You are here

Five Strategies to Manage Cost of Care in Outpatient Settings

Shifting to outpatient care model can raise expenses, reduce revenue, expert says

An organization’s ability to deliver high-quality patient care while effectively managing its financial health has become more critical than ever. As a result, providers are increasingly turning to outpatient care delivery with its lower cost and greater accessibility to patients, according to an article posted on the Hospitals & Health Networks Daily website.

A comprehensive strategy is needed to manage an organization's outpatient care portfolio, the article says. Without such an approach, providers may take on unexpected financial risks, as a shift to outpatient care can increase costs and lead to lower revenue, reducing the benefits of shifting care away from inpatient services.

The article describes five strategies that providers can employ to maximize the benefits of migrating to outpatient settings.

Develop a Scheduling Algorithm

Just as clinical care plans are developed for hospital-based patients, providers should develop a scheduling algorithm for each category of outpatient care, the article suggests. The critical aspect of the algorithm is to follow a patient from location to location within the organization’s facilities portfolio over time.

Articulating the specific number of visits associated with a given care path can help organizations to spot outliers, which can lead to both clinical and operational improvements, according to the article. Providers will be able to identify potential losses in revenue if inconsistencies in a patient's care path are identified. Typical examples of such losses include radiological and/or physical therapy services which may be completed at a competitor's location.

In addition, providers may seek to financially quantify the total cost of care by allocating per-visit expenses by facility, and then aggregating totals for different patient experiences. Quantifying in this way lets providers compare the cost of delivering care for selected clinical episodes in inpatient and outpatient facilities.

Enhance Patient Engagement

Managing a patient’s progression through the continuum of care may be simpler in an inpatient setting because providers have familiarity with the mechanics of service delivery, better access to patient data, and an incentive to manage length of stay, H&HN says. In such cases, providers, not patients, may be better positioned to manage care delivery for selected patients.

Hospitals can use case managers and care coordinators to help ensure that a patient receives proper care at the appropriate location and that the care is not duplicated. It’s critical to use a comprehensive care team to coordinate care among locations, the article says. In addition, implementing system-wide information technology associated with patient care will make these coordination efforts easier and more effective.

Ensure Proper Appointment Sequencing

A common challenge related to optimizing outpatient care delivery is not only managing the number of distinct visits but also the order in which they occur, according to the report.

In a common scenario, a patient arrives for a surgical consult without completing the necessary diagnostic radiological tests. This scenario creates operational inefficiencies for staffing and physicians, and patients may become frustrated and disenfranchised. In addition, complications may arise in the business office regarding reimbursement for the visit. Inefficiencies such as these are costly and common, the article says, but a proper level of oversight should minimize them.

Balance Location Dispersion With Patient Convenience

One of the critical challenges in maintaining patient engagement is to match a patient's clinical requirements and personal preferences with the scheduled openings and locations available, according to the report. Older patients with cognitive or mobility challenges may prefer to complete all services in one easily accessible location. Other patients will travel wherever necessary to access their preferred provider in the timetable they desire.

The only way to understand patients’ preferences is to engage with them directly through interviews and satisfaction surveys, the article observes. Such information can be used to create scheduling workflows, which can optimize facility and staff utilization.

Embrace Impending Reimbursement Models

Providers are aware that reimbursement models are shifting from transaction- or procedure-based payments to outcomes-based models, the article notes.

Providers may be paid a fixed sum for a patient’s diagnosed medical condition or an annual capitated rate to manage the patient’s overall health. As a result, payments may not be made for every visit or clinical transaction that occurs in an outpatient facility. Providers, therefore, have an incentive to resolve issues expeditiously, minimizing the transaction costs associated with numerous episodes of care.

Source: H&HN Daily; May 12, 2015.

Recent Headlines

‘The Perfect Drug for Trauma-Focused Psychotherapy’
Citrus, Berries, Broccoli Reduce Risk of Cancer and CVD
Changes in Antibiotic Recommendations for Children
Influences Gene Involved in Circadian Rhythms
Triggers the Body’s Own Natural Blood Flow Regulation
Inrebic Reduces Symptoms by 50% in Some Patients
Novel Catheter-based Technology for Treating Acute Ischemic Stroke
Decision supported by data from more than 4,000 patients