Get the E-newsletter
providers recognize that reporting on quality and efficiency offers an
opportunity to demonstrate their value in a competitive environment and unify
their organizational leadership around common strategies.
highest level, metrics are a language that can unite both the clinical and
financial leaders within an organization,” says Mary Beth Briscoe, FHFMA, CPA,
MBA, FACHE, the CFO of UAB Hospital and UAB Medicine’s clinical
operations, Birmingham, Ala. “With clinical metrics increasingly impacting our
financial performance, clinical leaders and administration have an opportunity
to align their goals through education and collaboration.”
Yet at the
same time, providers are suffering from data-reporting overload. “Financial and
clinical leaders are overwhelmed by the number of metrics,” Briscoe says.
Clinicians are especially frustrated, says Emily Boohaker, MD, UAB’s
associate chief medical officer for quality and patient safety. “Providers across the country have
so many metrics but not enough resources to realistically meet many of these
metrics in our daily practice, whether it is in the inpatient setting or
outpatient setting,” Boohaker says.
metrics overload causes confusion at the front line. Medical groups may track
dozens of metrics at once, and subtle variations can bump that number into the
hundreds. “The same metric might be in two different contracts, but even then
they might have slightly different definitions and different targets, so you
are still running slightly separate strategies even on the same metric,” says
Andrew Snyder, MD, FAAP, executive vice president and chief clinical
integration officer, Mount Sinai Health System, and president, Mount Sinai
Health Partners (MSHP), New York City. Each variation of a metric definition requires
separate coding and reporting, Snyder says, increasing the resources and time
needed for providers to receive credit for their efforts.
the system’s clinically integrated network, participates in everything from
upside-only to full-risk arrangements and tracks 94 ambulatory metrics on its performance
scorecard. No single metric
is common in more than two-thirds of its 15 to 20 contracts. Some payers ask
for a few metrics, while others require more than 25 to be reported. This
multiplicity has a huge effect, Snyder says.
Sinai’s experience is not unique. In a 2013 study,
Bailit Health Purchasing, LLC reviewed 48 state and regional measure sets and found
that only 20 percent of 509 measures appeared in more than one set.1
Of the common measures, approximately a quarter were slightly modified in some
way from one set to another.
report also found that states and regions tend to use non-standardized
measures. In addition to frustrating providers, this lack of alignment inhibits
direct comparisons across patients, institutions, and geographies in the era of
Micklos, executive director of the Health Care Transformation Task Force, Washington,
D.C., says the group’s provider members have been drawn to the idea of a more
cohesive set that might be based on government measures, in part because the
Centers for Medicare & Medicaid Services (CMS) has already established
value-based metrics through the Medicare Shared Savings Program (MSSP) and the
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
the other hand, there is less homogeneity on the payer side. “Sometimes payers
just think differently both on value and quality measurement,” Micklos says.
“Or they may capture the metrics slightly differently, which calls into
question whether you can compare them from one plan to another.”
to whether commercial contracts could simply follow the lead of CMS’s value-based
initiatives, Micklos does not think that is realistic. “Providers should not
expect a cookie-cutter approach between commercial plans and the
Medicare/Medicaid programs because metrics are driven by the specific needs and
demographics of a particular community,” he says.
commercial health plans developed sets of measures that were important to their
member populations, which led to the lack of uniformity. “Neither the
government nor the commercial side exist in a historical vacuum,” says H. Scott
Sarran, MD, chief medical officer for government programs, Health Care Service
Corporation (HCSC), Chicago. “Our commercial side has been using quality
measures in contracts for the past 30 to 40 years, while the use in our
government programs has been more recent.”
parallel histories mean that metrics are not always in sync. What’s more,
Medicaid programs increasingly are adding regulations that differ by state. This
variability is an issue for health systems and health plans that span multiple
states. For example, the Medicaid program in New Mexico has 14 quality measures;
only some are shared by the Medicaid program in, say, Illinois, and only some
are common to Medicare.
“We try to
align as best as we can with the ongoing work that has been done on our
commercial side, but it is very clear on the government side that we have to
focus on the quality metrics that are important to our government partners—for
example, the Star measures for our Medicare populations,” says Esther Morales,
division vice president, government programs and quality, HCSC. Medicare Star
Rating measures, which include metrics focused on prevention and chronic
disease management, often align with commercial agreements. But measures in
government plans that are not common in commercial plans should not be ignored—they
help managed care organizations (MCOs) identify noncompliant beneficiaries so
providers can deliver needed care, Morales says.
