Learn more about the healthcare finance industry's leading professional association. Find out why our members rely on HFMA as their go-to source for insight and information.
Members have many options for helping them advance their careers. Conferences, seminars, eLearning, certification, and more -- our education and events will keep you motivated.
Train your staff right, right from the start—help new hires in patient-facing positions understand how their roles impact revenue cycle performance and the organization’s reputation.
Enhance your skills, shape your career.
Leading and inspiring the business of healthcare. Discover a new and improved HFMA Annual Conference. Register today.
Healthcare Cost Containment, Revenue Cycle Strategist, and Strategic Financial Planning provide truly actionable steps for healthcare finance leaders needing to stay informed about today’s finance challenges.
Hear in-depth conversations with industry experts who face constant challenges and opportunities shaping health care. Start listening today.
Information about leading vendors helps your buying decisions.
Forum members can network during live webinars or access a library of past webinars on topics such as ICD-10 implementation, CMS audits, bundled payment, charity care, KPIs, and more.
An ever-expanding collection of spreadsheets, policies, job descriptions, checklists, and more that you can adopt and adapt.
Forum members can submit vexing questions to a panel of experts using our Ask the Expert service.
Your source for employment solutions.
Find new employment opportunities or reach out to qualified candidates.
Distinguish yourself as a leader among your peers and advance your career by earning certification in our healthcare finance programs.
When the designation "Peer Reviewed by HFMA" is earned, you know that those products and services have been rigorously evaluated. Only those earning top marks make THE SHORT LIST.
Hospitals, health systems, and physician practices use MAP App to benchmark and compare revenue cycle performance to data from more than 600 facilities.
Why start your product or service search organically when you can search HFMA's Buyer's Resource Guide - the go-to directory for HFMA members.
Guidance for understanding and communicating about the price of health care.
Find out how to achieve recognition as an Adopter of best practices and earn your patients' trust when it comes to financial matters.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
January 30, 2012
Marilyn Tavenner
Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, SW, Room 310G Washington, DC 20201 Attn: CMS 3239-P Re: Hospital Readmissions Reduction Program Dear Ms. Tavenner: The Healthcare Financial Management Association (HFMA) strongly supports CMS's efforts to implement a hospital readmissions reduction program. HFMA is committed to helping its members improve the value of the care they deliver and as such believes that this program is an important step in aligning financial incentives to encourage providers to improve quality in a manner that will lower the overall cost of care to purchasers. HFMA appreciates the thoughtful approach CMS took towards the readmissions reduction program and is encouraged by some of the comments in the 2012 IPPS final rule.However we are still very concerned that unless CMS takes steps to provide hospitals with data related to readmissions, aligns financial incentives across the care continuum, and changes how excess readmissions are defined and calculated, hospitals will be inappropriately penalized for circumstances beyond their control. Given the severity of the penalties associated with the readmissions program, HFMA believes that inappropriately penalized hospitals could be irreparably harmed, jeopardizing care not only for Medicare beneficiaries but for the entire community served by these providers. In an effort to avoid what we believe CMS would agree is both an undesirable and unacceptable situation, HFMA respectfully submits the following comments, which were developed in consultation with our local chapters through our Local Information Network committees (LINKS) and our Healthcare Reform Advisory Committee (HRAC). Data for Coordinating and Improving Care Delivery We strongly believe that access to current data related to readmitted patients is necessary if hospitals are to be held responsible for readmissions. Given that 20 to 40 percent of rehospitalized patients are readmitted to a different facility from where the index admission occurred, hospitals have a significant knowledge gap to even understand the extent of the problem(1). In order to accurately diagnose the problems contributing to readmissions, hospitals will need cross-continuum claims data for all readmitted Medicare beneficiaries. This will allow providers to accurately identify readmission drivers, apply scarce resources to mitigating these causes, and improve the quality of care provided to Medicare beneficiaries. HFMA believes that CMS should provide hospitals with all patient level Parts A, B, and D claims data on a monthly basis for readmitted patients attributed to the hospital. HFMA appreciates the concerns expressed in the final rule about the administrative burden this would pose to CMS. However, we believe CMS may be overstating the burden. The data set requested is no different from what CMS will provide to participants in the Shared Savings Program on a monthly basis and is for a limited set of Medicare beneficiaries. Further, HFMA believes that CMS should provide hospitals with access to real-time Part D claims data for Medicare beneficiaries to assist with medication reconciliation. Proper medication management is a significant