Today, heart failure patients at the skilled nursing facilities (SNFs) that partner with North Shore-Long Island Jewish (LIJ) Health System receive similar protocol-driven care and treatment while at home in the SNF as they would if they were admitted to the hospital. By following a standardized protocol developed by North Shore-LIJ inpatient nurses, SNF staff are better equipped to care for patients—and keep them from returning to the hospital.
The push for more coordinated care is why North Shore-LIJ and other health systems around the country are making partnerships with post-acute providers a strategic priority. Accountable care organizations (ACOs) and other providers are assuming more financial risk (i.e., under bundled payment and other value-based payment structures) when they assume cross-continuum responsibility for entire patient populations.
Attacking post-acute care costs is becoming a common tactic under these arrangements, which makes sense given that post-acute costs are growing faster than any other category of Medicare spending (Chandra, A., et al, “Large Increases in Spending on Postacute Care in Medicare Point to the Potential for Cost Savings in These Settings,” Health Affairs, May 2013, vol. 32, no. 5, pp. 864-72).
Another motivating factor is the financial penalties for hospitals with high 30-day readmission rates. More than one-fifth of all hospital discharges to SNFs are readmitted, which costs Medicare $4.34 billion a year (Mor, V., et al, “The Revolving Door of Rehospitalization from Skilled Nursing Facilities,” Health Affairs, January 2010, vol. 29, no. 1, pp. 57-64).
With quality and cost savings as key drivers, several forward-thinking health systems are reaching out to post-acute providers that share the same philosophy and patient-centered goals. Together, they are working toward better communication, smoother patient transfers, and standardization of care.
A drive to improve quality across the continuum was what triggered North Shore-LIJ, a 16-hospital system with a service area of more than 7 million, to develop a continuing care network of non-owned, post-acute providers focused on better care coordination in 2008. A continuing care network is an informal but structured way to pull together providers to work together on a number of objectives, such as reduced readmissions, decreased post-acute care costs, and improved quality of care.
“Since the majority of system discharges were going to nonsystem facilities, partnering with these subacute providers became a priority to ensure continuity of care across the continuum,” says Maureen McClusky, FACHE, executive director of North Shore-LIJ’s Stern and Orzac Centers for Rehabilitation. She also oversees the system’s affiliations with post-acute providers.
Selecting the SNFs. Leaders at North Shore-LIJ assessed potential post-acute partners using several quality metrics, such as nurse staffing ratios and star ratings on Medicare’s Nursing Home Compare. They also reviewed geographic proximity to system hospitals, referral patterns, and other criteria. From a list of 266 potential facilities, the health system selected 19 for its SNF affiliate network.
When developing its affiliate agreement, the health system chose to focus on quality, not on creating a financial link between the organizations, McClusky says. In the agreement, the health system and SNF agree “to work together to identify areas where they can seek to improve the safety, quality, and efficiency of care transitions.”
Improving quality together. One of the first quality initiatives that the health system and SNFs collaborated on as a group was implementing an advance directive tool across the continuum. Called the Medical Orders for Life-Sustaining Treatment (MOLST), this New York state initiative helps staff better understand patients’ end-of-life preferences across the continuum of care. It is similar to the national program, Physician Orders for Life-Sustaining Treatment (POLST). Between 2008 and 2010, the partners increased MOLST orders by 40 percentage points, from 10 percent of patients to 50 percent.
Soon after, they worked together on a standardized treatment protocol for SNF patients with heart failure. Heart failure is often tricky to manage in a SNF setting because symptoms can worsen rapidly and the patient can be relatively asymptomatic until the situation is critical, according to Howard Guzik, MD, FACP, senior medical director of SNF services, North Shore-LIJ Health System and the Stern Family Center.
Nursing leaders from North Shore-LIJ helped affiliated SNF staff implement a variation on the hospital protocol that includes patient assessment on every shift by an RN (who is on duty 24/7), daily weights, a low-sodium diet, frequent monitoring of vital signs, pulse oximetry readings, and other components.
“This joint initiative has successfully improved quality across the continuum and fostered a greater partnership between the hospitals and affiliate SNFs,” Guzik says. Guzik credits the standardized care for helping reduce the heart failure rehospitalization rate within the SNF affiliate network from approximately 6 percent in 2010 to 2 percent in 2012.
Better communication and collaboration have also reduced the all-cause readmission rate within the network from approximately 13 percent in 2010 to 7.5 percent in 2012. But there is still some room for improvement, Guzik says. To that end, North Shore-LIJ plans to roll out a universal transfer form by the end of 2013. The standardized form will help staff capture critical patient information to ensure smooth hand-offs between the hospitals and SNF affiliates.
