Get the E-newsletter
As healthcare consumers pay a greater portion of their costs out of pocket, they have an urgent need for meaningful and transparent price information. They also have more motivation than before to bring up questions about the cost of medical treatments and services when speaking with a
Although industry stakeholders are hopeful that implementation of widespread price transparency can enhance the value of health care, the path to such an outcome is difficult. Current tools have not gained widespread utilization or made much of a dent in healthcare shopping habits, in
part because consumers lack experience at interpreting the information and using it to make high-value choices.
In this edition of the Healthcare Challenge Roundtable, representatives of the healthcare finance, clinical medicine, and health plan segments discuss the challenges and opportunities that have arisen in the push to be more transparent and forthcoming about prices.
Participating are Aaron
Crane, CEO of Propel Health in Portland, Ore., and formerly CFO of Salem Health in Salem, Ore. (and a 2016-19 Board member of HFMA); Nathan Foco, senior director of market research and consumer analytics with Priority Health in Grand Rapids, Mich.; Mary Anne Jones, CFO and senior vice
president for operations with Priority Health; and Wynn Hunter, MD, resident physician in the Department of Medicine at Duke University Health System and a frequently published researcher on the topic of out-of-pocket healthcare costs and their impact on medical decision-making.
Aaron Crane: One of the current problems in the industry is that data is siloed across multiple sources. This problem is compounded by the misalignment of incentives among these sources. It’s hard for the consumer to understand what they really owe when you talk about transparency because different parts of the pie have different pieces of information. It’s not shared, it’s not easily
digested. It’s not that people don’t want to give you a straight answer—they honestly don’t really know, and it’s not a priority to figure it out.
When I look at what we’re trying to do at Propel, in a value-based business model one goal is to align incentives of the patient, insurance companies, and the provider. The idea is to manage the patient’s needs in the lowest-cost setting to optimize their health. This hopefully puts
all the information in fewer places and makes it easier for patients to understand what they need to make decisions. It does try to make it simpler, but it’s something that’s still being built.
Wynn Hunter: The
biggest change I’ve seen over the past few years has been in the way that physicians are being trained to deal with healthcare costs. With greater appreciation of our country’s unsustainable healthcare expenditures, and the rise of advocacy groups and campaigns like
Choosing Wisely, there has been greater emphasis on identifying and eliminating unnecessary testing, procedures, and medications. Additionally, as the health systems are focusing more on quality metrics like readmissions, we are working even harder to improve
adherence to medications and ensure follow-up.
Excessive healthcare costs and resulting financial distress are barriers to adherence and optimal treatment, so we find ourselves discussing out-of-pocket costs and affordability with our patients on a routine basis. As a result, many of us younger physicians are becoming comfortable with
discussing out-of-pocket costs with patients, and we embrace the importance of preventing financial distress.
Nathan Foco: We’ve
been on this journey for almost three years now. It has been slow to start. We’re not only providing our members with a tool that can help in their decision making, but we’re also making them aware that they have the option to do so. That’s part of the process that we’ve gone through over the last few
years—helping our members to understand that this is even an issue and that they have solutions.
We have obviously gone through a number of different targeted marketing approaches, general awareness. But we also reach out to people on almost a one-on-one basis. We’ll send people direct information even after they’ve had a particular procedure to let them know that they essentially
could have saved a little money had they actually used some of these tools.
Overall, about 10 percent of our eligible population has used our
cost estimator, which is a couple of times greater than the national averages that we’ve seen.
Mary Anne Jones: Our
cost estimator tool is actually part of what we call our MyHealth hub. It’s an app that you carry around with you on your smartphone or iPad, and you can also access it on your computer. You can be shopping in real time when you’re right there with your physician as you’re trying to identify where you want to have
your service done.
We also have a rewards program that goes along with that, where we share part of the savings. If they choose a lower-cost option, they get a reward for that.
We also incorporate this into our call center, so when members call with questions about services, we have our health navigators work with the members to educate them. Every opportunity we get to talk with our members about their health, we make sure that they are aware of what their
Hunter: Over time, physicians can identify patterns in terms of what insurance plans are most common among the patients that they see on a daily basis. Further, it is possible to find out which medications and tests are preferred, or covered well, on these patients’ formularies. Accordingly, from interactions with
patients and from documents detailing these formularies, a physician may be able to start prescribing medications and tests that have equal efficacy but lower out-of-pocket costs. That can be a very difficult task, though, and many physicians do not have the time or bandwidth in the context of their busy
clinical schedules to track down formulary documents or recognize lower-cost alternatives.
