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On February 10-12, Physicians, Payers, and Providers will discover strategies for implementing value-based payment arrangements with both private and public sector payers.
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Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
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In my years as a healthcare finance executive in the state of California, I had the opportunity to participate in several groundbreaking pay-for-performance initiatives. One reason this experience was so positive is that the California payers had collectively determined what they wanted to measure, which meant that the quality measures providers needed to track were consistent regardless of payer.
Measuring quality is rarely so straightforward today, particularly because most payers do not collaborate when establishing metrics. Health systems have to report on Medicare quality measures that determine important incentives and penalties. They also have to juggle the requirements of the host of private payers that have established their own value-based programs, all of which require different metrics.
Being paid for value is an exciting development, and the opportunities to benefit from value-based purchasing contracts are greater than ever before. But it can also seem complex and intimidating. It doesn't have to be—and it won’t be if organizations prepare systematically.
The process of preparing for value-based purchasing should begin with a critical first step: Assess your current performance. There are three additional steps that are also critical: Organizations should implement education programs, develop a healthcare analytics strategy, and identify areas for clinical quality and cost improvement. But as the all-important first step, assessing current performance warrants special attention.
Simply put, the first element of a successful value-based purchasing strategy is to understand where you stand now. This effort has three facets.
Ask important questions about performance. Key questions to ask about both past and current performance include the following:
The key to answering these questions accurately is data. It is difficult to measure performance if you don’t have an analytics strategy in place for doing so. Every organization does have an analytics strategy—even if that strategy doesn’t yet involve a sophisticated analytics infrastructure. The strategy may simply involve spreadsheets and nurses performing chart abstractions to pull relevant clinical data. Of course, such a system is not scalable in an environment where multiple payers are requiring more sophisticated quality reporting. Nonetheless, organizations should work with what they have to get the information they need—even as they work to develop strategies on how to streamline their analytics efforts.
Understand the quality measures that affect you most. Determining which processes present the greatest opportunities for clinical and financial improvement is an important early step in any value-based purchasing initiative. If you already have a sophisticated analytics infrastructure in place that combines clinical and financial data, you can identify areas of greatest cost and quality variation using the data.
Even if your analytics system is less developed, you’re likely aware of areas where you’ve failed to meet performance benchmarks used by the Centers for Medicare & Medicaid Services (CMS) and other payers. But you also need to look to the future to the measures is planning to implement soon. For example, in 2015, CMS will begin assessing a Medicare performance payment penalty for hospital-acquired conditions (HACs). Some of these HACs—such as central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs)—are already included under CMS’s Hospital Inpatient Quality Reporting (IQR) requirements and value-based purchasing. Failure to focus on such measures therefore equates to twice the penalty.
Obviously, very few, if any, hospitals have the resources in place to address every measure perfectly. Hiring 100 nurses to reach 100 percent compliance might be desirable, but that probably isn’t fiscally feasible. Instead, a cost-benefit analysis would be in order. Organizations also can benefit from modeling the potential drop or increase in revenue by year and by payer for the various value-based programs to identify which programs and measures should receive the greatest attention. Then, as the organization becomes more sophisticated with value-based purchasing, it can take on more and more measures successfully.
Collaborate with clinicians to understand measures. Understanding each of the clinical measures isn’t always intuitive for a finance executive. I constantly turned to the quality department to find out what each measure really meant and what our past trend had been. I would also talk to clinical experts. They not only can explain unfamiliar clinical terms, but also can share their opinion of where the best opportunities to improve might lie. They also can pinpoint specific measures or aspects of measures that would be difficult to work on—and explain why.
Here is a simple, real-world example of the utility of this kind of conversation. As a finance executive, I might not understand the implications of the following CMS measure for perioperative care: “prophylactic antibiotic received one hour prior to surgical incision.” So I would ask the clinician questions such as the following:
Clearly, a lot of insight can be gained from clinician resources—and it doesn’t require technical skills or an analytics infrastructure. These conversations also present the opportunity to ask clinical teams if they need support from a financial analyst. Assigning a financial analyst to help clinical teams assess how their clinical performance translates to financial outcomes in the value-based purchasing environment is an effective collaborative strategy.
Bobbi Brown is vice president of financial engagement for Health Catalyst, LLC, Salt Lake City.
Publication Date: Wednesday, April 30, 2014
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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.
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
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.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
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.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
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.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
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.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
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.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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.
Copyright 2016, Healthcare Financial Management Association.
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