The Nuances Within Quality Metrics
of a unified set of value-based metrics does not necessarily mean providers
lack a roadmap for enhancing the value of their care. For example, diabetes and
hypertension measures are common across both governmental and commercial
programs and are important for accreditation by the National Committee for
Quality Assurance (NCQA). Population heath management strategies targeting patients
with these chronic diseases will help providers do well on their
pay-for-performance contracts with MCOs, Morales says.
also can focus on preventive health by making sure they are performing well on
pregnancy measures and various screening measures—such as cervical cancer
screenings and mammograms—that are important for performance in Medicaid and in
Affordable Care Act marketplace plans.
who is putting money on the line in a pay-for-performance approach is incenting
preventive care and chronic care,” Sarran says. To succeed, providers should
follow recommendations from the U.S. Preventive Services Task Force and capture
the NCQA’s HEDIS measures, which are used to measure health plan and provider
years, Briscoe says, payers and providers have been moving away from measuring
quality with process measures to using outcomes measures such as
hospital-acquired conditions. She believes value-based care metrics will
continue to evolve in terms of quantity and depth of measurement, perhaps
changing dramatically over the next five years. “As measurement efforts in our
industry mature, metrics, definitions, and interpretations will continue to
evolve,” she says.
with room for improvement in the coming years is MACRA. UAB
reports metrics in the Physician Quality Reporting System—now a component of
the Merit-based Incentive Payment System in MACRA—under a single tax
identification number, so metrics apply to everyone in the organization’s provider
group, regardless of specialty. Boohaker says one issue with MACRA is that
definitions of metrics can vary depending on whether providers report as a
group or as individuals. In addition, MACRA measures may differ from MSSP,
Star, and commercial metrics.
performance under multiple contracts that are not well-aligned remains a
challenge that UAB shares with other provider organizations. Every year, UAB leaders look at
inpatient and ambulatory care metrics and prioritize where they have the
greatest opportunities to prevent harm and improve care, Boohaker says. Often,
they start by focusing on the metrics that are shared by most of their payers,
such as central line-associated blood stream infections and body mass index.
At Mount Sinai, a quality work group that includes
contracting experts, data analysts, finance leaders, care managers, and medical
directors prioritizes which 20 to 25 metrics will have the greatest impact on the
organization’s patient population and which it is best able to address.
Currently, Snyder and his colleagues are focusing on diabetes measures, which span
all their contracts. To support their efforts, they have more than doubled their
number of diabetes consults using telemedicine and enhanced their care
coordination across the system, among other tactics. “For any measure to
improve, you probably need four or five different strategies running in
parallel to influence large populations of patients,” he says.
influence the alignment of metrics, some providers are being more proactive in identifying
their own set of metrics based on the Triple Aim and in negotiating with health
plans to use those metrics, says Jim
Dietsche, CPA, executive vice president and CFO, Bellin Health, Green Bay, Wis.
Bellin Health currently tracks more than 600 measures, although leaders focus
on only about 30 at a time.
payers often ask providers to pull from measures created by the Wisconsin
Collaborative for Healthcare Quality, which publicly reports more than 40
ambulatory performance measures. Those involved in vetting the measures at
Bellin Health include primary care physicians, medical informaticists, quality
leaders, and managed care/contracting professionals. They make their selections
based on which metrics will have the greatest impact on their population as
well as the potential financial opportunities, Dietsche says.
is intrigued by the idea of a universal set of metrics for both professional
and technical services to help reduce the administrative burden on providers
and make a meaningful impact on patient populations. “What ends up happening is
that we build our own common set, and we have to vary the reporting and tracking
of information for different payers,” he says. If a universal set of metrics were
adopted, it should be based on evidence and developed with provider input. “The
measures would need to be current with the times and technology, and our
clinicians need to buy into them,” he says.
next few years, Micklos predicts, many providers will try to enhance their
market position to strengthen their negotiating position on performance metrics.
Larger providers that are well-positioned in their markets will have more
leverage to influence the metrics in their commercial contracts. For example,
national or large regional health systems may be able to create more
consistency in the markets they serve, not only in approaches to payment but
also in quality measurement overall.
The problem with having organizations pick their
own metrics is that providers may not always be in sync and may not choose the measures
that make the most difference to a large population of patients, Snyder says.
“We might focus on 20 metrics that reflect our patients the best, while another
provider organization near us might pick another 20,” he says. “We’re all
living in the same communities, but the different foci prevent us from truly
achieving population health.
“It would be much better if we all dealt with
aligned metrics, understanding that if you pick 20 metrics, you’re not going to
be touching every specialty, but at least it’s a start. And as three or four
metrics improve and the health of the community improves, you move on.”
Tracking Metrics Across Payers
there are no easy solutions for standardizing metrics across the industry.
Until there is more consistency, experts offer the following advice for health
plans and providers on aligning value-based care metrics to improve clinical
and financial performance.
Find resources to help define
measure sets. A tool
like the one developed by the Robert Wood Johnson Foundation (buyingvalue.org)
can help state agencies, employers, and other healthcare purchasers align their
quality metrics to federal, state, and commercial standards.
