Providers are trying a number of tactics to boost productivity:
At Appleton Medical Center in Wisconsin, nurses no longer waste time retrieving supplies because most items are stocked within easy reach of patient rooms. In New York, Mount Sinai Medical Center has connected a wireless communication system to ventilator and cardiac-monitoring alarms-and increased caregiver response times. And in Ohio, The Arthur G. James Cancer Hospital is increasing cancer volumes by pairing nurse practitioners with oncologists.
These types of output-boosting strategies are essential to solving one of the healthcare industry's fundamental problems: lagging labor productivity.
Compared to other segments of the workforce, health care might appear to be underperforming. Labor productivity in the healthcare sector decreased by 0.6 percent a year during the past two decades, according to a recent NEJM article (Kocher, R. and Sahni, N., "Rethinking Health Care Labor," NEJM, Oct. 13, 2011, vol. 365, no. 15, pp. 1370-1372).
Those in the healthcare trenches can quickly point to a key reason for declining productivity: complexity. At the same time that medical care has grown more specialized and intricate, the business of health care has gotten more complicated. Providers are having to comply with an ever-growing number of regulations while restructuring to succeed under health reform and adopting complex technologies.
Nurses, physicians, and other staff complain that they spend too much time documenting, preparing equipment, searching for needed items, and carrying out other nonclinical tasks-and not enough time engaged in direct patient care. Research is on their side: Patients do better clinically when nurses spend more hours at the bedside.
All of this serves as a reminder that increasing productivity is not only about accomplishing more, but also about ensuring that staff are engaged in work that best matches their skills and experience.
Experts tend to define labor productivity in terms of output per worker, or the volume of all encounters, treatments, tests, or surgeries per unit of cost. The Arthur G. James Cancer Hospital & Richard J. Solove Research Institute in Columbus, Ohio, is improving productivity by using nearly 200 nurse practitioners to help oncologists manage patients and boost volumes. "Here at the James, we are growing by leaps and bounds," says Tracy Ruegg, MS, CNP, AOCN, a thoracic medical oncology nurse practitioner at the hospital, a part of The Ohio State University Comprehensive Cancer Center.
And that growth will continue. Nationally, the demand for oncology care is expected to increase by 48 percent by 2020, while the number of practicing oncologists will rise by only 14 percent, according to the American Society of Clinical Oncology (ASCO).
An ASCO study underscores the role of nonphysician providers (NPP)-a term that includes nurse practitioners and physician assistants-in meeting that growing demand for oncology services (The ASCO Study of Collaborative Practice Arrangements funded by Susan G. Komen for the Cure®, June 2011). "The integration of nonphysician practitioners into oncology practices offers a reliable means to address increased demand for oncology services without adding physicians."
This approach is working so far at the James. Productivity increased by 30 percent in the first year after the hospital began hiring mid-level providers, says Ruegg. The ASCO study, which analyzed 33 oncology practices, found that physicians and NPPs working together is correlated with improvements on two productivity measures: total patient encounters and work relative value units (RVUs), which is the measure of value that Medicare uses to determine reimbursement for physician services.
The ASCO study also identifies three practice models that lead to successful physician/NPP collaboration (see the exhibit below). Incident-to-practice model. In an incident-to-practice model, the NPP routinely sees patients independent of the physician, but the physician is available in the office suite. For example, on Mondays, Ruegg uses this practice model-which she calls a tandem clinic-with one of the lung cancer specialists at The Arthur G. James Cancer Hospital.
Each of them schedule up to 40 patients for the day. The oncologist sees patients who discuss their most recent images with the physician, while Ruegg sees patients who need to be cleared for chemotherapy treatments and handles other matters that do not require a physician. "I'm seeing patients independently, but the doctor is right there if a patient needs a treatment change, for example," she says. "The good thing about a tandem clinic is you can increase your volume, and you get more new patients into the system."
This practice model can essentially double the productivity of an oncologist, as measured by total patient encounters, she says.Shared practice model. In this model, the NPP always sees patients in conjunction with a physician. Ruegg uses this model-she calls it a collaborative clinic-on Thursdays. She examines about 25 patients, reviews images, and documents the visit for the oncologist, but the oncologist also sees each patient for a few minutes.
"The amount of time the oncologist spends with the patients is a lot less than it would normally be because I've done everything, including the physical exam," she says. "He just needs to do what is required for billing purposes."
A traditional clinic with no NPP typically serves about 20 patients per day, making the collaborative clinic slightly more productive. Because the oncologist spends much less time with each patient, he or she is free to handle administrative or research duties in addition to a full patient load, says Ruegg.Independent practice model. Sometimes NPPs see patients completely independent of a physician. For example, on Fridays, Ruegg sees cancer survivors who are no longer in active treatment, and the patients do not see an oncologist during these visits. Ruegg monitors lingering side effects of their treatment, conducts cancer screenings, and adjusts medications as needed. Having the capacity to serve cancer survivors is critical because this is one of the fastest growing segments of oncology care.
