July 2018Cover Story

Empowering Physicians to Become Stewards 
Texas hospitals are providing physicians with a tool that gives them greater insight into the costs and risks associated with the care they provide, enabling them to lead the way to achieving the goals of value-based care.
By Stephen Sibbitt, MD, and Lawrence Martinelli, MD, FACP, FIDSA


Video

Denials and the Revenue Cycle 
David Dyke, former vice president of product management for Change Healthcare, discusses how to reduce denials that disrupt the revenue cycle and how to keep up with changing rules around claims.


Early Edition

How to Grow High-Value Service Lines Effectively  
Growing top-performing service lines can be an effective strategy for healthcare organizations to advance their business objectives.
By Gary Druckenmiller, Jr.

Physician Distribution, Mobility, Fair Market Value and Compensation Surveys  
An analysis of regional differences in physician compensation coupled with the general tendency against long-distance relocation shows there is no truly national market for established physicians. Rather, local market conditions must be considered in setting fair market value.
By Mark O. Dietrich, CPA/ABV

Healthcare Matters
Who’s Afraid of a Little Risk?
The Medicare ACO modeled advanced by CMS has encountered some challenges, but it still holds promise if CMS addresses the flawed idea of retrospective attribution of patients to an ACO. 
By Jeff Helton, PhD, FHFMA, CMA, CFE


Features

Optimizing Physician Referrals: A Key to Successful Population Health Management 
Providers should focus on improving quality, reducing costs, and delivering a positive patient experience to stage a high-functioning physician referral network.
By Clive Fields, MD

The Shift to Outpatient TKA—What’s the Big Deal? 
Hospitals should prepare for the impending revenue impact of a shift of total knee arthroplasty (TKA) procedures from inpatient to outpatient settings by developing strategies to retain market share for TKA.
By Michael Rovinsky, MBA, Sean Looby, MHA, and Laura Zacchigna

Optimizing Care Delivery Through Perioperative Value-Based Care 
A focus on value during perioperative care can result in better financial and clinical performance.
By Zeev Kain, MD, MBA, FAAP, and Dawn Bowden, PhD, GBA

3 Keys to Defending a Healthcare Organization’s Margins
As the healthcare industry transitions from volume-based to value-based payment, healthcare organizations must establish priorities and prepare to assume risk in select areas of focus. To do this, providers must develop an understanding of the precise costs for individual encounters, procedures, and episodes of care, and hone in on specific cost drivers. 
By Rita E. Numerof, PhD


Focus Area

Revenue Cycle
Reinventing Medical Payments: The Urgency for Digital Transformation to Prioritize Patients 
The rising cost of health care has made the need for convenience in patient payments necessary for both patients and providers. 
By Chris Wenner


Columns

On Point
Challenges and Opportunities, Part II: Responding to Health Care’s Evolving Landscape
With hospitals on the move to enter new payment arrangements and participate in programs disciplining hospital readmissions, they should consider two new approaches to healthcare.  
By Lia Winfield, PhD, and Jenna Jackson

From the Chair  
Fostering Innovation in Healthcare Finance 
HFMA’s 2018-19 Chair, Kevin Brennan, explains that fostering innovation while also maintaining day to day operations is a challenge, but that when innovation starts at the top it can grow a culture where change is not feared, there are no “bad ideas,” and innovation can occur in a variety of forms. 
By Kevin Brennan, CPA

Eye on Washington            
Yet One More Legal Attack by Republicans on the ACA 
Arguing that the removal of the insurance mandate means Affordable Care Act is no longer a tax, the DOJ has now challenged its constitutionality in court. The author also discusses some of the likely outcomes, depending on the court’s decision.        
By Gail R. Wilensky, PhD

Healthcare Innovation 
The Critical Role of Health Systems in the Nation's Response to the Opioid Crisis
Although state and federal programs dedicated to the opioid crisis are helpful, communities—specifically hospitals and health systems—must be dedicated to making improvements. 
By Ken Perez

From the President 
Rededicating Ourselves to Building a Better Future 
HFMA President and CEO Joe Fifer suggests solutions to healthcare finance leaders such as helping shape change, rather than passively observing it, or finding other ways to transition in the industry to avoid change fatigue. 
By Joseph J. Fifer, FHFMA, CPA 


Departments

Data Trends 
Acute Care and Critical Access Hospital Occupancy Rate Variability by Location 
An analysis of Medicare cost reports from 2016 shows that urban U.S. hospitals typically had higher occupancy rates than their rural counterparts, with notable exceptions in the Northeast and Arizona.
By William Shoemaker 


Advertising

Business Profile    
Cedar: Reimagining the Patient Financial Experience     
Cedar’s CEO and co-founder tackles the topic of patient payment and the importance of having an innovative patient financial management system. 

Publication Date: Sunday, July 01, 2018