factor in preventing unnecessary readmissions. Our members' experience has shown that, despite best efforts, medication reconciliation performed at discharge with patients and family members varies significantly from reconciliation performed subsequently in the patients' homes by home care nurses. Having a nurse visit every discharged patient's home may not be the best way to allocate scarce nursing resources when there is a more cost-effective way to improve quality. Access to real-time Part D claims data would provide the care team with a snapshot of the patient's medications to perform an accurate reconciliation and could serve as an indication of uncoordinated care based on the number of prescriptions prescribed. Misaligned Incentives Contributing to Readmissions Across the care continuum, there are misaligned financial incentives that pose barriers or result in missed opportunities to coordinate care, reduce readmissions, and improve patients' outcomes. Examples of barriers HFMA's members have identified as most pressing, as well as recommended solutions, are outlined below. Physicians: Research shows patients who receive timely physician follow-up care post discharge are significantly less likely to be readmitted.(2,3) However, in many instances, beneficiaries do not receive follow-up care in the recommended time frame. There are many reasons for this, which include-but are not limited to-socioeconomic issues (addressed later), appointment availability, and patient compliance. While hospitals and the physicians they employ are working diligently to address the issues listed above, these efforts are limited in their effect by a lack of aligned incentives with community physicians. We believe altruism motivates many community physicians to participate in efforts to reduce readmissions where they can. However, given the intractable nature of the issues that contribute to readmissions, we believe altruism is insufficient to create the urgency necessary.HFMA recommends that CMS use "a carrot and stick" approach to align physician and hospital incentives to reduce readmissions:
Skilled Nursing Facilities (SNFs): MedPAC estimates that 25 percent of Medicare SNF residents are readmitted to the hospital.(4) Although hospitalizations are often medically necessary, expert evaluation suggests that 28 to 40 percent of such admissions might be avoided with high-quality SNF care.(5) In most instances, the hospital where the index admission occurred does not have an ownership interest or financial relationship with the SNF that is the source of the readmission. Not only are the financial incentives between hospitals and SNFs misaligned but in some cases CMS's SNF reimbursement policy makes it financially advantageous to the SNF for patients to be readmitted. As a case in point, CMS's policy covering only the first 100 days of SNF care post-discharge creates an incentive for SNF patients to be readmitted. HFMA recommends that CMS:
Telemonitoring and Other Technological Care Extenders: There is a growing body of evidence that proves the efficacy of telemonitoring as a means to coordinate care, improve patient outcomes, and reduce readmissions and overall episode cost. Despite these results, few hospitals have implemented it because the technology is expensive and currently not supported by the Medicare reimbursement system beyond limited circumstances.HFMA encourages CMS to pay Medicare providers for effective use of telemonitoring technologies for at-risk individuals. We propose to define at risk as a beneficiary who is burdened with one or more chronic diseases. This payment should be available for telemonitoring services provided in settings such as the patient home, SNF or group home settings. Given the technology's potential to improve outcomes and the readmission penalties, even a nominal level of payment would likely encourage wider adoption among fee-for-service providers and significantly improve beneficiary outcomes. Patients: Socioeconomic issues play a significant role in hospital readmissions. For example, when an indigent patient cannot afford the necessary medication to manage a chronic condition or a patient with a limited support network cannot keep a follow-up appointment with a community healthcare provider, the odds of a potentially preventable readmission are significantly increased. While the scope of these problems is beyond what hospitals alone can solve, there are significant legal barriers related to beneficiary inducement that prevent hospitals from supporting vulnerable beneficiaries.HFMA recommends that CMS and the OIG create waivers, similar to those afforded participants in the Shared Savings Program, allowing hospitals to provide vulnerable Medicare beneficiaries with medically indicated services aimed at preventing readmissions. Following the examples discussed above, items covered by the waiver would run the gamut from providing low/no-cost prescriptions to rides to follow-up appointments. HFMA realizes that many of these recommendations will require congressional action. We strongly recommend that while CMS pursues the necessary legislation to implement the recommendations outlined above, it also uses the Center for Medicare and Medicaid Innovation to launch pilot programs to test each recommendation and better align incentives. Definition and Calculation of Excess Readmissions HFMA's members continue to be deeply concerned with the manner in which a potentially preventable readmission for each of the selected conditions is defined and calculated. Specifically, HFMA believes:
