Get the E-newsletter
Alternative payment models (APMs) are being touted as a way to help the industry shift away from fee for service and toward value-based care—and, in turn, to improve the quality of health care while reducing costs. The passage of the Medicare Access & CHIP Reauthorization Act (MACRA) is incentivizing physicians and medical groups to join APMs. Although federal policy related to these models for hospitals and health systems is uncertain after the recent election, they are expected to continue in some form and to retain a significant place in commercial insurance contracts.
In this edition of the Healthcare Challenge Roundtable, senior provider and payer leaders discuss how various stakeholders can optimize APM implementation and ensure these programs have their intended effect. Participating are Paul Bolin, FHFMA, CPA, the CFO at Williamson Medical Center, Franklin, Tenn.; Ingrid Gerbino, MD, FACP, chief of primary care, Virginia Mason Medical Center, Seattle; and Dan Rosenthal, president, UnitedHealthcare Networks.
Dan Rosenthal: Value-based care can take many forms, and each one serves a purpose. At their core, these arrangements tie a portion of annual payment to quality and cost measures. In my experience, the different options break down into three main categories.
In the first, bonuses are paid out based on the provider achieving a predetermined benchmark. For example, UnitedHealthcare has a Medicare Advantage program with primary care physicians in which we've paid just under $150 million in bonuses to participants for hitting predetermined quality metrics.
Another category would be bundled payments, which revolve around managing the care of a specific condition or service line, such as joint replacement. Finally, accountable care organizations (ACOs) are another type of program where financial payments are tied not only to performance measures but to clinical-coordination activities as well.
UnitedHealthcare has about 15 million members across the country who access care from a physician who has some kind of value-based relationship with us. It's a big footprint, and it's growing.
Ingrid Gerbino: At Virginia Mason Medical Center, we have partnered with several payers to implement bundled payments for certain elective services and costly procedures that tend to have high variability in clinical appropriateness. Bundled payments for total joint replacement would be one example. We can participate in these arrangements because our organization only performs surgery if it is clinically appropriate—if the patient meets readiness criteria, such as weight, smoking status, and diabetes control, which can influence surgical outcomes. We are then able to warranty the care, and if there are any complications requiring readmission or another surgical procedure, we assume that cost.
Paul Bolin: Williamson Medical Center is just starting to get involved in these types of models, and I think that's in part because organizations in the South are somewhat slower with adoption than other areas of the country are. This is perhaps because there is a lot of vertical integration here as opposed to horizontal. Even though there is talk about how fee for service is going away, the fact is that's still my bread and butter. That said, we have started incorporating pay-for-performance mechanisms into a few of our commercial contracts.
One aspect of these new value-driving models that I appreciate is that they foster an attention to detail that didn't exist before. It used to be that physicians weren't all that concerned about whether they correctly coded or documented a complication or other situation. Now, there's usually a piece of reimbursement tied to it—most often the annual increase—so providers are paying more attention to documentation than they used to.
Rosenthal: When providers have "skin in the game," that's when these programs take off—some type of shared risk is essential for activation. The more engaged the providers, the more improvement there is in terms of quality and efficiency. So it's less about the specific payment model and more about the degree of integration and collaboration between the care-provider organization and the payer.
Gerbino: Tying incentives to quality measures is key. That said, provider teams should have compensational alignment with the overall program incentives to ensure payers and providers are on the same page, pursuing the same goals.
Bolin: It's also beneficial to have clear and complete communication about the incentives. Sometimes physicians don't exactly know what their incentives are and how they can achieve them. They don't know what they're working toward, and consequently they may underperform simply out of a lack of awareness. Organizations that address this disconnect have a better chance of success.
Rosenthal: One thing that energizes these arrangements is when the provider organization internally shares performance information that shows individuals or subgroups of physicians how they compare with their colleagues—both inside the group and with others in the market. Not only does this turn provider attention to best practices, it also promotes the principles of value-based care delivery in a more productive way than any kind of negative approach does.
Gerbino: For every payment model, there are basic structural elements that need to be in place. First and foremost, you have to be able to access timely and accurate data and reliable analytics. As a healthcare delivery system, we require access to data about the care our patients receive, and that can be difficult to get. For instance, if we're trying to control healthcare costs for a patient population for which we have assumed risk, and one of our patients goes to a hospital that's not part of our system, and we don't have access to the data from that visit, there's no way for us to reach out to the patient and help with care transitions. That puts us at risk.
