Medicare’s Value-Based Purchasing (VBP) program steps on the accelerator, beginning Oct. 1, 2014, when it adds an efficiency score—a hospital’s spending per Medicare patient—to the formula that determines hospital pay. This marks the first time that the Centers for Medicare & Medicaid Services (CMS) has included a straight financial measure in its VBP calculation. It is also the first instance in which hospitals are directly accountable for non-acute care costs accrued by non-affiliated physicians and post-acute providers.
“We have come to a point where the folks who pay for health care are no longer looking at the hospital silo or the physician silo,” says Chad Mulvany, HFMA technical director. “They are looking at the total bottom-line dollar number.”
The new efficiency score may be inducing heartburn in many healthcare leaders, but not for Susan Dragoo, director of quality and innovation at INTEGRIS Health. “In a way, this is a measure of how well we are coordinating care, which is something that we are working very hard to improve,” she says.
Melinda Hancock, CFO at Bon Secours Virginia Health System, shares Dragoo’s enthusiasm because the efficiency score reinforces her health system’s focus on cost reduction. “We were accepted into the Medicare Shared Savings Program as of January 1, so the timing couldn’t be better,” she says. “We are trying to reduce our spend so this is beautifully aligned.”
The efficiency score introduces a new acronym—MSPB—for Medicare spending per beneficiary. The measure covers a hospital’s spending-per-Medicare-patient for eligible patient care episodes, starting three days before an inpatient hospital admission and ending 30 days after discharge.
Each hospital’s baseline MSPB, which reflects its performance for the period from May 1, 2011 to Dec. 31, 2011, is currently posted on Medicare’s Hospital Compare website. The score is determined by dividing the hospital’s MSBP by the median amount per Medicare beneficiary that CMS spends nationally.
The efficiency score will be worth 20 percent of a hospital’s VBP score for the federal FY15, which begins Oct. 1, 2014 (see the exhibit below).
A hospital’s federal FY15 efficiency score will be determined by one of two calculations: Its MSPB score for the performance period of May 1, 2013, to Dec. 31, 2013, or its improvement since the baseline time period in 2011.
Hospital MSPB scores are not always predictable, say Dragoo and Hancock. For example, INTEGRIS Baptist Medical Center, a tertiary care center, had an admirable 0.99 efficiency score for the 2011 performance period, despite treating the highest acuity patients in the INTEGRIS system. “By the same token, one of our hospitals that I know to be fairly efficient was also at either 0.99 or 1.0,” Dragoo says. “I would have expected them to have a better score, so we just have to dig into those numbers and understand what’s driving that, which is a new conversation.”
“You can either improve substantially over your baseline, or you can look really good compared to every other hospital in the country—and those are the only two ways you score points in value-based purchasing,” Hancock says. “So we needed to first identify which Bon Secours hospitals were already looking good in their baselines and which ones weren’t to determine where we had work to do.”
Pinpointing cost containment opportunities. That was the starting point for the Bon Secours Health System, based in Marriottsville, Md. The system includes 14 acute-care hospitals along with nursing care and other facilities. “When we first saw the efficiency component show up on the Hospital Compare website, we quickly pulled all of our hospital scores and presented them to our CMOs, CNEs, CFOs, and CEOs from across the system,” says Hancock, the finance lead for Bon Secours’ systemwide clinical transformation efforts.
While that single number—say 1.01 for a hospital that is about average—seems simple, it is backed by a lot of data points. The MSPB reports available on CMS’s QualityNet.org reveal each hospital’s spending for three phases of each episode—the three days before admission, the inpatient stay, and the 30-day period after discharge—and it compares those spending levels to state and national averages.
In addition, the report breaks down spending in each phase by claim type—outpatient, skilled nursing, durable medical equipment, and others—to allow for comparison with state and national averages.
The report also identifies a hospital’s average spending per episode by major diagnostic category and compares that amount to state and national averages (see the exhibit below). Thus, leaders can see, for example, if a hospital has relatively high costs for nervous system issues or low costs for mental disorders.
