive quality ratings as well as to maximize receivables.

Care Management

A strong focus must be on the management of chronic disease in those considered to be frail elderly, and nearing the end of life.

Regulatory Compliance

CMS rules related to all aspects of the value chain must be a strong operational focus of the program and built into its design.

Physician/Provider Alignment

Practitioners must buy into and be an active part of the management of the health integration plan.

Marketing

Internal and external communications about new geriatric service lines must well describe the most salient benefits of the services for patients, families and providers.

Patient Balance

Controlling the balance of the frail elderly with their “well” counterparts balances the financial risk.  Catering to patients who are Medicare eligible but who either have Medicare as a secondary payor or have secondary insurance should be a priority for hospitals.

Tuning Up Your Geriatric Service Line

Many financially challenged geriatric programs fail to reassess and reconfigure their geriatric service lines to fit modern reimbursement practices and codes.  Reassessing and reconfiguring geriatric service lines for proper Medicare reimbursement is step one for those who already have functioning geriatric service lines. Murer will assess your current operation and identify areas of weakness and possibilities for growth. Murer will examine such areas as the service line design, revenue management protocols, care management, regulatory compliance, physician alignment and marketing initiatives. Most healthcare systems have many or perhaps all of the components of geriatric care, but few have properly aligned those components to form a cohesive, fully integrated service line. Additionally, Murer frequently conducts a comprehensive market analysis to identify opportunities for growth. Based on its analysis of current practice, the Murer Team will offer recommendations for strengthening, expanding or changing your approach to geriatric service lines.

Partnering with Geriatric Service Line Providers

If hospitals or health systems are unable or uninterested in creating new geriatric service lines, they should – at a minimum – create or strengthen strategic alliances with pre- and post-acute care facilities that can or do provide these services. Carefully crafted partnership arrangements between acute care hospitals and post-acute care facilities can offer benefits to both parties. Typically, acute care hospitals are more experienced with the complexities associated with billing for multiple care plans and may be able to beneficially assist post-acute providers as part of a partnership agreement. At their core and at a minimum, alignment plans must account for the different operational, regulatory and financial realities of hospitals and post-acute care facilities. The Murer team has helped create strong partnerships between acute and post-acute facilities which offer many benefits, including:

  • Opportunities for hospitals to embrace post-acute care;
  • The potential for hospitals to expand into new markets;
  • Development of deeper relationships with patients and families;
  • Shared risk among partners;
  • Transformation of competitors into allies; and
  • Solving for some of the challenges in utilization management and transitions in care.

Creating your own Geriatric Service Line

text 1 Successful programs for the elderly can range from a comprehensive geriatric service line involving many providers and offerings to a small outpatient geriatric assessment facility with a single provider and limited offerings. But in either instance, the alignment and integration of the provider with the patient will prove key. Facilities need to use information about their own market area to help define the types of geriatric service lines they offer. Through careful market study and a comprehensive analysis of operations and assets, Murer partners with providers to identify service line options and works diligently to implement them. Factors considered in developing recommendations include:

  • The financial implications of proposed service line, including cost-benefit analysis;
  • An examination of the complexity of integration of the new service line and the organizational structure required for its support;
  • Consideration of the business environment for the proposed service line, including a full analysis of the strategy and market position and a study of competitors and possible partners;
  • Full articulation of desired outcomes; and
  • Analysis of the regulatory implications of the new service line.

Some possibilities for Geriatric Service Lines include:

  • Providers with expertise in geriatric medicine, including primary care and geriatric psychiatry;
  • Multi-disciplinary outpatient “one-stop-shop” facilities;
  • Geriatric Assessment Centers;
  • Geriatric Immediate Care Centers;
  • Acute Care for Elders (ACE) Emergency Departments;
  • ACE Inpatient Units;
  • Home Visits;
  • Palliative Care;
  • Providers-in-Residence Programs for senior facilities, including assisted living facilities; and
  • Geriatric Hospitalists and Extensivists.

Additionally, the alignment, integration and expansion of geriatric services may produce many positive effects:

  • Acute Care services specifically designed to meet the unique needs of seniors (from emergency departments to hospital inpatient units) will distinguish forward thinking hospitals from their competitors.
  • Pre-acute service lines designed specifically for the unique needs of seniors can help drive market share, improve patient loyalty and satisfaction, decrease care fragmentation and drive volume to the acute care setting.
  • Post-acute service lines can enhance a hospital’s financial performance by capitalizing on growing market demand and historically profitable margins.
  • Post-acute services can successfully position hospitals and health systems for value-based care imperatives and bundled payment reimbursement systems.
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Achieving full Medicare Reimbursement

Acute-care hospitals often struggle to achieve full Medicare reimbursement while their post-acute counterparts usually have stronger Medicare margins. Post-acute facilities typically perform better than acute hospitals because they are set up with smaller cost structures, lower nurse-to-patient ratios, and less capital-intensive equipment and services. Value-based care models and reimbursement formulas must focus on quality. They must focus on the costs of the patient/illness and subsequent care as an episode of care, not just as a one-time health event that ends with the patient’s release. This factor, alone, is a powerful reason for hospitals to consider the creation of, or alignment with, pre- and post-acute providers. Value-based payment models are built on the continuum of care approach, with strong emphasis on post-acute care and bundled payment models. The intent of bundled payments is to encourage care coordination among providers and encourage more efficient use of resources. Because of bundled payments for a patient’s entire episode of care, acute care hospitals may become “payors” to post-acute providers.

Summary

Health systems that launch integrated geriatric programs will be treating geriatric patients with greater knowledge and an enhanced skill set that may well result in significant institutional benefits:

  • An increase in elderly patients’ satisfaction rates. Elderly patients who receive care through an integrated system from outpatient to acute care to post –acute care will be receiving services at the locations and by the providers who are part of a single system who know the patient best and are best suited to deliver their care throughout the continuum.
  • A decrease in length of stay (LOS). Integrating an acute facility with a post-acute partner may improve LOS issues for providers. For instance, many acute facilities may keep patients longer than medically necessary because no discharge location has been identified.  Acute- and post-acute alignment will likely lead to lower LOS for inpatients transitioning to post-acute care. This improved bed utilization rate translates into quicker patient turnover as well as improved patient satisfaction and outcomes.
  • A reduction in readmission rates.  About 20% of Medicare patients are re-admitted to an acute-care hospital within 30 days of having been discharged. Partnering and coordinating care between the acute and post acute facilities can reduce the complications from care fragmentation when patients are transferred between providers and care settings, increasing the length of time between admissions.
  • Having access to patient information that is accurate and timely as patients move between acute and post-acute care may increase overall quality of care. It may also reduce future readmissions and liabilities as well as overall cost.
  • An overall reduction in the costs associated with care for the elderly. 

Clearly, doing the right thing should inure to the great benefit of those who actively pursue this opportunity in Geriatric Services. Murer Consultants is available to work with providers to assess their current geriatric service lines or create new service lines from the ground up. Contact Beth Hughes, the team lead for Murer’s Geriatric Service Team, at bhughes@murer.com.

A Personal Reflection

Murer CEO and President Lyndean Brick Explains Her Firm’s Dedication to developing Comprehensive Geriatric Service Lines for Modern Healthcare Facilities

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