Participants should be aware of the following financial/non-financial relationships:
Vincent Fedele, MBA: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Michael Sciacca, MHA, MPT: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Unlike FFS Medicare, actionable provider-specific Medicare Advantage data does not exist. Individual facilities have little idea or often no idea at all how they are doing relative to their peer group. These data limitations foster a challenging environment for the provider when negotiating with the plans, who typically hold all the cards when it comes to rate-setting. This session will introduce per diem and episodic revenue benchmarks, with the goal of promoting transparency and leveling the playing field between plan and provider.
Learning Objectives:
Discuss challenges associated with managed care case management.
Determine the correlation (or lack thereof) between quality-of-care outcomes and episodic revenue.
Quantify the potential opportunity of episodic MA payment.