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Kadlec Health System, a locally owned, locally governed, not-for-profit health system serving southeast Washington state, has a lot going for it. It is home to a growing open heart surgery and interventional cardiology program, it has a strong neuroscience center, and it boasts the region’s only neonatal intensive care unit. In addition, the system’s hospital, Kadlec Regional Medical Center, has earned the coveted Planetree designation for patient-centered care and was rated No. 5 in the country for patient safety by Consumer Reports in 2012.
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But as an independent health system, Kadlec faces some significant challenges, according to Rand Wortman, the system’s president and CEO. “As a stand-alone entity, Kadlec probably doesn’t obtain the highest reimbursement from the insurers. We lack the negotiating leverage of a larger network,” Wortman said during a November 2012 teleseminar. Another challenge is that Kadlec continues to compete with larger health networks for referrals. As payments across the country become more risk-based, the system will face even greater pressure to coordinate care among providers for better quality and cost control.To meet these problems head on, leaders at Kadlec have taken steps to better attract referrals into the system—and keep revenue from leaving the network. At the same time, they have started to move from a structurally integrated system to a functionally integrated system. This involves several strategies, including building better bridges between primary care physicians, specialists, service lines, and the hospital.Here are four actions they have taken along the way.
According to Wortman, physician leadership is critical to promoting functional integration, which relies on a common vision and shared trust between the medical staff and administration. Currently, Kadlec’s system board includes five physicians who help guide the organization’s vision. In addition, Kadlec’s employed physician network, Kadlec Clinic, is governed by a partnership of nine members, six of whom are physicians.Over the past several years, Kadlec has actively recruited and developed physician leaders by specialty. “Those employed clinical leaders have become champions on our medical staff,” Wortman said in a follow-up interview via email. In addition to defining clinical quality metrics throughout the organization, these physician leaders have actually helped the health system reduce friction between physicians and executives, which can stall integration efforts.While Wortman concedes that it’s more challenging for executives to have physicians as partners in governance at the board level and operational level, the result is a better organization and fewer operational silos. “Physicians can be your best ally when you’re in a tough spot, and at the same time, they keep you honest.”Today, most Kadlec physicians realize that their success depends on the success of the healthcare system, Wortman said. “In a functionally integrated system, it becomes more and more difficult to tell whether you’re in a medical executive committee meeting or whether you’re in a system business meeting because many of the issues begin to overlap,” Wortman said. “The physicians aren’t just practicing at the hospital—they are the hospital. You can’t tell where the hospital starts and stops and where the practice starts and stops.”
In addition to putting more physician leaders in place, Kadlec executives have added more physicians to the payroll. “About eight or 10 years ago, it became obvious—certainly here at Kadlec—that if we didn’t have an employment model or an employment option for physicians who were looking for a position—that we weren’t going to be able to recruit and we couldn’t compete,” Wortman said.Over the past five years, the system has acquired five existing practices and recruited new physicians into the community. Today, primary care providers represent about 56 percent of employed physicians in the Kadlec Clinic, which has 15 sites in the region. As a result, specialty dollars are staying in the system, Wortman said. “Having a strong primary care network has allowed Kadlec Clinic to attract top-notch specialists who want to be busy and to attract that market share,” he said. “We have also made a conscious capital investment in the specialty practices themselves, allowing subspecialty physicians to enhance their service offerings.”This summer, the health system will open a new $19.2 million, three-story building dedicated to outpatient specialty care. It will offer neurosurgery and neurology, endocrinology, gastroenterology, cardiothoracic surgery, and other specialty services. Hospital leaders expect the new building will lead to more collaboration and coordination between providers. In addition, Kadlec leaders plan to recruit more specialists in cardiology, pulmonology, and urology.Through these efforts, leaders at Kadlec are helping manage the referral path that runs from the primary care physician to the subspecialist to the hospital. “Managing that referral path becomes absolutely critical whether a system is in a discounted fee-for-service model or, more importantly, in some type of global capitation or risk model,” said Marc D. Halley, president and CEO of The Halley Consulting Group. In fact, measuring referrals in and out of the system can indicate whether or not a system is actually working as it should, he added. “PCPs [primary care providers] will become increasingly directive as we share additional financial risk. Referral patterns will change based on things like cost and utilization as well as service quality.”
Accountable care organizations (ACOs) and other risk-based systems tie payment to measurable outcomes. To succeed in a future dominated by these evolving payment structures, Kadlec leaders are improving care coordination, which requires better communication among providers.“The organizations that learn to integrate properly and pull all the pieces together—the organizations that have single medical records to allow all the system pieces to see as much of the patient care as possible, the systems that learn how to relate to the patient and make the patient experience better, the systems that become more efficient—those systems are the ones that are going to be the most competitive and lead in their markets,” Wortman said.To improve care coordination in the Kadlec Health System, executives have implemented a central medical record. In addition, physician network leaders have been working with the hospital’s service line managers to improve care coordination across the continuum, particularly for heart, lung, vascular, and other surgical patients. “We have hospitalists, intensivists, and pediatric hospitalists who meet with the leadership of Kadlec Clinic frequently,” Wortman said. “Communication between these hospital-based specialists and our ambulatory specialists is critical to our continued process improvement.”Kadlec executives are also looking to improve communication and care coordination with physicians outside of the system. Last year, the system entered into a strategic alliance with a public hospital, PMH Medical Center, Prosser, Wash. The agreement included a plan to bring PMH physicians and PMH Medical Center online with Kadlec’s new electronic health record, so that it would be easier for them to coordinate care with specialists in the Kadlec system.
In addition to measuring revenue and quality metrics, leaders at Kadlec are developing numerous performance measures to track their progress toward functional integration, Wortman said. These include:
Laura Ramos Hegwer is a freelance writer and editor based north of Chicago (email@example.com).
Access Halley’s and Wortman’s slides from their November 2012 webinar,From Structural to Functional Integration, organized by The Halley Consulting Group.
Interviewed for this article:Marc D. Halley is president and CEO, The Halley Consulting Group, Westerville, Ohio (firstname.lastname@example.org). Rand Wortman is president and CEO, Kadlec Health System, Richland, Wash. (email@example.com).
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In this Business Profile, Shawn Yates, director of healthcare product management at Ontario Systems, discusses the growing challenge of managing self-pay accounts and provides insight on how providers can successfully collect patient payments.
In this business profile, Cathy Smith, leader of the revenue transformation consulting practice at The Claro Group discusses how the organization helps hospitals and medical groups reimagine their revenue cycle.
In this business profile, Deloitte & Touche LLP executives Anne Phelps, principal and U.S. healthcare regulatory leader, and Daniel Esquibel, senior manager, explain ways health systems, health plans, and physician practices can prepare for MACRA.
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
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.
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.
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.
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.
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.
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.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
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.
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.
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.
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.
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.
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.
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.
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.
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 (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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
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