Those details make it easier to see where a hospital needs to reduce costs, INTEGRIS’ Dragoo says. “Because it breaks spending down into the three phases, and it also breaks spending down by major diagnostic category, I definitely think that it gives you a place to start,” she says. “You can see how CMS derived the numbers. So if people take the time to review these reports, then the reports will be helpful.”
Pairing up finance and clinicians. At Bon Secours, Hancock tasked a team of finance leaders to analyze the hospital-specific MSPB reports for their respective markets to identify the best opportunities for improvement. Rather than trying to address all of the major diagnostic categories simultaneously, each hospital will focus on two categories to start with.
The finance leaders are meeting with CMOs and chief nurse executives at each hospital to ask why, for example, the nervous system diagnostic category is higher than the national average and what might be done to lower the cost for patients in that category.
“As you can imagine, the answer is different at every single hospital, for every single major diagnostic category. There is not a one-size-fits-all answer,” Hancock says. “This is really forcing that conversation between the clinical and financial leaders saying, ‘Here’s the data—what do we do about it?’”
When Hancock distributed the reports to hospital leaders, they were surprised to see that they were accountable for costs beyond the inpatient stay. What could they do about the costs of care provided by physicians or nursing homes that have no ties to the Bon Secours system?
“And I said: ‘That’s what Medicare is asking: What can you do about it?’” Hancock says. “Is it not in your best interest to discharge that patient in a manner that optimizes the care and reduces the spend?”
Swedish Health Services, in Seattle, has not yet focused much attention on the MSPB scores at the health system’s five hospitals. “But we have already begun our efficiency process improvement work, which will then roll up into CMS’s efficiency score,” says Mary Gregg, MD, vice president of quality and patient safety.
Bringing together teams. Indeed, the health system’s flagship hospital, Swedish Medical Center/First Hill, had a baseline MSPB of 0.93, showing it to be considerably less costly than the national average. In addition, for three consecutive years, Swedish/First Hill has been recognized as a Leapfrog Group top hospital because of its success in preventing medical errors, reducing mortality for high-risk procedures, and reducing hospital readmissions.
Cardiac patients are generally treated at a smaller facility in the health system—Swedish Medical Center/Cherry Hill—which has a 0.99 efficiency score. Its cardiac-related core measure scores are all extremely high, and it has one of the lowest door-to-balloon times in the country. Swedish/Cherry Hill’s baseline door-to-balloon time was 127 minutes; today it is about 50 minutes.
“The only way we have done that is by having an entire multidisciplinary team come to the table and identify how to get patients from the door to the intervention quickly,” says Gregg, a heart surgeon. The lessons learned at the Cherry Hill campus were shared with the two other Swedish facilities that treat heart patients, so that all three use the same care processes.
Leading with quality. Although many quality improvements translate into reduced costs, Swedish emphasizes patient safety and quality as institutional values in their own right. “When an institution says, ‘We’re all about finance,’ I think it is really hard to get clinicians and other staff to buy into the mission,” says Todd Strumwasser, MD, the system’s chief operations officer. “It’s important to constantly lead with quality and safety because that resonates with staff and with the medical staff. You are going to get a lot more traction on every initiative that way.”
Meanwhile, Swedish/First Hill pioneered the health system’s work to improve sepsis care, reducing its mortality rate from severe sepsis and septic shock to 18 percent, compared to a national rate of at least 50 percent. Its processes were then shared with other Swedish campuses.
More recently, Swedish/Cherry Hill implemented nurse-initiated telephone calls to newly discharged heart failure patients in an attempt to reduce readmissions. The national 30-day readmission rate for Medicare heart failure patients is 24.7 percent, just slightly higher than the hospital’s starting point.
“We took our 30-day readmission rate from about 23 percent down to 16 percent just by making these phone calls at 48 hours, talking to these patients about the importance of taking their medications, and guaranteeing that they would have some kind of follow up with a practitioner within a week of discharge,” Gregg says.
The transition-of-care process that connects acute care with outpatient providers is currently being tested in pilots at Swedish’s other campuses. “We are pretty confident that this will work in a group of real complicated patients who need more chronic management, but we now have to figure out how this could work with other populations,” Gregg says.
At INTEGRIS, a 15-hospital system in Oklahoma, Dragoo thinks the MSPB will support the health system’s use of value stream management, a continuous process improvement strategy that covers the continuum of care for a specific patient population.
