Browse by Topic
More than 40,000 members value HFMA's thought leadership and practical strategies. HFMA is where you need to be.
Get acquainted with the
healthcare finance industry's leading professional association. Find out why our
members rely on HFMA as their go-to source for insight and
Members have many
options for helping them advance their careers. Conferences, seminars,
eLearning, certification, and more -- our education and events will keep you
Connect the dots on today's big issues, explore collaborations, get career-boosting tips, and network with colleagues nationwide at the leading finance conference. Save $100 off the full conference rate when you register by May 8.
Real-time presentations with nationally recognized experts, networking opportunities, and industry solutions—no travel required!
Get the latest, practical education in key areas of healthcare finance over 1, 2, or 3 days. Choose Essentials Programs or Master Sessions in DC or Seattle. Register early and save $100.
If you're a subscriber to any of our three newsletters, you have access to online education. Learn more or subscribe.
Get the perspectives of leading healthcare finance professionals on today's hottest issues.
Information about leading vendors helps your buying decisions.
Forum members can network during live webinars or access a library of past webinars on topics such as bundled payment, charity care, and ICD-10.
An ever-expanding collection of spreadsheets, policies, job
descriptions, checklists, and more that you can adopt and adapt.
Forum members can submit vexing questions to a panel of experts
using our Ask the Expert service.
Your source for employment solutions.
Find new employment opportunities or
reach out to qualified candidates.
Distinguish yourself as a
leader among your peers and advance your career by earning certification in our
healthcare finance programs.
Get an objective third-party evaluation of products and services used in the healthcare finance workplace.
MAP App is a web-based application that helps organizations improve revenue cycle performance based on industry-standard metrics called MAP Keys.
Find suppliers and products in this comprehensive vendor directory for healthcare finance professionals.
Guidance for understanding and communicating about the price of health care.
Guidelines on how to make it easier for consumers to get information about healthcare prices.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
When he was leaving his post as the Centers for Medicare & Medicaid Services (CMS) administrator, Donald M. Berwick, MD, shared in an interview with the New York Times that 20 to 30 percent of healthcare spending is waste that yields no benefit to patients. Given that large amount of waste, surely, then, one would have thought that almost all of the original 32 Pioneer accountable care organizations (ACOs)—many of which are generally considered the most sophisticated healthcare organizations in the nation—should have been able to shave a few percentage points off their costs during their first year in the program and, thereby, meet or beat their expenditure benchmarks.
As we know from a July 16 press release from CMS, that was not what happened. Although every one of the Pioneer ACOs successfully reported the required quality measures, a majority—60 percent—failed to produce shared savings, missing their cost-reduction (or more accurately, cost curve bending) targets. Moreover, two of the Pioneer ACOs incurred sufficiently large losses requiring penalty payments to CMS.
Because CMS’s complicated process for establishing expenditure benchmarks incorporates the last three years of per beneficiary costs for each ACO’s population, one could contend that heretofore high-performing provider organizations are placed at a disadvantage, because they may find it increasingly difficult to wring out more savings—the diminishing returns phenomenon. In that same vein, one could say that the Medicare ACO programs are skewed in favor of poor-performing organizations and/or ACOs with high-cost populations with a lot of room for improvement. For example, according to the Kaiser Family Foundation, New Hampshire ranks ninth highest in both healthcare expenditures per capita and annual growth in health care, spending $7,830 per person in 2011. The Dartmouth-Hitchcock ACO, centered in Lebanon, New Hampshire, successfully generated $1 million in savings for CMS in the first year of the Pioneer ACO program.
Historical cost handicaps and advantages aside, is it realistic to expect ACOs to achieve their cost-reduction targets in the first year of the program, and if not, why is that the case? A majority of the Pioneer ACOs failed to meet their financial objectives, which is consistent with the experience of the Physician Group Practice Demonstration (2005-10), a precursor to the current Medicare ACO programs, in which only two of 10 participating physician groups generated shared savings in the program’s first year. Also, as Advocate Physician Partners CEO Lee Sacks and chief medical officer Mark Shields shared in a presentation at the AMGA 2013 Annual Conference in March, in terms of sequence of impact, the AdvocateCare ACO’s quality metrics were put in place in six months, but it took longer to impact the major levers of cost: length of stay (6-12 months), readmissions (12-24 months), admissions/1,000 (12-24 months), and emergency department visits/1,000 (24-36 months). The lesson: Successful cost reduction in year one is the exception, not the rule, and look for brighter days to come in year two and beyond in ACO programs.
Any parent taking children on a long car trip has fielded the question, “Are we there yet?” The most common reply is, “No, but we’re on the right road.” And so it is with the ACO journey to bend the cost curve and improve quality.
Ken Perez is a healthcare policy and IT consultant in Menlo Park, Calif.
Publication Date: Thursday, August 29, 2013
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
Scott Schmidt, vice president, Cerner RevWorks, LLC, shares insights on best practices for maximizing a revenue cycle management partnership.
©2015 Copyright Healthcare Financial Management Association
HFMA.org is best viewed using IE9 or the latest versions of Chrome, Firefox, and Safari.
Join HFMA today and enjoy: