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A trio of large health systems has implemented initiatives to understand current prescribing patterns, in particular why some doctors rely on opioid drugs to manage pain rather than non-narcotic alternatives. The physician-led initiative is part of a growing movement among acute care providers to reverse a
disturbing trend of opioid misuse and addiction that begins in the hospital, often in the aftermath of a surgery.
A lack of access to information—whether for benchmarking clinical practices and patient outcomes or for quantifying the shortage of primary care physicians who are available and licensed to treat opioid withdrawal—is a significant challenge. So is the
sheer magnitude of the epidemic. Over 2 million Americans are addicted, and prescription-opioid overdose deaths are reported to have more than quadrupled between 1999 and 2015. Research also finds that opioids prolong hospital stays and increase the risk
Prevention is the starting point at Brentwood, Tenn.-based LifePoint Health, Nashville-based HCA Healthcare, and San Diego-based Scripps Health. At a perioperative pain management collaboration summit, hosted earlier this year by HealthTrust, a handful of representatives from each of those health systems
came to recognize that opioid abuse and dependency could legitimately be described as hospital-acquired conditions.
Instituting a standardized, enterprise-wide patient care approach can be a prickly and time-consuming exercise in the best of circumstances, but addressing the reflexive overprescribing of opioids is uniquely complex. It is a clinical habit that has
been decades in the making, traceable to 1996, when the American Pain Society declared pain to be the fifth vital sign—and that it was being undertreated. The Joint Commission has only recently revised its pain assessment and management standards to require hospitals to provide nonpharmacological pain
treatment methods and to facilitate practitioner and pharmacist access to Prescription Drug Monitoring Program databases, which are used to reduce prescription drug abuse and diversion.
Numeric pain scales also remain in widespread use, tying the prescribing of pain medicines to patient discomfort rather than to the patient’s ability to function (e.g., trouble getting out of bed or engaging in physical therapy).
Physician leaders at LifePoint, HCA, and Scripps are advocates of pain scales that measure patient functioning. They also point to e-prescribing as a possible remedy for overprescribing that occurs to avoid inconvenience for patients and surgeons. Refilling a prescription for a narcotic painkiller otherwise requires
a return trip to the doctor’s office, creating a perverse incentive to prescribe too many pills “just in case.”
HFMA podcast: How healthcare stakeholders can address the opioid crisis
A newly launched opioid stewardship program at Scripps Health is devoted to fundamentally changing the attitudes and expectations that prescribers, patients, and their caregivers have about pain and how it should be managed. It is modeled after an existing antibiotic program that focuses on patient
education and on consistent and coherent messaging by all caregivers. Providers contact patients several times during the 90-day postoperative period to ask about continued narcotic use and offer counseling on the safe disposal of unused pills. Whether that message is delivered via print brochure, video,
telephone, or in person, the “because we care” theme dominates. Patient satisfaction thus is not expected to suffer.
The initial focus is on general and gynecological surgeries that are part of a rapid-recovery protocol favoring the use of multimodal pain management. The program will expand to spine surgery and orthopedics and, ultimately, nonsurgical patients, including those going through opioid withdrawal.
Getting organized has been one of the chief challenges, given that meetings involve representatives from nearly a dozen disciplines, including primary care, palliative care, and, most recently, orthopedic surgery. Project management work falls to the clinical pharmacy director and an emergency medicine
physician who self-delegate based on skill set—one compiles data and coordinates meetings while the other facilitates collaboration and writes first drafts of educational materials.
Generating before-and-after statistics on opioid utilization, specific to individual prescribers—with plans to ultimately share the data within groups to allow physicians to see where they stand in comparison to their peer group—has been slowed by data quality
issues and a systemwide electronic health record conversion that will ultimately resolve the dilemma. The longer-term conundrum is where to refer patients with opioid use disorder, given the dearth of practicing addiction specialists and evidence-based treatment programs. Residency programs and
fellowships in addiction medicine may be required.
The program’s official kickoff came only this past September, when the chiefs of staff and the Scripps corporate team formally blessed the program and the initiative was introduced to the medical executive committee. The system’s surgery care line co-chair, an anesthesiologist, took on the task of educating
fellow physicians about the “hidden” nature of the epidemic during grand rounds. Data helped tell the story: States with more opioid prescriptions per capita also experience more drug overdose deaths, and restricted access stemming from state laws has led users to search for alternatives—notably, heroin.
In fact, prescription pain medications are a gateway drug in most cases of heroin addiction, and every type of surgery holds the potential to put patients in the downward spiral. Medical staff were immediately and overwhelmingly supportive of efforts to reduce opioid prescribing and, unprompted, began helping to raise
awareness of the issue and promoting use of nonopioid alternatives for both short- and long-term pain management.
An opioid stewardship committee has been assembled to produce and disseminate patient and clinician education materials, identify patients at high risk of opioid abuse, and track outcomes related to the initiative (e.g., in-hospital opioid use and related adverse events, and readmissions or emergency room visits for
subsequent opioid-related issues). Effective leadership has meant over-communicating with all stakeholders and giving them a voice on proposed changes—most especially the naysayers and curmudgeons. The disheartening statistics invariably get everyone’s immediate and undivided attention:
Achieving a systemwide reboot of pain management practices begins with dialogue between providers at different points in the care continuum to spot the gaps. Are orthopedists overprescribing pills because they don’t want a patient’s supply to run out on a Saturday night, for example? Do emergency department (ED)
physicians become upset with surgeons when patients present in the emergency room because they were prescribed too few pills—or don’t understand that some pain is good, helping to foster recovery? Teamwork is essential in setting reasonable expectations for opioid use for different surgeries and in reducing the wide
variability in prescribing practices.