HFMA first shared the concerns of its membership with CMS regarding these issues in a comment letter on the proposed rule. Unfortunately, CMS in the IPPS final rule published on August 18, 2001 accepted the language in the proposed rule unmodified. Given the severity of the financial penalty borne by providers who are inappropriately sanctioned by an ill-constructed readmissions measure, HFMA strongly encourages CMS to reconsider the following issues. Insufficient Exclusions for Unrelated Readmissions: The final rule identifies a limited number of excluded "planned readmissions," as defined by the NQF, from the 30-day risk-standardized AMI measure. As a result, Percutaneous Transluminal Coronary Angioplasty (PTCA) and Coronary Artery Bypass Graft (CABG) are excluded from the AMI 30-day risk-standardized readmissions measure unless the principal discharge diagnosis for the readmission is one of the following diagnoses that are not consistent with a scheduled readmission: heart failure, acute myocardial infarction, unstable angina, arrhythmia, and cardiac arrest. No such exclusions exist for the 30-day risk-standardized measures for HF and PN. CMS, in the final rule, declined to expand the number of exclusions for planned readmissions, citing Sec. 1886 [42 U.S.C. 1395ww] (q)(5)(A)(i)(I) of the Social Security Act requiring that "measures of such readmissions - have been endorsed by the entity with a contract under section 1890(a) (the NQF)." The final rule articulated CMS's concern that if the measures were modified, they would no longer be NQF-sanctioned and therefore ineligible for usage in the program. However, in this analysis HFMA believes that CMS overlooked the second subpart ([42 U.S.C. 1395ww] (q)(5)(A)(i)(II)), which also requires CMS to ensure that "such endorsed measures have exclusions for readmissions that are unrelated to the prior discharge (such as a planned readmission or transfer to another hospital)." CMS argues that the statute "does not state that the measures must account for all possible unrelated readmissions."(6) Respectfully, however, the statute does not qualify its blanket requirement that the measures must have "exclusions for readmissions that are unrelated to the prior discharge." The NQF measures adopted by CMS do not satisfy this statutory requirement. Rather, as CMS has acknowledged, they are "'all-cause' readmission measures (that is, they count readmission regardless of the reason for readmission) . . . ."(7) Thus, by definition, the NQF measures do not exclude unrelated readmissions. By including the second subpart, Congress intended for CMS to modify the readmissions measures to account more accurately for unrelated admissions than is currently reflected in the NQF-endorsed measures. HFMA strongly encourages CMS to reconsider its position and recommends at a minimum that CMS develop modifiers to identify and exclude the following from the hospital specific readmissions count:
Further, HFMA recommends that CMS follow Congress's intent in the second subpart and create an exhaustive list of MS-DRGs for which a readmission could not be related to one of the conditions included in the readmissions policy. We strongly encourage CMS to reconsider a methodology similar to 3M's Potentially Preventable Readmissions (PPR) model to identify other conditions for which readmissions should be excluded. We believe it is appropriate to follow the review process used by 3M when defining clinically related admissions and use those criteria to review the relationship between the MS-DRGs included in CMS's readmissions program and all other MS-DRGs. MS-DRGs that are identified as either not clinically related or preventable should be excluded from the calculation of the risk-adjusted readmissions rate. This would align the readmissions reduction program with similar efforts occurring in the private sector. Commercial contracts that include readmissions programs will typically exclude readmissions related to cancer treatment, kidney failure, rehabilitation services, and mental health/substance abuse. Included in Attachment I is an overview of 3M's PPR methodology. Insufficient Risk Adjustment: In the final rule, CMS declined to expand the risk adjustment factors considered to include socioeconomic factors. CMS stated that: The proposed readmission measures are risk standardized readmission measures that adjust for case-mix differences based on the clinical status of the patient at the time of admission to the hospital. That is, they are risk-adjusted for certain key variables (for example, age, sex, comorbid diseases and indicators of patient frailty) that are clinically relevant and/or have been found to have strong relationships with the outcome. To the extent that race or SES results in certain patient groups having a greater disease burden, those factors are accounted for in the measure. However, these measures are not adjusted for other factors such as race, English language proficiency or SES. We believe such additional adjustments are not appropriate because the association between such patient factors and health outcomes can be due, in part, to differences in the quality of health care received by groups of patients with varying race/language/SES. Differences in the quality of health care received by certain racial and ethnic groups may be obscured if the measures risk-adjust for race and ethnicity. Additionally, risk-adjusting for patient race, for instance, may suggest that hospitals with a high proportion of minority patients are held to different standards of quality than hospitals treating fewer minority patients.We agree with CMS that race or ethnicity should not be included in the risk adjustment mechanism. However, given the predictive power that variables such as the presence of Supplemental Social Security Income (SSI) have related to