If you multiply that across several hundreds of patients, you start to see the importance of timely and complete data. It gets especially complicated when a payer is hesitant to share information because of concerns regarding intellectual property. That can pose roadblocks to an already-challenging situation. As such, payers and providers must be willing to share data and work together to overcome existing hurdles.
Rosenthal: The need to share actionable data definitely comes up during contract negotiations. Actionable data is the engine that makes these programs go, and thus it is often a top focus for our provider partners. We can share data in a variety of ways based on how a care provider is set up and wants to receive the information. We try to work with each of our physician partners to get them the information they need when they need it.
Gerbino: It's also critical to have proactive and defined patient attribution. It seems like it would be simple to know which patients are attributed to which primary care providers, but it's not—obtaining this information can be quite difficult. When providers are going to be assessed on their ability to achieve certain quality metrics, and they look at their list of patients and realize that they don't know all of them—and perhaps didn't even know they were patients—it can be frustrating. If you don't know who's attributed to you until the end of a performance period, it's difficult to manage that population and that patient.
Bolin: Having transparency around attribution is absolutely crucial. Without that, it can be hard to gain physician buy-in for a program because they don't know who they're being assessed on. Fundamentally, organizations have to educate their providers on the performance metrics, make sure they are clear about attribution, and then tie incentives to quality—and this will get everyone pointing in the same direction.
Gerbino: If an organization participates in an APM as part of a provider network, there also must be strong integration across the network so the entire group can share information and understand how they deliver on quality-improvement goals. In these cases, you need systems that talk to each other. If each provider office is using a different electronic tool, that adds a layer of complexity when trying to gather outcome metrics. You also should have an established method of collaboration among the various organizations and a venue for doing that, such as shared meetings. Since every organization is a little different in how it approaches care processes and seeks quality improvement, having standardized protocols that govern the delivery of certain types of care is also valuable.
Bolin: Aligning measure definitions is also important to ensure both providers and payers are measuring the same things in the same ways. If that doesn't happen, then it can be hard to positively affect an outcome. We recently had a situation in which different payers had varying definitions of how much blood loss constitutes a hemorrhage. This led to some confusion and an uneven playing field among physicians. Working with payers at the time of contracting to clearly define metrics and expectations allows organizations to effectively shape performance improvement around the metrics.
Rosenthal: Aligning measure definitions can be challenging. Many of our provider partners want flexibility to customize metrics or select particular metrics. This lets them standardize the measures they're monitoring across all their health plan arrangements and patient populations. Striving for this level of consistency is certainly understandable. What we try to do on our end is offer a broad set of metrics. We have about 40 quality measures that we look at. Hopefully, out of those 40, we can find between eight and 12 that match up with what the care provider wants to capture.
Another issue we see is that care providers are often looking for plans designed to facilitate a strong connection between patients and the primary care provider—as opposed to more open-access attribution models. In response, we have started to introduce more plan designs with primary care selection and features. By participating in these plans, providers can engage faster with members, which is good.
Gerbino: To keep these programs moving forward there has to be transparent data sharing. As a provider, we need rich data on the patients who are sitting in front of us, and that means claims data, risk data, clinical care data, and so on. We also need to have data on the patients whom we have not seen within our organization but who yet are attributed to us. Currently, some of the data that gets shared has about a six-month lag. It goes through various channels and gets managed and processed, resulting in significant delays. To sustain APMs long-term, providers and payers are going to have to work together to find new and more-efficient methods for sharing claims and other data in a timely fashion.
There are also opportunities to boost coordination between case managers. Many payers have case managers, and provider organizations do as well. Oftentimes, these staff members are focused on the same things—managing high-risk patients and those who are living with chronic diseases. There are tremendous opportunities to learn about who's doing what and avoid role duplication. By partnering closely with payers, provider organizations can streamline care coordination and eliminate waste.
There is also room for growth within the pre-authorization process—there is a good deal of waste in this area. I think providers and payers could work together more closely to understand how to either eliminate the need for pre-authorizations or at the very least make the process more efficient.