Reporting what matters. Selecting the right metrics has been critical to North Shore-LIJ’s ongoing efforts to standardize care and improve quality across the continuum. To identify and define what to measure, leaders turned to their system’s data analytics division.
The division developed a set of 26 metrics, including:
SNFs in the affiliate network report their facility- specific data each month using a web-based reporting tool developed in-house. The tool automatically calculates the key rates associated with the data—such as mortality rates and 30-day all-cause readmission rates—and creates reports that allow affiliates to compare their numbers to the network average.
During quarterly meetings, high-performing facilities discuss their strategies with other affiliates in the network. The aim is to “benchmark and share best practices in an environment of mutual trust and support,” McClusky says.
Parker Jewish Institute for Health Care and Rehabilitation, New Hyde Park, N.Y., was the first SNF to join North Shore-LIJ’s affiliate network. Since then, staff at the 527-bed SNF have reported smoother care transitions, says Michael N. Rosenblut, president and CEO.
“Understanding what the clinical pathways and the expectations are, and gaining more precise information from North Shore-LIJ have helped us deliver better care,” Rosenblut says. “When our physicians or nurses have a question about a treatment protocol for one of the patients, we are able to get the right person on the telephone at North Shore-LIJ, who can explain what the expectation is and what they told the patient. We rely on them, and they rely on us,” Rosenblut says.
Having a closer relationship with the system was also an advantage during Hurricane Sandy. When Parker took in nearly 40 evacuees from other facilities, North Shore-LIJ was able to assist with equipment and resources to care for the displaced residents.
Preparing for bundled payments. Health system leaders expect that all of this groundwork will help North Shore-LIJ as it prepares to participate in several Medicare Bundled Payments for Care Improvement (BPCI) initiatives, which include post-acute care. Members of its SNF affiliate network will be included in one of the models of care.
In December 2011, Indianapolis-based Franciscan Alliance, which has 13 hospitals in Indiana and Illinois, was awarded a Pioneer ACO contract. After doing a deep dive on three years of Medicare fee-for-service claims, ACO leaders realized they had an opportunity to improve post-acute care transitions for their 20,000 attributed Medicare patients, says Jenny Westfall, regional vice president, Franciscan Alliance ACO.
“We wanted to communicate better with post-acute providers that were receiving our patients, and we needed some quality measures in place so they would be accountable if patients were readmitted,” Westfall says.
120 days to partnership. In late 2012, Franciscan Alliance ACO set out to develop a continuing care network of providers to help them manage patients in the post- acute care portion of the care continuum. It started by reviewing the top 20 high-use, post-acute facilities in its community based on 12 months of discharge data. After gauging providers’ interest and reviewing their quality metrics, ACO leaders invited six SNFs, one long-term acute care facility, one home health agency, and one acute inpatient rehabilitation facility to participate in their continuing care network.
Together, the facility and ACO leaders designed the quality metrics that would document post-acute care progress on an ongoing basis, including new metrics that providers were not already reporting to the state, such as catheter-associated urinary-tract infections (CAUTIs) and patients scheduled to be seen by a primary care provider within seven days of post-acute setting discharge. Additionally, they are asked to report and monitor progress on returns to the ED within 72 hours of post-acute admission, inpatient readmission rate, readmission to acute care within 30 days of post-acute discharge, and average length of stay in the post-acute setting.
From start to finish, building the continuing care network took just four months (see the related sidebar).
Better communications, better care. With the network in place, ACO leaders recognized that they had a unique opportunity to smooth transitions by improving communications between acute care and post-acute providers, says Joseph LaRosa, MD, MBA, the ACO’s medical director. One priority was getting patients’ hospital records to their post-acute partners more quickly.
“Indiana doesn’t require physicians to send discharge summaries to post-acute facilities for seven days. That is the standard, but we realized that was way too long,” LaRosa says. “Now, hospitalists must complete discharge reports before patients leave the hospital, and these reports are transferred with the patient to the post-acute facility.” SNFs also can tap into the system’s electronic health record (EHR) to get hospital records and lab reports on patients, which improves care coordination.
24- to 48-hour follow-up. ACO leaders hired a dedicated care coordinator and clinical nurse specialist for the network to monitor patients along the continuum of care. Once it is determined that a patient will most likely require a post-acute facility, the care coordinator (who is a nurse) visits with the patient and their family at the hospital. Within 24 to 48 hours of discharge to a provider in the post-acute care continuing care network, the patient receives a visit from the care coordinator to ensure the care plan is being followed. The clinical nurse specialist regularly monitors the quality measures and assists the network participants to implement processes and optimize practices to achieve expected outcomes.