readmissions(9) which are not included, HFMA recommends that CMS include SSI and other similar socioeconomic indicators (e.g., presence of Medicaid as a secondary payer) to improve risk adjustment. If CMS does not believe that it can improve the risk adjustment mechanism without sanction from the NQF, HFMA recommends that CMS delay the implementation of the readmissions reduction program until NQF develops readmissions measures that fully account for socioeconomic drivers. Recent analysis (10) has shown that safety net hospitals are more likely to have higher readmission rates for the conditions included in CMS's readmissions policy. We continue to believe that refining the risk adjustment mechanism is necessary to ensure a level playing field for all providers while protecting safety net hospitals and their communities from the unintended and counter-productive consequences of an incomplete risk-adjustment mechanism. For many of these facilities inpatient Medicare payments are a larger than average component of their revenue. Any reduction in Medicare payment related to an incomplete risk adjustment will have both direct and indirect consequences. As a direct consequence, it will limit providers' ability to invest in programs to reduce unnecessary readmissions, and the socio-economic factors that cause them, further harming Medicare beneficiaries. Indirectly, it will reduce employment and increase the ranks of uninsured in these communities as safety net hospitals will likely respond to additional financial pressure by reducing staffing levels. In the future as more providers adopt EMRs, HFMA also recommends that CMS explore ways to use the embedded data to refine the risk adjustment mechanism and improve the accuracy of readmissions models. Examples of variables for consideration in the future should include housing discontinuities as measured by address changes, census tract, history of drug use, and marital status.(11) Minimum Discharges for Inclusion: The final rule sets 25 discharges for each condition as the minimum number needed to be included in the Hospital Readmissions Reduction Program. CMS chose this number as it is the current minimum required for reporting in the Inpatient Quality Reporting Program (IQR). The rule further states that CMS is "currently conducting additional analyses to further evaluate the appropriate minimum number of discharges needed to yield reliable excess readmission ratios for the three proposed measures." HFMA continues to strongly believe that in the absence of complete certainty around a minimum threshold to "provide sufficiently reliable information on hospital performance," CMS needs to increase the minimum threshold to a sufficient size to guarantee data reliability with a 99 percent confidence level. While unreliable data is an undesired outcome in a reporting program, it is completely unacceptable in a program that could potentially reduce a hospital's inpatient Medicare revenue by up to three percent. The national average hospital operating margin in 2009 was 1.98 percent.(12) Given that Medicare inpatient payments are 18 percent(13) of total hospital payments, any reduction due to unreliable data will irreparably harm hospital finances and threaten hospitals' ability to serve the communities that depend on them. Further, a low (and therefore unreliable) minimum threshold will disadvantage smaller hospitals as not only will they have lower volumes for each condition, but also will tend to have smaller margins and a higher reliance on Medicare revenue to sustain operations. HFMA looks forward to any opportunity to provide assistance or comments to support CMS's effort to create a preventable readmissions reduction program that improves the quality of care for all patients. As an organization, we take pride in our long history of providing balanced, objective financial technical expertise to Congress, CMS, and advisory groups. We are at your service to help CMS gain a balanced perspective on this complex issue. If you have additional questions, you may reach me, or Richard Gundling, Vice President of HFMA's Washington, DC, office, at (202) 296-2920. The Association and I look forward to working with you. Sincerely, Richard L. Clarke, DHA, FHFMA President and Chief Executive Officer Healthcare Financial Management Association Cc: Shaheen Halim
ENDNOTES
About HFMA HFMA is the nation's leading membership organization for more than 37,000 healthcare financial management professionals. Our members are widely diverse, employed by hospitals, integrated delivery systems, managed care organizations, ambulatory and long-term care facilities, physician practices, accounting and consulting firms, and insurance companies. Members' positions include chief executive officer, chief financial officer, controller, patient accounts manager, accountant, and consultant. HFMA is a nonpartisan professional practice organization. As part of its education, information, and professional development services, HFMA develops and promotes ethical, high-quality healthcare finance practices. HFMA works with a broad cross-section of stakeholders to improve the healthcare industry by identifying and bridging gaps in knowledge, best practices, and standards.
Appendix I: Overview of 3M's Potential Preventable Readmissions Methodology
Publication Date: Tuesday, January 31, 2012
Andrew Motz, assistant vice president, supply chain consulting at HealthTrust, discusses the value of a data-driven approach when procuring purchased services.
Jason Williams, vice president for strategy and business analytics, Change Healthcare, discusses the importance of technology and technology-enabled services in reinventing the revenue cycle.