Nevertheless, it is possible to help patients avoid financial distress by providing contingency plans in case a medication is particularly expensive. For example, certain inhalers for patients with asthma or COPD can be several hundred dollars each month depending on the nuances of
insurance coverage. If the patient has had insurance-coverage issues before, the physician can write a second prescription for a similar inhaler for the patient that could be filled if the first option is too expensive.
Foco: Ultimately our members, the patients, want to be able to have the conversation at the point of care. That’s really the ideal place, and it’s starting to shift. We’re starting to see that, but this is another one of those long journeys that we’re
on—trying to help give physicians the tools and information they need so they can help take care of not only the health of their patient, but even their financial health.
Hunter: In our research, we analyze full transcripts of conversations between doctors and patients in outpatient clinics. We found that discussions about out-of-pocket costs were happening more frequently than previously thought—in about a third
of visits. Although it’s difficult for physicians to identify an exact amount that a patient would pay for a given medication, they were often able to give a ballpark estimate of how much it might cost. For example, some physicians were familiar with medications on the Walmart $4 list. They were also familiar with
the newest and supremely expensive medications that often cost patients several hundred or thousands of dollars.
It is important for physicians to recognize that even general discussions about patients’ out-of-pocket costs can mitigate financial distress or nonadherence. Simply asking patients, “Do you ever have trouble filling your medications?” can lead in to very helpful conversations about
patients’ capacity and willingness to pay for important medications.
Jones: We actually engage with that—not only with our integrated health system, Spectrum Health, but also with our other providers within our network. Over the three-year journey that we’ve been on, we started out having a lower number of procedures that were in the cost estimator tool, and then we’ve expanded that
to include labs, physical therapy visits, and recently the drug pricing, and so forth. Every time we make these adjustments, we’re out educating the providers and providing them with opportunities to understand what’s available to their patients.
Crane: Maybe there’s also some protection that we need to give providers. They can provide a price, but it is not a guarantee—they can’t be responsible for the unknowns. There are complications and there are risks, so part of the conversation includes
sharing these risks in the context of likelihood and cost impact, and the patient needs to understand that if one of those things happens, the patient shouldn’t expect the fee to be the same, or the outcome.
The expectation on the payer or the financier is to communicate X, Y, and Z. The expectation on the patient is to understand that this is not a factory and that there are dynamics in play that make this completely unguaranteeable or not fully predictable, so there’s always an
asterisk to any information you get.
Hunter: This is a huge issue that I wish we had more time to discuss. Hypothetically, it could be helpful for patients to have an app that provides real-time information about out-of-pocket costs of medications, imaging, or procedures. However, I’ve never
seen or heard of such a thing, which likely indicates the difficulty of creating such an app. Of equal importance, though, is that the patient and physician would need to be willing and able to integrate this seamlessly into their conversation about the risks and benefits of various treatment options at
the point of care. We have a hard enough time navigating the electronic health record while working with our patients in the clinic, so it is hard to imagine such an app making its way into routine practice.
A more reasonable option may be for insurance plans to work together with electronic health record companies to provide instant price information to physicians when they attempt to order a particular medication, procedure, or imaging test. Then the physician would be alerted to potential
high costs immediately and could share the information with the patient and choose different treatment options if needed.
Jones: We would love to be able to publish more quality information on our tool. The unfortunate reality is that there isn’t really consistent, reliable quality information that is specific to procedures. We would love to get the provider community to have that level of data that we could share on the tool for our
members. We haven’t found where that’s available yet, but I think that’s the next big push that providers should make available.
The other thing that is really important—even for myself from a consumer perspective—is that the wide range of pricing that’s out in the marketplace is very shocking. That’s information to really get people engaged. They just don’t realize how much of a price differential is out there, and I
think that once people see that and their awareness is perked, then they’re more apt to go out and use the tool more often.
The other thing that’s really valuable is when we can highlight what other options are available. In our drug-pricing transparency, you go out and look at one of your drugs, and then we say, “Did you know that there’s a lower-price alternative?” In the pharmacy space, the industry has
been experiencing double-digit or sometimes 100 percent price increases in certain drugs. I think the call to action to make pharmaceutical costs accountable for the cost of care is to get this information out into the public and get that level of public awareness of the price disparities that take place.
Crane: I really think that whoever is acting on the patients’ behalf to negotiate rates for the care they get ought to be responsible for explaining it to them. The idea that you call up the hospital and say, “How much is my delivery going to cost?” is
not reflective of how our system works. Instead, the patient should call the insurance plan, because they’re the ones who have purchased that service from us and have divvied responsibility between the patient and the plan. They’re the ones who should be talking to the patient about this.