Although patients and their families are free to choose a facility outside of the continuing care network, many choose network facilities. One benefit they cite is the network’s policy of having a Franciscan Alliance care management team visit patients at post-acute facilities within 24 to 48 hours of admission, as well as the ongoing monitoring provided by the post-acute setting, says Kim Kolthoff, BSN, RN, CPUR, director of integrated case management and clinical services. “Families perceive that choosing a provider in the continuing care network is a benefit to their loved ones because the ACO is measuring the quality of post-acute care and helping to manage patients’ care after they leave the hospital.”
Case managers on-site. The ACO post-acute transitions care coordinator visits the patient within 24 to 48 hours of inpatient discharge, guides the continuing care network facility staff in weekly care plan meetings, and helps facilitate whatever needs the patient might have after discharge through the design and implementation of a transitional plan of care. He or she also works cooperatively with the system’s case management team as needed. One example is when an ACO patient at a network facility is readmitted to the ED. The facility’s case manager will work with a case manager from the hospital’s ED to create a discharge transition plan.
Better medication management. Franciscan Alliance ACO has organized a medication reconciliation workgroup for its continuing care network partners, led by the system’s director of pharmacy. The ACO is also piloting a program using pharmacists to conduct medication reconciliation at the time of discharge. The goal is to reduce duplicate medications and prevent dangerous drug interactions.
Staff engagement. The ACO’s early efforts to improve continuity of care have had a positive impact on the Franciscan Alliance system overall, leaders say. “One of the benefits of building our continuing care network was that it got our system’s management team engaged,” says Jay Brehm, the system’s senior vice president for strategic planning and business development. “The ACO had been viewed as a pilot that only a few people understood. But the continuing care network has gotten more people involved in our accountable care strategy, which is fundamental to our goal of developing a team approach to caring for patients.”
Like Franciscan Alliance, OSF HealthCare, an eight- hospital system in Peoria, Ill., also views collaborations with post-acute providers as a critical piece of its Pioneer ACO strategy. “Our focus has been on how to play better together,” says Tara Canty, COO for accountable care and senior vice president for government relations. “We are trying to achieve better integration in our system and at the same time, work on better integration within our community.”
With 51 accredited medical home sites and one EHR that connects inpatient, physician, and home care sites, OSF already had a strong foundation for its ambulatory care management program. It wanted build a similar program for patients moving from the hospital to a skilled nursing facility, and the ACO gave it an opportunity to experiment.
SNF standards. With better community integration as its goal, OSF launched a preferred skilled nursing network with 17 member facilities in late 2012. These members are required to meet the following standards:
House calls to SNFs. To make sure that ACO patients receive the therapies they need across the continuum, OSF employs a dedicated physician who rounds at facilities in the preferred network each week as well as four advanced registered nurse practitioners who visit the facilities nearly every day.
The SNF staff appreciates these “house calls” because the physician and nurse team can respond to acute issues, such as confusion and UTIs, says Stephen Hippler, MD, vice president of quality and clinical programs for OSF Medical Group. “When there is a status change, the nursing home is in a tough position,” he says. “Someone needs to assess the patient. All too often, it has been the ED and the hospital doing this assessment. We are able to do that on-site through the dedicated team.”
To identify older adults at high risk of readmission, OSF uses an assessment tool based on the Society of Hospital Medicine’s Better Outcomes by Optimizing Safe Transitions (BOOST) project. OSF’s care transitions risk assessment tool includes “8 Ps” to assess during transitions:
These strategies have helped bring readmissions from the SNFs down from 27 percent in 2012 to 11 percent in 2013. Visits to the ED also have been cut by more than half.
The leaders involved in building post-acute networks shared the following lessons on how to make them work:
Choose your strategy. If health systems cannot serve their market with their existing post-acute assets, a continuing care network that includes owned and independent facilities is one option. For those that own a comprehensive post-acute portfolio, another option is a management services organization (MSO). In an MSO, the system manages its hospitals’ post-acute operations.
Get support from the top. Partnering with post-acute providers requires buy-in from senior leaders, including physicians, who understand the value of collaboration. Case in point: The oversight committee for Franciscan Alliance’s continuing care network includes the director of emergency medicine, the head of the hospitalists group, and geriatricians.
Understand what moves post-acute providers. Like acute care providers, SNFs want what’s best for the patient. Collaborating with hospitals can help them smooth transitions, which ultimately improves patient satisfaction. Being in a select network also can help them boost their reputation and keep their occupancy high with a regular influx of new patients at a higher reimbursement level.