Rosenthal: It's easy to sign a contract, but that's not where the magic is. If all of this were about signing contracts, it would not be worth it. Fundamentally, engaging in these programs is about creating value that allows us to collectively achieve the Triple Aim.
During and after contract negotiations, we continuously try to get everybody on the same side of the table and act as a collaborative partner as opposed to taking a more traditional negotiating posture. This is a journey, but something we are committed to doing.
For example, to help providers in our ACOs, we built ACO activation teams. These are multidisciplinary groups from UnitedHealthcare that work shoulder-to-shoulder with the physicians and clinical staff from the ACOs to review data and share best practices. A consistent team works on a routine, regular basis with each of our ACOs to develop relationships and create synergies between the different participating organizations. We have defined goals and objectives around rapid engagement, and we launch these teams right away—sometimes even before the contract is signed. The teams keep working together throughout the life of the program, and it's exciting to watch partnerships unfold.
We also created the role of strategic account manager. This person is focused on making sure that we're building closer relationships with care providers and that these providers are leveraging the full resources of UnitedHealth Group. Basically, this person serves as a relationship sponsor. We have deployed strategic account managers at many of the largest health systems across the country.
Bolin: All the factors we've discussed so far—challenges with data transparency, attribution, measure alignment, and so on—present hurdles that organizations must overcome to make participation in these models worthwhile. That said, I think as providers and payers start to work together, these programs will become more widespread.
Rosenthal: As a payer, we should be flexible and offer a wide range of models that can be adapted to the specific needs of the provider community with which we're working. If you have a model that makes sense for a market where providers have been taking on full population risk for a long time, and you try to apply that program to a market where providers haven't been assuming risk, it's not going to work—and adoption will slow and possibly stop.
We can also help providers look at quality across their entire practice—not just with our members. If we can assist providers in applying the collaboration and data-sharing concepts we've talked about across their entire populations—and not be payer-specific—we can work together to break down some of the historical barriers.
Fundamentally, providers and payers must commit to building stronger relationships. We need to be more transparent with each other and cultivate trust. After pursuing these goals, both parties will be more receptive to the partnership.
Value-based care is pushing payers and providers in this direction. We're moving away from the historically transactional fee-for-service approach and into a more collaborative value-based mindset.
Bolin: From a financial standpoint, I don't think fee-for-service is a viable methodology for anyone in the future, and I think we're going to see a lot of consolidation of smaller hospitals as a result. These small organizations won't be able to play well in the sandbox, and I think that's going to drive them into merging with larger entities.
Rosenthal: I firmly believe that some form of value-based care is important for every organization. That doesn't mean that providers should think full capitation is the only option. The concept of putting incentives in place to improve quality is something everybody should be able to commit to and support. This doesn't necessarily require taking on full risk; however, it does require transitioning away from the transactional mindset and toward a more outcomes-based philosophy.
As you get larger populations of people participating in these programs and as organizations become more sophisticated and have the capital to take on increasing levels of risk, then it makes sense for them to move across the spectrum of models. In the end, there's always a place for a value-based arrangement to complement—if not replace—fee for service.
Kathleen Vega is an HFMA contributing writer and editor.
Interviewed for this article:
Paul Bolin, FHFMA, CPA, the CFO at Williamson Medical Center, Franklin, Tenn.
Ingrid Gerbino, MD, FACP, chief of
primary care, Virginia Mason Medical Center, Seattle.
Dan Rosenthal, president,
UnitedHealthcare Networks, Minnetonka, Minn.
UnitedHealthcare has issued a report on how value-based care programs are affecting care quality and population health.
HealthTrust: Solving Workforce Management Challenges
Two of HealthTrust’s senior leaders talk about strategies for optimizing the hospital workforce to improve productivity and reduce waste.
Grant Thornton: Optimizing the Ambulatory Workforce
One of Grant Thornton’s senior healthcare consultants addresses the topic of workforce management and the importance of a data-driven approach.
Cedar: Reimagining the Patient Financial Experience
Cedar’s CEO and co-founder tackles the topic of patient payment and the importance of having an innovative patient financial management system.
TRIMEDX: Moving Healthcare Providers Toward Mature Clinical Asset Management
This article includes a discussion by TRIMEDX leaders about the best ways to mature a clinical asset management program.
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.