Now, the self-pay patient has absolutely every right in the world to go to the hospital and say, “Look, I don’t have insurance, I’m paying for this out of pocket. If I have my delivery at your hospital, what’s it going to cost me?” That conversation belongs there.
If we could establish who’s accountable for sharing that information, we could then maybe even put some standards around what we think minimum communication looks like, and timing, etc.
There’s a role for IT and technology companies, too. The data’s there to be aggregated. Algorithms can be created that improve the information provided to patients. The solution doesn’t have to require lengthy conversations. We make it complex because there are so many different
policy-plan designs, etc. But answers can be created with computers and delivered online if the right people or companies are willing to make this a priority.
Jones: It’s an ongoing process with us, and we are regularly engaging with our providers to understand where they are positioned with respect to market-based pricing and help improve their awareness as they’re making their own decisions. Certainly,
within just the last few years, the level of awareness has been raised that there is a market price for health care.
I think that for many, many reasons, the healthcare industry has been shielded from the basic economic laws of supply and pricing and price elasticity, and in today’s world, providers’ eyes are more open to that. They’re making more conscientious decisions to make their pricing more
market-based. We’ve seen that the level of variation that existed three years ago has actually shrunk down somewhat.
Jones: We needed this level of disruption to take place in the industry to get people to focus on the realities of what was taking place in healthcare economics. We’ve seen savings resulting from the implementation of this tool—about $6 million—and we
are now able to reduce our premium prices accordingly. Those savings that we have with the cost-curve bend now turn around to trying to keep premium increases closer to a cost-of-living level of increase.
I’m hopeful that as this continues to expand into the area of drug pricing that we will see that also taper down, in terms of the level of trends that we’ve seen in past years. It’s completely unsustainable. Drug pricing is 20 percent of the total cost of health care today. People need to
understand what’s been happening in pricing in that space, and we need to make that more manageable.
Hunter: If price transparency does improve, and physicians become facile in discussing out-of-pocket costs with patients, I think we will be better able to identify therapies that are optimal from a medical sense and do not cause undue financial distress. Treating a patient’s disease but driving them into
bankruptcy, financial hardship, food insecurity, etc., is not necessarily a success.
The question of whether we’re actually going to bend the cost curve is more difficult. If you’re my patient, my duty and responsibility is to you, not your insurance company. If I identify a therapy that is optimal from a disease standpoint, and affordable to you, then I’m not going to consider
what the overall price will be to your insurance company. It is not my job to ration health care, so I’m always going to do what is best for your health and well-being in that moment, even if it is expensive for society at large. I think this is absolutely critical for maintaining the sanctity and inherent
trust of the patient-physician relationship. I’m always going to advocate for you and your best interests. It is the job of politicians and economists to determine the broader impact.
So I think we can improve each individual patient’s likelihood of developing financial distress, but I’m skeptical that price transparency will bend the cost curve in general.
Crane: The fact that we can’t explain costs to someone, while it’s embarrassing and disappointing, is not the core problem. The billion-dollar problem is that the cost of our healthcare delivery model is not sustainable and the quality produced is not acceptable compared to other models around the world.
The key questions are: How do we align incentives for keeping people healthy? How do we optimize a care system so that people get the right care in the right setting at the right time? And how do we optimize health outcomes while lowering the overall cost?
I come back to the value-based system. If I can put a product on the market where someone has little to no out-of-pocket costs as long as they follow the standards of care that the evidence says they need to follow, while incenting them to be healthy, there is less of an issue
related to cost transparency.
Hunter: For those trying to work on this issue, I cannot underscore enough the importance of a team-based approach. Once you get siloed, and it’s only doctors in the room, or only hospital administrators, or insurance companies, or only industry
representatives, that’s when you start dreaming up solutions that are never going to be effective on the ground or on a societal level. Making headway on this problem will require teamwork from a lot of people with different backgrounds, experiences, and training who actually listen to each other and
have patients’ best interests at heart.
Nick Hut is managing editor of Leadership.
for this article: Aaron Crane, CEO, Propel Health; Nathan Foco, senior director of market research and consumer analytics, Priority Health; Wynn Hunter, MD, resident physician, Department of Medicine, Duke University Health System; Mary Anne Jones, CFO and senior vice president for
operations, Priority Health.
Check out previous installments of the Healthcare Challenge Roundtable:
In Pursuit of Interoperability
How to Optimize Ambulatory Care
Integrating Behavioral Health Care and Primary Care
Assessing the Value of Care
Optimizing the Preauthorization Process
Working Together to Make APMs Succeed
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.
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.
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.