“That approach is very consistent with the need to have more integration of care and better coordination of care, and the new CMS efficiency measure can help us understand our performance in that regard,” she says.
Value stream management for stroke care starts with building awareness in the community about the signs and symptoms of stroke and the importance of getting stroke patients treated as quickly as possible. “Then, of course, it goes through the physician’s office, the emergency department, the inpatient stay, rehab, and post-hospital care—looking at the entire episode of care and ways to create the ideal value for the patient,” she says.
The stroke performance improvement team at a given hospital gathers around the “mother” value stream map on a regular basis to review performance on key metrics, including core measures related to stroke care, mortality, and cost. In addition, each patient care area that has some responsibility for stroke patients has a “data wall” that shows progress on quality measures.
The team regularly “walks the value stream” to review stroke care performance in the emergency department, rehabilitation, and other areas, always looking for opportunities to further reduce waste. When opportunities are found, rapid improvement events are executed, and measurement begins again.
INTEGRIS’ use of value stream management for stroke care has reduced the cost by $300 per inpatient admission. When healthcare costs are going up, and we are bringing that number down, I think that’s pretty exciting,” Dragoo says.
Like all measures in the government’s VBP initiative, CMS’s way of measuring efficiency is likely to evolve over time. The American Hospital Association (AHA) recently offered comments on a proposed efficiency measure specifically for a heart attack episode of care. Nancy Foster, AHA’s vice president for quality and patient safety policy, says many hospital executives would prefer to have cost accountability for particular diseases or conditions, rather than an entire diagnostic group or all Medicare patients.
“Hospitals oftentimes manage or change processes by first understanding where they stand relative to others in caring for, say, hip replacement patients or back surgery patients or some other condition-specific population,” she says. “So we look forward to working with CMS as they build out a cadre of measures that look at efficiency in many different ways.”
Meanwhile, Chad Mulvany, HFMA technical director, believes CMS’s approach to measuring efficiency will be flawed until all caregivers across the continuum share accountability. “Until you align the incentives for physicians and also for post-acute care providers to focus on the cost efficiency of care delivery, then I don’t think it’s an appropriate measure,” he says.
That said, the MSBP measure may help focus the attention of physicians who will soon have their own motivation to be cost conscious. The Physician Value-Based Modifier, which includes an efficiency score, will go into effect for large physician groups in 2015 and expand to all physicians two years later. “I think the hospital efficiency score is a real opportunity for hospitals to work with the physicians in the community,” Mulvany says. “I certainly would try to use that as a springboard to start the conversation.”
Of course, hospital costs account for the largest portion of the MSPB score. So the best place to start improvement efforts is at home.
“I’m a broken record on this subject, but if a hospital has not begun to use Lean, then they need to do that to understand how to eliminate waste and create ideal patient care,” INTEGRIS’ Dragoo says. “You cannot just focus on cost cutting from an old-school perspective. You must really understand what’s driving costs and how better care can result in lower costs.”
Lola Butcher is a freelance writer and editor based in Missouri. Interviewed for this article (in order of appearance): Chad Mulvany is technical director, HFMA. Susan Dragoo is director of quality and innovation, INTEGRIS Health, Oklahoma City, Okla. Melinda Hancock is CFO, Bon Secours Virginia Health System, Richmond, Va., and a member of HFMA’s Virginia, Washington D.C. Chapter. Mary Gregg, MD, MHA, is vice president of quality and patient safety, Swedish Health Services, Seattle. Todd Strumwasser, MD, is senior vice president and COO, Swedish Seattle campuses, Seattle. Nancy Foster is vice president, quality and patient safety policy, American Hospital Association, Chicago.
AvaSure: Using Video Monitoring to Improve Patient Safety and Achieve Cost Efficiencies
Professional Credit: ‘The New Deal’ Approach to Healthcare Collections is Data-Driven and Consumer-Focused
Medxcel Facilities Management: Working Smarter to Make Organizations Safer
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
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.
Does Your Budgeting Process Lack Accountability?
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.
Cost Accounting: the Key to Cost Management and Profitability
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.