eConsults Lower Financial Risk for Practices Operating Under Value-Based Payment Models

In this video, Cindy Craddock, RN at AristaMD discusses how eConsults can lower your practice’s financial risk and support value-based payment models.

How do eConsults Lower Your Practice’s Financial Risk?

How do eConsults lower financial risk? Since value-based payment models focus on improving outcomes and quality while reducing costs, it’s easy to see how specialty advice will lower that financial risk. Visiting a specialist is expensive, and not visiting the specialist can be catastrophic for the patient in the PCP and costs a lot more money. Specialty care is much more costly than primary care. Primary care is only 5% of healthcare costs, while specialty care is around 16%. The trick is to provide the right amount of specialty care in the right setting. As mentioned, providers are incentivized to provide the right quality care in the right setting. Patients are often sent to the wrong specialist. So not only is it difficult, expensive, and time-consuming all of that to finally get to the specialty office, but imagine going to the specialty office for chest pain and you go to the cardiologist; you’ve waited forever, and they’ve run all of these expensive tests to figure out that maybe you needed to see a general surgeon because it was the gallbladder.

That’s just one example. We see this a lot with, um, renal masses. With that referral to nephrology, the patient gets to the nephrologist and learns they also need to see a urologist. That could be taken care of, at least the first step, by eConsult. The eConsult specialists would say, you know, they would look at the film or the report and say, This looks like the patient needs to see urology, not nephrology. So you’d save that patient the months of waiting, the time off of work, the daycare you’ve opened up that spot in the nephrology office for someone who needs to be in that.

eConsult platform use in community primary care settings reduces uncompensated care for value-based payment models

Digital Health Consultations use Reduces Uncompensated Care

Uncompensated care drops hospital revenue, but digital health consultations by PCPs offer a proven solution to decrease uncompensated care.

Rural hospitals are facing severe challenges in maintaining operating margins, with uncompensated care being a major factor. A digital health consultations platform use in local primary care settings to improve “right time, right place, right provider care” have been shown to decrease the number of patients receiving avoidable and unnecessary care within the hospital setting, thus supporting hospital’s ability to mitigate uncompensated care.

As aligned with organizational missions, hospitals incur costs while delivering services to a diverse population of patients in need of medical attention.

Uncompensated care is an overall measure of hospital care provided for which payment was not received from the patient or payer group. It equates to the sum of a hospital’s bad debt plus the financial assistance it provides to patients, often referred to as charity care.

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