Judson Ivy, president of Ensemble Health Partners, discusses the value of revenue cycle outsourcing and the importance of selecting the right partner.
Bill Slama and Ken Deakyne of Grant Thornton LLP Business Consulting and Technology and Technology Solutions Services discuss the importance of enterprise asset management.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities. Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
As value-based payment models evolve, providers are challenged to maintain superior clinical outcomes while controlling costs.
Read more about factors contributing to the changes in the post-acute marketplace and what it means for manufacturers, physicians, clinicians, patients, and post-acute facilities as they anticipate the transition to the second curve.
HSG helped the physicians and executives of St. Claire Regional in Morehead, Kentucky, define their shared vision for how the group would evolve over the next decade. As well as, develop the strategic and operational priorities which refocused and accelerated the group’s evolution.
The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care. Though the clinics were of substantial size (they employed 98 physicians) and comprised of multiple specialists, the physicians functioned as individuals and the practices lacked any real group culture.
Clinical integration can be expensive, but it doesn’t have to be, as this four-step road map for developing a CIN proves. Does it have to cost millions to initiate a clinical integration strategy? Contrary to popular belief, we have clients who have generated substantial shared savings and a significant ROI over time, without massive investments. Yes, some financial capital is required for resources the CIN providers can’t bring to the table themselves. But the size of that investment can be miniscule relative to the value it produces: improved outcomes and documentation for payers.
Today’s concerns about physician compensation are the result of the changing healthcare environment. The transition to value is slow, but finally becoming a reality. Proactive hospitals want to ensure that provider incentives are properly aligned with ever-increasing value-based demands. This report focuses on the three big questions HSG receives about adding value to physician compensation; Why are organizations redesigning their provider compensation plans? What elements and parameters must be part of successful compensation plans? How are organizations implementing compensation changes?
Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records, evolving local carrier determinations (LCD), and payer credentialing [The emphasis on healthcare fraud, abuse and compliance has increased the importance of accuracy of data reporting and claims filing). The efficiency of a medical practice’s billing operations has critical impact on the financial performance. In many cases, patient billings are the primary revenue source that pays staff salaries, provider compensation and overhead operating cost. Inefficiencies or inaccurate billing will contribute to operating losses.
This publication identifies and outlines the necessary characteristics of a fully-functioning clinically integrated network (CIN). What it doesn’t do is detail how hospitals and providers can participate in the value-based care environment during the development process. One common misconception is that the CIN can’t do anything significant until it has obtained the FTC’s “clinically integrated” stamp of approval. While the network must satisfy the FTC’s definition of clinical integration before single signature contracting for FFS rates and contracts can legally start, hospitals and providers can enjoy three key benefits during the development process.
Nearly half of all Medicare beneficiaries treated in the hospital will need post-acute care services after discharge. For these patients, a stay in an inpatient rehabilitation facility, skilled nursing facility or other post-acute care setting comes between hospital and home.
With the proper process, tools, and feedback mechanisms in place, budgeting can be a valuable exercise for organizations while helping hold organizational leaders accountable. Having a proper monthly variance review process is one of the most critical factors in creating a more efficient and accurate budget. Monthly variance reporting puts parameters around what is to be expected during the upcoming budget entry process.
Managing the cost of patient care is the top strategic priority of most hospital CFOs today. As healthcare shifts to more data-driven decision making, having clear visibility into key volume, cost and profitability measures across clinical service lines is becoming increasingly important for both long-range and tactical planning activities. In turn, the cost accounting function in healthcare provider organizations is becoming an increasingly important and strategic function. This whitepaper includes five strategies for efficient and accurate cost accounting and service line analytics and keys to overcoming the associated challenges.
TRENDSETTER
Learn how Premier Inc. partners with health systems to reimagine workforce management, offering integrated data and advisory services to improve efficiency, reduce costs, and drive performance.
This article discusses how Imprivata is transforming the patient identification process, leveraging next-generation biometric solutions to ensure accuracy and improve efficiency.
Receive expert insights and how-to action to achieve and maintain peak revenue cycle performance.
Stay informed about new directions in healthcare finance. Share tools and strategies for improving performance. Be an active participant in your profession. Together, we’ll reshape the business and practice of healthcare. Join us.
Of all the transformations reshaping American health care, none is more profound than the shift toward value. Access HFMA’s Value Project to discover how healthcare finance leaders are joining this transformation.
HFMA's print, email, online, and mobile opportunities provide you maximum reach and impact. We will work with you to build a plan that meets your needs. Contact a sales rep.