Share your GPO savings. North Shore-LIJ allows SNFs in its affiliate network to purchase discounted drugs through its GPO. The goal is to allow for standardized care and treatment across acute and subacute organizations while creating savings.
Implement care paths. North Shore-LIJ encourages members of its SNF network to use standardized care paths for UTIs and other conditions to improve quality of care and reduce unnecessary readmissions.
Consider requiring round-the-clock RN staffing. Some SNFs are simply not staffed to care for today’s higher- acuity patients, such as those on ventilators or who require extended wound care. Requiring 24-hour nurse coverage was a priority for OSF and Franciscan Alliance when selecting its post-acute partners.
Make data transparent, but nonthreatening. At quarterly meetings of its SNF affiliates, North Shore-LIJ presents aggregate, blinded performance data and distributes individualized report cards detailing a facility’s performance against quality indicators. Franciscan Alliance presents unblinded performance data each month at its post-acute care partner meetings and uses this data to collectively create and implement processes.
Use SBAR as a learning tool. Franciscan Alliance ACO requires providers in its continuing care network to provide SBAR (situation, background, assessment, recommendation) reports of all patients readmitted to the hospital as well as any unanticipated or adverse events. This helps providers identify areas for improvement.
Share your classroom. Many post-acute providers lack the resources to offer in-depth staff training. Both Franciscan Alliance and North Shore-LIJ invite providers from their post-acute networks to receive free or reduced-cost education and training at their systems’ educational centers. Similarly, OSF sends wound care specialists to train staff at SNFs in its preferred network.
Be flexible on size. North Shore-LIJ is tracking system discharges to see if 19 SNFs is the magic number for its network. Despite the importance of the affiliate network, by virtue of its size, the health system continues to work with a variety of SNFs across the region and seeks to use similar strategies that have been successful within the network.
As collaborations between health systems and post-acute providers move forward, there is a lot on the line, leaders say. Patients’ health and safety is the top priority, followed by the need to keep costs under control.
With so much at stake in these partnerships, picking the right leaders will be critical. Collaborations should be led by “people with an understanding and sensitivity toward the SNF industry,” says McClusky of North Shore-LIJ. “You need people with a strong knowledge of all the moving parts, the complexity of the continuum, and an ability to lead through change. They need to be able to go back to their teams and inspire them to sail through this uncharted territory.”
Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.
Interviewed in this article (in order of appearance): Maureen McClusky, FACHE, is executive director, North Shore-LIJ Stern and Orzac Centers for Rehabilitation, Manhasset, N.Y. Howard Guzik, MD, FACP, is senior medical director of SNF services, North Shore-LIJ Health System and the Stern Family Center, Manhasset, N.Y. Michael N. Rosenblut is president and CEO of the Parker Jewish Institute for Health Care and Rehabilitation, New Hyde Park, N.Y. Jenny Westfall is regional vice president, Franciscan Alliance ACO, Indianapolis, Ind. Joseph LaRosa, MD, MBA, is medical director, Franciscan Alliance ACO, Indianapolis, Ind. Kim Kolthoff, BSN, RN, CPUR, is director of integrated case management and clinical services, Franciscan Alliance, Indianapolis, Ind. Jay Brehm is senior vice president for strategic planning and business development, Franciscan Alliance, Indianapolis, Ind. Tara Canty is COO for accountable care and senior vice president for government relations, OSF HealthCare, Peoria, Ill. Stephen Hippler, MD, is vice president of quality and clinical programs for OSF Medical Group, Peoria, Ill.
In 2012, Franciscan Alliance ACO set an aggressive target: to create a continuing care network for post-acute care in just four months. Here are some of the key steps it took along the way.
120 days to launch
90 days to launch
60 days to launch
30 days to launch
Priority Advantage: Helping Organizations Optimize Their Medicare Advantage Plans
ROi: Delivering a Complete Provider Driven Supply Chain and GPO Strategy
TriMedx: Unlocking the Full Potential of an Organization's Clinical Assets
Grant Thornton: Providing Robust Due Diligence to Facilitate Successful Health System Mergers and Acquisitions
Xtend Healthcare: Helping Organizations Optimize Their Revenue Cycle
In this business profile, Mike Morris, president of Xtend Healthcare, discusses the value of partnering with a revenue cycle management vendor that has deep experience in delivering strong ROI.
AvaSure: Using Video Monitoring to Improve Patient Safety and Achieve Cost Efficiencies
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.