Not all participants in the opioid stewardship program are formal members, with some instead serving on a committee or in an ad hoc capacity. A family practice resident, for example, began attending meetings to provide an extra set of hands and pursue a legitimate leadership development opportunity.
Among the significant first steps taken by LifePoint is authoring a national guidance statement on responsible opioid prescribing for the EDs of its 70-plus facilities. The move reflects preexisting interest in the topic by the organization’s national ED Physician Guidance Council, where members were already working on
standardizing the approach to managing painkillers and opiates. One LifePoint hospital could point to a quantitative reduction in its opioid prescribing rate after issuing similar guidance.
At the corporate level, a new multidisciplinary opioid stewardship committee is meeting monthly to maintain momentum and guide efforts moving forward. It is composed of LifePoint’s national medical director and representatives from the IT clinical team, as well as subject-matter experts from the quality department,
pharmacy operations, surgical services, and the ED. The committee’s agenda includes identifying appropriate “milestones and metrics” around opioids for the ED and surgery service lines, as well as developing a multimodal pain management order set.
On the treatment side, one of the more time-consuming tasks is taking inventory of physicians who have been trained and licensed to prescribe antiaddiction medications such as methadone and naltrexone. LifePoint employs approximately 2,600 providers, half of whom are primary care physicians who rarely step foot
in a hospital, including some practitioners in small groups without a designated medical director. In some markets, committee members are collaborating with physicians in director-level positions to identify who to call to obtain the information.
Collaboration across disciplines and leadership levels will continue to be critical. Hospital leaders who serve as conveners of local resources, including public health departments, are being pulled in early to ensure a full accounting of active programs that target the opioid epidemic.
Orthopedic surgeons at Southern Joint Replacement Institute (SJRI) serve on the medical staff at HCA’s TriStar Centennial Medical Center in Nashville. These surgeons are actively investigating pain-reducing strategies that minimize, if not eliminate, the need for narcotics in the perioperative period. On the community
level, they are focused on preventing diversion of opioids from the individual for whom they were prescribed to another person—often a loved one at home—for illicit use. The surgeons are also serving as subject-matter experts at a series of regional pain management summits that HCA is holding around the country to
help its hospitals and divisions develop action plans for balancing patient comfort and safety.
With the full support of CEOs in HCA’s TriStar Division, SJRI has assembled a multidisciplinary team of physicians, nurses, and mid-level providers who are part of the prescription process for surgery patients, plus a pharmacist and addiction treatment specialist, to help identify the most effective pain
management regimen for the group’s total-joint patient population. Research is underway on various perioperative cocktails and an older intravenous anesthetic, as well as alternative pain management approaches such as massage and acupuncture that are already commonplace in obstetrics and oncology. A
nurse at the clinic is serving as de facto project manager.
The pharmacist on the team is with a local psychiatric hospital and already has facilitated a large in-service event to educate nurses on how to identify, diagnose, and treat opioid withdrawal symptoms. As at Scripps, patient education is viewed as the big need over the long term and will require consistent, repeated messaging
by everyone involved in delivering care—with emphasis on the importance of properly disposing of unused narcotics, and how and where to do so (including year-round collection sites). Behavioral issues of patients will also need to be addressed preoperatively. Mood disorders are a knowable—and modifiable—surgical risk
factor, and mental health treatment may prevent patients from “medicating” with pain medications for the wrong reasons.
Regarding diversion prevention, TriStar Centennial Medical Center recently began participating in the biannual National Prescription Drug Take Back Day, a program of the U.S. Justice Department and the Drug Enforcement Administration. The community was
invited to drop off unused opioid prescriptions during a one-day “Crush the Crisis” event on the hospital campus, with complimentary t-shirts going to the first 100 attendees. The local police department served as medicine collection agents, and Centennial’s medical office staff provided refreshments. Roughly
21.5 pounds of medications was collected—a record for such events in the Nashville area.
The ability of physician leaders at SJRI to delegate responsibilities to other team members has helped make difficult work rewarding for all involved. When it comes to finding fresh ideas and plausible strategies for combating a seemingly intractable problem, every voice in the room truly counts.
All three authors serve as physician advisers to
HealthTrust: Solving Workforce Management Challenges
Two of HealthTrust’s senior leaders talk about strategies for optimizing the hospital workforce to improve productivity and reduce waste.
Grant Thornton: Optimizing the Ambulatory Workforce
One of Grant Thornton’s senior healthcare consultants addresses the topic of workforce management and the importance of a data-driven approach.
Cedar: Reimagining the Patient Financial Experience
Cedar’s CEO and co-founder tackles the topic of patient payment and the importance of having an innovative patient financial management system.
TRIMEDX: Moving Healthcare Providers Toward Mature Clinical Asset Management
This article includes a discussion by TRIMEDX leaders about the best ways to mature a clinical asset management program.
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.