How Tying Clinical Privileges to Healthcare Quality Affects the Bottom Line
If any gaps exist between the quality, performance, and privilege functions at your hospital, reimbursement is about to get a whole lot trickier under value-based care payment systems.
We’ve long known about the benefits of shared governance and accountability between the medical staff office and the quality department. Proper privilege delineation, coupled with streamlined provider performance monitoring for quality and safety, lead to: improved outcomes, better risk management, strengthened compliance, and fortified reimbursement.
But never before has there been such a strong financial incentive to connect your healthcare organization’s:
- Performance monitoring
- Peer review
That’s because to be included in payer networks, and to receive optimal reimbursement, provider organizations must transform and prove value, demonstrating that their practitioners can deliver high-quality, evidence-based care while managing or reducing the cost of care. Both Gain Share and Risk Share models have incentives for improvements through demonstrated outcomes. And there are extensive negative consequences when a healthcare organization bills for a procedure that a provider is not privileged for or not currently competent to perform. Preventing such scenarios requires integrated governance—over the often-disparate processes of credentialing/privileging, quality and performance monitoring, and revenue cycle.
This first webinar in a series begins with the basics for medical staff professionals and quality and performance improvement staff:
- Who’s responsible for obtaining and assessing clinical provider performance?
- How do we gather information for measuring provider quality and performance?
- What are the leading practices to support privileging, compliance, and revenue goals?
- Quality (OPPE)
- Reimbursement oversight
- Cite which parties in hospitals and healthcare organizations are responsible for gathering and assessing physician and nonphysician providers’ ongoing performance data.
- Cite two accreditor-recognized methods to gather provider quality/performance information.
- Explain three leading practices for connecting your organization’s privileging, quality (OPPE), and reimbursement oversight to support compliance and revenue goals.
Attendees of the live program are eligible for 1.0 NAMSS CE credit and/or 1.0 CPHQ CE credit from NAHQ.
Senior Quality Consultant, symplr
Joni Orand has been in the healthcare industry for 28 years, in both managed care and hospital environments.