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As the only acute care option for the 17 percent of Americans who live in rural areas, rural community hospitals are a key delivery resource for health care in our country. Rural hospitals provide emergency, outpatient, long-term care, and many other services locally for residents and are key access points for larger acute care hospitals caring for sicker patients. However, due to the demographic and economic realities in rural areas, economic sustainability is becoming increasingly difficult. According to a report published by the CDC in April, rural hospitals had a higher percentage of inpatients aged over 65 (51 percent) than did urban hospitals (37 percent), and the average number of diagnoses and average length-of-stay also were lower in rural hospitals, creating an uphill reimbursement battle. Rural hospitals also often serve as entry points for higher levels of care performed at larger regional hospitals. According to the same study, patients in rural hospitals were transferred to other acute care hospitals 7 percent of the time, while urban hospitals transferred their patients only 3 percent of the time.
Over the past several years, independent community hospitals—especially those in rural communities and those not designated as critical access hospitals—have been asking themselves: When should we seek affiliation? The answer is now. However, this assertion does not mean leadership should forego seeking capital through traditional routes, or should make recommendations to the Board to seek to sell, shut down, or merge with another facility. It does mean that leaders should be considering what types of affiliation options exist and how to access the capital needed to deploy this strategy. Leaders of rural community hospitals should realize that traditional options such as the debt markets, sale-leaseback structures, taxes, and outright asset sales may not be the only path.
Leadership can fight the uphill battle against reimbursement pressure by seeking alternative types of affiliation as well. Hospital executives should communicate with their boards to educate them on these options. They should view affiliation as a type of managed integration within the delivery system as a whole. The important thing is for leaders to take an active approach to managing the current relationships that exist along the spectrum, and focus on creating new ones where they are lacking and leveraging existing networks for financial success.
Many rural hospitals have strong and productive relationships with federally qualified health centers and long-term care providers that have mutually aligned incentives and goals. These types of relationships can be extended to all ancillary services in the community, including hospice, home health, imaging, ambulatory surgery, and others. This strategy can facilitate the adoption of new payment models that emphasize clinical integration and risk-based reimbursement. Rural communities will naturally be slower to adapt to these types of care models based on geographic and demographic limitations, but rural hospitals cannot ignore these changes.
Likewise, large hospital systems and tertiary and quaternary providers that depend on independent rural hospitals for admissions should investigate how they fit into the plans of these hospitals and leverage rural care delivery systems as the low-cost and most efficient local option. The risk- and value-based models will drive large acute care facilities to integrate with local providers to reduce expenses and improve patient satisfaction. The solution for large hospitals, therefore, is not only to look at acquiring a rural facility but also to seek to understand the nuanced relationships that exist and improve integration.
When assessing integration, hospitals first need to define their role in the continuum of care. What are the services the hospital provides to the community, and what are the services that are fundamentally not feasible? For instance, hospitals that do not provide tertiary and quaternary care should understand where their patients receive this care and proactively manage the relationships with these hospitals. A merger or other formal affiliation with a tertiary or quaternary partner might be the best approach. Before deciding whether to explore such an option, however, the hospital should define and understand the relationship. Rural hospitals are fundamental as entry points for tertiary and quaternary care and often provide the highest value for the continued care a patient might receive after a tertiary or quaternary episode. Managing the integration that already exists with quaternary and tertiary partners is a good way to stay relevant and fulfill a rural hospital’s mission, vision, and values.
Peter Salisbury is a Senior Consultant, The Camden Group, Los Angeles.
Publication Date: Thursday, May 22, 2014
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
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.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
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.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
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.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
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.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
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.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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.
Copyright 2016, Healthcare Financial Management Association.
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