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The patient had multiple health
problems and, over a 21-month period, 44 emergency department (ED) visits and
27 inpatient admissions, more than half of which included time in the intensive
Then Thomas Cornwell, MD, a house call
physician, entered the picture. By seeing the patient in his home, Cornwell was
able to understand and address his many issues holistically. In the first year
under Cornwell’s care, the patient had one ED visit and one hospitalization.
“The following year, he had none,”
says Cornwell (pictured at right), who founded Home Care Physicians in Wheaton, Ill., nearly 25
years ago. Now part of Northwestern Medicine Regional Medical Group in the
Chicago area, he has made more than 32,000 house calls.
Based on the patient’s historical
utilization pattern, he would have been expected to have 25 ED visits and 14
hospitalizations in a single year, racking up $176,000 in hospital charges.
Those numbers hint at why, even though the delivery model has never gained
widespread traction under fee for service, Cornwell thinks a tipping point is
Value-oriented payment strategies
incentivize health systems to lower the cost of caring for a population of
patients. Pointing out that 5 percent of patients account for 50 percent of
healthcare expenditures, Cornwell sees home-based care as a way to make their
lives easier while reducing their high-cost utilization of acute care services.
“When you are taking on financial risk, this 5 percent is
where the greatest cost savings are,” Cornwell says. “That is where house calls
really come in.”
About 400,000 elderly Americans
currently receive home-based primary care, Cornwell says. Programs vary widely
in the scope of services provided and the mode of care delivery.
One of the longest-running and
most-studied programs is the Medical House Call Program at MedStar Washington
(D.C.) Hospital Center, started in 1999 by two geriatricians to reach patients
who were too sick, frail, or disabled to travel to physician offices. The
program, which serves an average of 550 patients a day, relies on philanthropic
support and subsidies from the health system, in addition to insurance payments.
Most patients are covered by fee-for-service Medicare, Medicaid, or commercial
insurance; they are eligible for the house calls program if they are 65 or
older, insured, have a functional problem that makes getting to the doctor’s
office difficult, and agree to switch from their previous primary care
About one-third of patients in the
program are Medicare beneficiaries who receive home-based primary care through the
hospital’s participation in the Independence at Home demonstration, sponsored
by the Center for Medicare & Medicaid Innovation. Patient eligibility criteria
for IAH include at least two chronic conditions, a non-elective hospitalization
in the past 12 months, and problems with at least two activities of daily
The MedStar program’s success stems
from a team-based approach to primary care, says co-founder K. Eric De Jonge, MD (pictured at right),
a geriatrician and incoming president of the American Academy of Home Care
A geriatrician conducts an initial
at-home assessment that covers issues ranging from clinical and psychological symptoms
to social and home-safety concerns. From there, a team that includes a nurse
practitioner, social worker, and licensed practical nurse develops and
implements a plan of care.
An analysis of 722 patients who were served by MedStar’s
House Call program in 2004-08, along with a control group of 2,161 matched
patients, found that patients in the program had 17 percent lower Medicare
costs over two years of follow-up. They had significantly less hospital and
skilled nursing facility (SNF) care than the control group, although their home
health and hospice costs were higher. They had fewer subspecialist visits but
more than double the number of generalist visits.
That study found no difference
between patients in the program and the control group in either mortality rate or
average time to death. But a different approach to end-of-life care is a likely
reason that MedStar’s house calls program reduces high-cost inpatient utilization.
About 60 percent of the program’s patients have the support they need to die at
home with hospice care, while 25 percent die in a hospital and 15 percent die
in an inpatient hospice facility.
In contrast, just 34 percent of
Medicare fee-for-service beneficiaries died at home in 2009, according to an analysis of Medicare data. Nearly 70 percent
had a hospitalization and 45 percent had a SNF stay in the last 90 days of life,
and 29 percent spent time in an intensive care unit in the last 30 days before
Noting that most elderly patients
say they want to die at home, Cornwell says home-based primary care increases
patient satisfaction. His practice, HomeCare Physicians, cared for 230 patients
who died in 2015; of those, 80 percent were at home and 76 percent were on hospice
Because house call programs
generally require some form of subsidization, however, very few health systems
provide the option to their patients.
“Most house call programs are not
breaking even under fee for service because of the travel time and the staff
costs,” De Jonge says.
But health systems could take a
closer look at the ROI as the value movement takes hold. For example, Cornwell’s
practice has received support from Central DuPage Hospital—now a part of
Northwestern Medicine—for two decades. The hospital is now benefiting from the
fact that house calls decrease 30-day readmissions—Central DuPage has never had
to pay a penalty under Medicare’s Hospital Readmission Reduction Program.
Similarly, because the vast majority of house call patients die at home, the
hospital has a low mortality rate, which boosts its score in Medicare’s Hospital
Value-Based Purchasing Program.
The financial equation for house call programs changes
dramatically when the programs are rewarded for reducing costs to Medicare.
For the Independence at Home demonstration, MedStar is in a
consortium with two other large health systems. In the first year of the
demonstration, the consortium reduced Medicare spending by 20 percent, compared
to expected spending for the patient population. That performance generated
$1.8 million in shared savings.
Cornwell and De Jonge hope that results from the Independence
at Home demonstration, now in its third year, will persuade Congress to make
house calls a standard Medicare benefit. A Senate bill that would expand the
demonstration and extend it for two years has bipartisan support.
Convinced that house calls for frail,
elderly patients will eventually become the standard of care, Cornwell has
started a nonprofit organization, Home Centered Care Institute, to help health systems and
providers learn how to start and operate house call programs.
MedStar Health and
seven other provider organizations—Cleveland Clinic, Icahn School of Medicine
at Mount Sinai, Northwestern University Feinberg School of Medicine,
Perelman School of Medicine at the University of Pennsylvania, University
of Arizona Center on Aging, University of Arkansas for Medical
Sciences, and University of California, San Francisco—were recently named to be
the Institute’s first Centers of Excellence to spread home-based primary care best
practices across the country.
the majority of primary care home visits are being made by only about 1,000
providers; he wants to train 5,000 clinicians and practice managers over the
next five years.
“What’s the biggest
roadblock to this becoming the norm?” he says. “It’s the work force.”
Lola Butcher writes about healthcare
business and policy topics for several HFMA publications.
Interviewed for this article:
Thomas Cornwell, MD, physician, Northwestern Medicine Regional
Medicine Group, Wheaton, Ill., and CEO, Home Centered Care Institute, Schaumburg,
Ill.; K. Eric De Jonge, MD, co-founder, Medical House Call Program, MedStar
Washington Hospital Center, Washington, D.C.
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.
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.
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.