A nurse practitioner for 16 years, Ruegg says simply hiring nurse practitioners and physician assistants does not automatically increase physician productivity. The staffing model and the working relationship between the physicians and NPPs also influence the amount of work accomplished.
The ASCO study found that practices in which an NPP works with all physicians in the group showed significantly higher productivity than those in which a nurse practitioner or PA worked exclusively with one physician. In fact, the average work RVUs for the "NPP working with all physicians" model was about 25 percent higher and the average number of patient encounters in that model was almost 20 percent higher than for practices in which an NPP was paired with a single physician.
Ruegg encourages hospital administrators to educate physicians about the proper role of NPPs. "Approach it with, 'This is how we can increase your productivity. This is how we can increase patient access to care while generating revenue,'" she says. "And set the expectation that you will come back after a year and see if the doctor is using the nurse practitioner effectively with these goals in mind."
ThedaCare in Wisconsin is launching a new team-based care model in all medical/surgical units in Appleton Medical Center and Theda Clark Medical Center this year after a pilot project found that it improved nursing productivity by 11 percent-while lowering costs, improving quality, and increasing patient satisfaction scores (Bielaszka-DuVernay, C., "Redesigning Acute Care Processes in Wisconsin," Health Affairs, March 2011, vol. 30, no. 3, pp. 422-425).
In the new model-called Collaborative Care-a team that includes a physician, a nurse, and a pharmacist visits each patient within 90 minutes of admission. Together, they review the patient's medical history and health status, develop a care plan with input from the patient, and begin developing a relationship with the patient and family members.
From there, nurses are responsible for moving a patient's care forward, ensuring diagnostic and therapeutic processes occur on time. If a process breaks down-for example, lab results are not reported at the proper time-the patient's nurse is responsible for solving the problem, identifying the root cause, and communicating to all parties what happened so the problem will not happen again.
In the first two hospital units that adopted the new care model, the average length of stay dropped by at least 10 percent and the 30-day readmission rate fell to below 9 percent. The amount of time spent on documentation has been cut in half, allowing nurses to spend more time with patients. Not surprisingly, perhaps, 95 percent of patients on Collaborative Care units rated their satisfaction level as "excellent" in 2010, up from 68 percent before the model was introduced in 2007. Reengineering paradigms. "This isn't just about new process flows," says Jamie Dunham, MS, RN, director of clinical care transformation. "It's a culture change, it involves paradigm shifts, and it involves professionals working together in the same environment in different roles. For example, it requires physicians and pharmacists and nurses and discharge planners to work together differently."
ThedaCare used the lean improvement methodology to guide its overhaul of inpatient care processes. One of the early steps in that methodology-value-stream mapping, which identifies every step in a process and evaluates the value that it delivers-revealed many areas that needed improvement:
The pilot project team tested 24 rapid-improvement events to address problematic issues and redefine care processes and clinicians' roles-creating the new Collaborative Care model.
After health system leaders realized the benefits of Collaborative Care, they remodeled all the medical/surgical units in one hospital and built a new inpatient unit in the other, designing the space to accommodate the new care model, says Dunham. For example, the units do not have traditional nursing stations; rather, "consultation alcoves" are scattered throughout each unit to allow the physician-nurse-pharmacist teams to convene near a patient's room to discuss the patient's care.Copying the model. What works for ThedaCare may not work for other health systems in the exact same way, says Dunham. Any hospital that wants to adopt the Collaborative Care model must go through the same steps-starting with a value-stream mapping of current processes-that ThedaCare has already traveled.
"My advice is that this has to be your individual journey, and you have to start where you are at," she says. "You can take the concepts, but you can't cookie- cutter the exact process flows we adopted because it won't work."
In New York, Mount Sinai Medical Center has increased the efficiency of its nursing staff by layering technologies on top of one another. The first step was acquiring staffing and scheduling management software that allows nurse managers to manage their budgets on a real-time basis.
The technology allows nursing managers to track staffing resources, patient census, and patient acuity whether they are at the hospital or at home. At any point in time, they can see how their actual use of nursing resources compares to their monthly budgets. Because they can share information about under- and overstaffing, they can allocate resources within the department to match patient demand and budget needs. The result: Nursing units reduced overtime, curtail the use of agency nurses, and achieve their targeted nursing hours per patient day.
"That was the foundation because first you have to get control of your budget," says Carol Porter, DNP, RN, Mount Sinai's CNO and senior vice president.
Shortly thereafter, the medical center gave each nurse a hands-free communication device-which attaches to a lanyard or can be pinned to clothing-that allows wireless voice communication. Nurse managers working anywhere in the hospital now convene electronically in "e-huddles" at certain times during the day to adjust staffing as needed. They refer to the staff management software to identify the competencies of the nurses on duty so they can shift resources if necessary.
