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Day 2 - Forging New Pathways to Growth and Sustainability
Working Session 2
Determining Costs, Negotiating Rates, and Developing Contracts
Steps to Negotiating a Contract with a Hospital
Participating in a Bundled Payment Program
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Document the Return on Investment for your program, based on your
past performance providing care transitions services.
Incorporate the ROI investment outcome and calculation method in your
presentation materials.
Assess to determine if the hospital is participating in one of the CMS
Bundled Payments for Care Improvement (BPCI) program?
If the hospital is a CMS BPCI participant, assess to determine which Model
they are participating in, the length of the episode, and the types of
conditions selected.
Compare your current care transition program model to the BPCI episode
of care time period and types of conditions selected to ensure that your
program addresses the requirements of improved care and reduced costs
over the course of the episode, for the targeted conditions selected.
Be prepared to modify your current program delivery model if required
to meet the needs of the hospital in achieving the goals of their BPCI
participation.
Identify if there are post-acute care providers also participating in the
BPCI initiative with the hospital.
Determine if your program has existing relationships with any of the
post-acute care providers that are involved in the BPCI initiative.
Develop an implementation strategy documenting how your program will
support the goals of BPCI for the episode of care integrating with the
hospital and other post-acute care providers.
Assess how your program provides value towards meeting the goals of
the BPCI program.
Determine who the decision maker is at the hospital as it relates to BPCI.
Oftentimes the BPCI program activity is managed in the business office of
the hospital and not at the level of case management or clinical quality.
Know your break-even cost and volume rate prior to entering a
negotiation.
Present the cost of your program and the ROI as it relates to the BPCI
target price goal attainment requirements.
Prepare to negotiate on price and volume, while ensuring that you do not
accept a price below your break-even amount.