Inpatient Facility Coding & Compliance Alert

Question: I’ve heard that quality issues will become a bigger part of contract negotiations in the near future. Is that right? 

Maryland Subscriber 

Answer: Yes, quality measures likely will become a more important focus when hospitals negotiate with insurers on care measures. Some payers are already offering incentives to promote a better coordination of care. 

Example: 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 reworked their contract to focus more on comprehensive, quality-focused reimbursements. The new contract included definitions of specific metrics based on quality-related programs, such as creation of a more patient-centered model for both maternity care and behavioral health. 

Other facilities can learn from this example to prepare for new types of negotiations with their own payers.