Risk Codes in Institutionalized Patients Are Paying Less 

Risk codes in institutionalized patients are paying less.

The monthly capitation for nursing home patients is still high, but the risk adjustments themselves are moderating—and in some cases are disappearing altogether.

Conditions like stroke, pneumonia, and seizures pay a fraction of what they do in beneficiaries who do not reside in a nursing home. And some, like hip fractures, pay none at all.

Your strategy is clear.

Collect as many nursing home patients on your panel as you feel comfortable with. Take good care of them. And don’t sweat the risk-coding so much.

If you have a good relationship with your nursing homes, you can leverage these patients for significant revenue by keeping them out of the ER through delivering them great care..

These changes in nursing home risk scores allow you to concentrate on what you do best and then be rewarded for it.

Take advantage, for both your sake and your patient’s wellbeing.