Choose metrics that make a
says the test of a meaningful metric is whether it reflects the Triple Aim:
better population health, an improved patient experience, and lower costs.
Create a culture of improvement. “Leaders are focused on ensuring
their organizations are learning from the data collected to achieve continuous
improvement of the delivery and associated outcomes of patient care,” Briscoe
says. In addition to technology, a culture focused on improvement requires
accountability at all levels of the organization—C-suite, middle management,
and frontline staff.
Such an effort
also entails communicating which metrics are essential to improve performance. At UAB, leaders have developed
physician and administration education materials that illustrate the linkage
and associated impacts among various measures. This methodology focuses on
improving patient outcomes while also explaining why select measures enable the
organization to meet both payer and patient expectations.
example, clearly demonstrating how reducing readmissions affects Medicare
Spending per Beneficiary (MSPB), commercial contracts, other programs, and
patient satisfaction can coalesce the organization around working toward a
common goal. Seeing how movement of a single metric improves organizational
performance in various programs helps financial and clinical leaders to
prioritize immediate efforts and to agree on which measures both improve
patient outcomes and accomplish strategic and operational goals.
Be open to new ways of sharing
outcomes data with payers.
Some measures, particularly the Medicare Star Rating metrics, are more
outcomes-based and cannot be mined from claims data. MCOs such as HCSC have
created portals that allow providers to submit a standard supplemental data
file from their electronic health record each month. In return, Morales says, providers
receive information on which members are noncompliant so they can focus their
efforts to meet specific measures.
recent years, the industry has made some progress to align metrics used by CMS,
state Medicaid agencies, state insurance departments, employer coalitions, and
other stakeholders. In 2015, the Institute of Medicine (now called the Health
and Medicine Division of the National Academies) released a report that
proposed a streamlined set of 15 standardized measures.2 The metrics
were developed by a consensus committee representing health plans, providers,
government agencies, and other stakeholders.
set to watch may be the core measures developed by the Core Quality Measure
Collaborative, led by America’s Health Insurance Plans. The measures were
developed by health plans, physician organizations, employers, and consumer
groups that reviewed measures that are currently in use by CMS and health plans
and that have been endorsed by the National Quality Forum. In March, the
American Academy of Family Physicians (AAFP) wrote a letter urging CMS to adopt
the core measure sets developed by the collaborative, which includes the AAFP.
common set of metrics works only if it is universally adopted by the diverse
group of stakeholders involved in purchasing and delivering health care—from
national government agencies to local providers.
transition to value-based care moves forward, providers will continue to
explore ways to optimize their performance under multiple contracts that are
not well-aligned. “It’s not easy, but it’s what they have been doing for
years,” Micklos says. “I don’t think we’ll ever get to a one-size-fits-all
scenario. But my hope is that moving to more outcomes-based measures should
help winnow down the measures to a more realistic number and make each of the
measures more meaningful.”
Ramos Hegwer is a
freelance writer and editor based in Lake Bluff, Ill.
Interviewed for this article: Emily Boohaker, MD, associate CMO for quality and patient safety, UAB Medicine, Birmingham, Ala.;
Beth Briscoe, CPA,
MBA, FHFMA, FACHE, CFO, UAB Hospital and UAB Medicine clinical
operations, Birmingham, Ala.; Jim Dietsche, CPA, executive vice president and
CFO, Bellin Health, Green Bay, Wis.; Jeff
director, Health Care Transformation Task Force, Washington, D.C.; Esther
vice president, government programs and quality, Health Care Service
Corporation, Chicago; H. Scott Sarran, MD, senior vice president and
chief medical officer, government programs, Health Care Service Corporation,
M. Snyder, MD, FAAP, executive vice president and chief
clinical integration officer, Mount Sinai Health System, and president, Mount Sinai Health Partners, New
1. Bazinsky, K., and Bailit, M., “The Significant Lack of Alignment Across State and Regional Health Measure Sets,” Bailit Health Purchasing, LLC, Sept. 10, 2013.
2. Blumenthal, D., Malphrus, E., and McGinnis, J.M., “Vital Signs: Core Metrics for Health and Health Care Progress,” Institute of Medicine of the National Academies, 2015.
HealthTrust: Optimizing Purchased Services
Andrew Motz, assistant vice president, supply chain consulting at HealthTrust, discusses the value of a data-driven approach when procuring purchased services.
Change Healthcare: Accelerating Revenue Cycle Transformation
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.
Ensemble Health Partners: Driving Revenue Cycle Innovation
Judson Ivy, president of Ensemble Health Partners, discusses the value of revenue cycle outsourcing and the importance of selecting the right partner.
Grant Thornton: Facilitating EAM
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.