"Say it's 10 o'clock…what does the ED look like? How many post-op patients are you getting? What's the staffing like on your unit?" says Porter. "The nurse managers can assess the utilization of resources, the flow of patients, and whether anybody has a problem they can help with."
Next, Mount Sinai connected the wireless communication system to ventilator and cardiac-monitoring alarms in a way that increases response times and, thus, improves patient care. When a nurse signs in to the electronic nursing assignment system at the beginning of a shift, the software identifies which of the nurse's patients are using ventilators or cardiac monitors. Those monitors are automatically connected to the nurse's wireless device so, if the alarm goes off, the nurse is notified immediately. If a nurse does not respond within a designated time frame, other members of the nursing team are notified via their wireless devices.
The wireless devices are also connected to patients' call buttons so patients can talk to their nurses, regardless of where they are on the unit. If a patient wants pain medicine, the nurse can check the physician orders on the electronic medical record before going to the patient's room. If the patient requests water, the nurse can call an aide-also equipped with a wireless device-to fulfill the request.
"We are talking about a whole level of communication that we've never had before, and it's instantaneous," says Porter. "Nurses are more efficient because they have information right when they need it. That saves steps and improves patient safety."
All three healthcare organizations in this article are ensuring the best staff for a particular task are in the right place at the right time. For example, at ThedaCare, this translates into having a trio of healthcare experts-physician, pharmacist, and nurse-conduct a joint patient assessment. At Mount Sinai, it means equipping nurses with technology that allows them to conduct e-huddles on demand to work out staffing issues.
Executing these redesign changes is anything but easy. As ThedaCare's Jamie Dunham says: "It's a culture change, it involves paradigm shifts..." But their hard work is paying off in improved productivity.
Interviewed for this article (in order of appearance):
Tracy Ruegg, MS, CNP, AOCN, is a thoracic medical oncology nurse practitioner, The Arthur G. James Cancer Hospital, Columbus, Ohio (firstname.lastname@example.org).
Jamie Dunham, MS, RN, is director of Clinical Care Transformation, ThedaCare, Appleton, Wis. (Jamie.email@example.com).
Carol Porter, is CNO and senior vice president, Mount Sinai Medical Center, New York City (firstname.lastname@example.org).
The Claro Group: Partnering for Performance Improvement
In this Business Profile, Larry Volkmar, a managing director in the performance improvement
practice at The Claro Group, discusses key strategies for improving
clinical and financial performance.
Deloitte: Taking Data Analytics to the Next Level
In this Business Profile, Christine Santos, chief of strategic business analytics for
Providence Health Services and Chris DeBeer, principal at Deloitte
Consulting LLP explain the value of enterprise data analytics.
PatientMatters: A Patient-Centered Financial Experience
In this Business Profile, Sheila Schweitzer, founder and CEO of PatientMatters, offers insights
on ways hospitals and healthcare systems can address rising patient
Cerner RevWorks: Helping Providers Boost their Bottom Line
In this business profile, Jason Rawlings, vice president ambulatory
and revenue cycle for Cerner talks about leveraging third-party
management services to improve revenue cycle health.
The Claro Group: Transforming Clinical Documentation Improvement
In this business profile, Tim Marshall, managing director at The
Claro Group, discusses the value of rethinking and retooling clinical
Ontario Systems: Maximizing Self Pay Collections
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
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.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
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.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
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.
The Future of Online Patient Billing Portals
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.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
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.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
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.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
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.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
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.
Revenue Cycle Payment Clarity
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.
Streamlining the Patient Billing Process
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.
Wallace Thomson Hospital Automates to Maximize Limited Resources
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.
7 Steps for Building and Funding Sustainability Projects
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.
Key Capital Considerations for Mergers and Acquisitions
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.
Key Capital Considerations for Mergers and Acquisitions
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.
Trend Watch: Providers adapt as value-based care moves from hype to reality
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 case study
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.
Reforming with a New 50-Bed Acute Care Facility
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.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
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.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
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.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
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.
Providers Focus Too Much On Revenue Cycle Management
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.
Lucille Packard Children’s Hospital Stanford Case Study
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.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
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.
ZOLL and Emergency Mobile Health Care Case Study
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.
Maximizing Medicare Reimbursements White Paper
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.
Denials Deconstructed: Getting Your Claims Paid
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.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Building a Clinically-Integrated Network
As value-based payment models evolve, providers are challenged to maintain superior clinical outcomes while controlling costs.
Winning in the Post-Acute Marketplace
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.
Building A Common Vision with Employed Physicians
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.
Practice Performance Improvement
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 Without Spending a Fortune
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.
Adding Value to Physician Compensation
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?
Effective Revenue Cycle Management in Your Network
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.
Succeeding in Value-Based Care
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.
Therapy: Benefits at All Levels of Care
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.