Inpatient Facility Coding & Compliance Alert

BCBS gives hospital incentives to better manage patients.

Contracts between hospitals and insurers cover virtually every facet of care, so be aware that a greater focus on quality might find its way into your paperwork.

Case in point: Blue Cross Blue Shield (BCBS) of Rhode Island and Care New England, a major hospital group in the state, reached a five-year plan that includes BCBS paying the hospital additional amounts based on quality measures. The two entities are reworking their contract to focus more on comprehensive, quality-focused reimbursements.

"We want to create incentives to better coordinate care and management of these patients, rather than keep them in silos," Peter Andruszkiewicz, president and CEO of Blue Cross, explained in a statement.

The new contract, which Andruszkiewicz says will likely be effective by the end of September, will define specific metrics based on quality-related programs, including creation of a more patient-centered model for both maternity care and for behavioral health, according to Providence Business News.