Can Better Bariatric Design Lead To Better Reimbursement Rates?
Obesity is a problem in this country that’s not going away, says Christopher Upton, a project manager at the University of Texas Office of Facilities, Planning, and Construction (Austin, Texas).
That means healthcare facilities will continue to see its bariatric patient populations rise—but there’s a huge gap in terms of demand and the ability to serve this specialized patient group. “If you’re in the business of doing bypass or other types of weight-loss surgeries, you’re more sensitive to dealing with these patients and patient size, so your focus is there,” Upton says.
For others, access to bariatric care is mostly found in areas with the highest obesity rates, while other parts of the country have little support programs in place. Yet, the obesity rate in the U.S. is still growing—albeit slower than before—meaning facilities will continue to see these patients walk through their doors.
To expand services and care capacity within a hospital, Upton wants to start by introducing a more defined description for the bariatric patient that helps address the physical handling requirements and specific health concerns of these patients.
Upton’s revised definition of bariatrics breaks down patients into four levels, with a Level 1 bariatric patient having a BMI of 30 or more, no visible skin sores or blisters, a waist of more than 45 inches, and moderate independence when it comes to maintaining hygiene and dressing themselves. A Level 4 patient would exceed 450 pounds and be fully dependent on caregivers.
Upton, who served as chair of the bariatrics committee for the 2014 Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities, says adding that type of analysis to a system can let operators know what the staffing and equipment requirements are.
He points to the parameters outlined in the 2014 guidelines as a starting point for design ideas, such as installing patient lifts, bariatric toilets, adding larger bed sizes, and making sure doorway widths are designed to accommodate bariatric equipment.
Armed with this better understanding of bariatric patient needs and the resources needed to care for them, providers can seek increased reimbursement rates from insurance companies and Medicare and Medicaid programs, Upton says. For example, if a facility is treating a Level 3 bariatric patient and knows that care will require four staff members and a bariatric bed, they can make a case for reimbursement based on those needs, similar to how a facility would quantify care for an isolation patient.
“Once the reimbursement rates start to reflect the specialized equipment, staffing, and spaces that are needed to handle these patients, then more hospitals will bring it online,” he says.
Do you agree—will clarity in the way bariatric patients are defined lead to better care and better reimbursement rates? What else needs to happen?
Upton will share his ideas on bariatric care at the Healthcare Design Conference & Expo (Nov. 14-17, Washington, D.C.) during the session “The Bariatric Patient: Making the Case for Reclassification.” For more information on this year’s conference, including educational sessions, tours, and networking events, visit HCDConfernece.com.