“I do not believe you can do today’s job with yesterday’s methods and be in business tomorrow.” – Nelson Jackson

As the dynamics of our country’s health care system change, so too must our methods of managing the intricate web of patient encounters. We have all heard the buzzwords “population health,” “bundled payments,” “full risk” and “value-based purchasing.” These phrases signal the movement from a reimbursement model predicated on frequency to one based on patient outcomes. In essence, the new reimbursement paradigm forces us to reconsider yesterday’s methods.

Traditionally, hospitals used their resources to report quality data, as required by the Centers for Medicare & Medicaid Services (CMS). They maximized reimbursements by capturing all patient comorbidities and by working with physicians to minimize the length of stay. This model improved the profit margin with medical DRGs such as CHF,...

You do not currently have access to this content.