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One of the biggest risks for healthcare CFOs right now is underestimating the extent to which payer contracting has become intertwined with every aspect of organizational strategy.
Life was simpler in the old days. If a hospital CFO could negotiate substantial increases from private payers, and Medicare increases were reasonable, life was good. Sure, there was the challenge of managing operating costs. But it was someone else’s job to worry about market share, quality, physician alignment, and countering competitors.
Now, contracting is a multifaceted strategic endeavor. Each contracting decision is complex, and success depends on multiple stakeholders. Even Medicare, the low-paying but dependable bastion of simple contracting, has pushed complicated questions on hospitals: Should we do a bundled payment pilot, or an ACO deal? How can we avoid readmission and quality penalties?
Whether you are talking about risk arrangements, shared savings, bundled payments, pay for performance, or tiered networks, there are several questions to consider beyond the direct contractual results.
Can we strengthen our relationships with physicians through this contract? A contract that gives physicians greater financial opportunity with your hospital or health system could help align physician interests and better secure physician loyalty. Many new payment arrangements open the door for greater sharing of incentives with physicians (all subject to regulatory requirements, of course). Healthcare organizations that don’t create these opportunities for affiliated physicians may lose out to those that do.
Can we reduce operating costs? With Medicare increases below 1 percent, and pressure from private payers, reducing operating costs is an imperative for almost every hospital. Some payer arrangements, like bundled payments, can engage physicians in smoothing clinical workflow and reducing supply chain costs. Although the contracts may apply to a fraction of total patients, the benefits of cost reduction may accrue across all patients as physicians adjust their approaches.
Can we retain or grow market share? In payment models designed to reduce utilization, shared savings and other incentives rarely make up for lost hospital revenue. So why consider these options? Assume someone is going to squeeze down unnecessary utilization. It could be a competing hospital’s ACO or a physician network’s ACO, or primary care physicians with patient-centered medical homes.
To offset volume lost due to reduced utilization, look to better coordination of care. It can reduce leakage for follow-on care, keeping more patients at your hospital.
Healthcare organizations need to apply a strong analytic structure that compares these factors across all different types of payment models. A colleague and I discuss one such structure an article published in the April 2013 issue of hfm, “The Transition to Emerging Revenue Models.”
John Harris is a principal, DGA Partners, Bala Cynwyd, Pa., and a member of HFMA’s Metropolitan Philadelphia Chapter.
Publication Date: Thursday, October 31, 2013
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
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.
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