Healthcare organizations are using a number of key strategies to improve care coordination:
When patients are admitted to Bassett Medical Center in Cooperstown, N.Y., their primary care physicians are notified by email. When a patient is discharged, another email is sent-and the patient goes home with a toll-free number that rings into Bassett's case management department.
Having a phone number to call helps patients feel like the hospital cares about them-and may prevent an unnecessary trip to the emergency department or the misuse of a medicine that causes a new medical problem, says Ronette Wiley, Bassett's vice president of performance improvement and care coordination. "They can call this number and have their questions answered."
A few decades ago, hospital leaders rarely worried about coordinating care with other providers. Today, however, everyone understands that good patient outcomes require teamwork among many kinds of caregivers-and hospitals are often expected to serve as the quarterback. The launch of bundled payment, accountable care organizations (ACOs), and other payment and delivery system changes have also created a business imperative for care coordination.
The following four case studies illustrate various ways that providers are approaching this new paradigm.
Norton Healthcare, a five-hospital system serving Kentucky and southern Indiana, is operating one of the nation's first ACOs. It was chosen as one of five pilot sites for the ACO Learning Network, which is headed by the Engelberg Center for Health Care Reform at Brookings Institute and the Dartmouth Institute for Health Policy and Clinical Practice.
ACOs are groups of hospitals, physicians, and other providers that share responsibility for providing coordinated care to a particular population of patients. The Norton pilot, which started in June 2010, includes roughly 10,000 patients, all of whom are employees of either Norton Healthcare or Humana- two of the three largest employers in the Louisville area. Patients were attributed to the ACO if they had used a Norton facility or visited one of its physicians in the year before the ACO started.
"It made a good testing ground for us because we have such a large population base of employees," says Norton CFO Michael Gough.Improving quality and efficiency. Norton is well-positioned for the ACO model because it has employed primary care physicians for the past 15 years, says Gough. More recently, Norton began hiring specialists, and it currently employs nearly 550 physicians. All are paid based on productivity with financial incentives for hitting quality and efficiency goals.
"This model has worked well for us," he says. "The physicians are largely happy, and we have high patient satisfaction. The key to this whole thing is having the physicians on a production model. Basically, if they don't work much, they don't get paid much. If they want to work really hard, they get paid a lot."
That alignment between the health system and its physicians is important to Norton's ability to target quality and cost improvement goals. For example, Norton has asked its physicians to prescribe generic drugs when appropriate and to avoid unnecessary radiology images for patients complaining of lower back pain. Both these metrics improved within one year of the ACO's launch (see the exhibit below). Improvements were made in other quality measures as well. For example, the percentage of patients with diabetes who had recommended blood sugar testing increased from 87.7 percent to 93.4 percent.
Equally noteworthy, the ACO appears to be curtailing costs. As a self-insured employer, Norton has slowed the growth of its healthcare expenditures, says Gough. "In fact, it's almost flat. Our FTE count is up about 6 percent, and our health insurance expense year over year is up about the same," he says. "That's pretty successful."Piloting care coordination approaches. Another way Norton is reducing costs is through care coordination. Norton is piloting the use of nurse navigators in five of its largest primary care practices, says Ken Wilson, MD, the system's vice president of clinical effectiveness and quality. The nurses are working with patients who were recently discharged from a Norton hospital and have one or more chronic condition (i.e., congestive heart failure, diabetes, chronic lung disease, and pneumonia).
"These nurse navigators are targeting those transition of care problems that research shows impact whether a patient is at risk of being readmitted to the hospital," says Wilson.
The registered nurses ensure appropriate and timely follow-up care for high-risk patients, complete previsit chart reviews, and use chronic disease and prevention protocols to identify diagnostic and preventive care needs. The nurses assist patients and families in developing and adhering to self-management plans-and frequently interact with the patients to make sure they are complying with the plan.Stepping toward bundled payments. The ACO model was created to solve the problem of disjointed and redundant patient care by establishing financial incentives that reward highly coordinated care-specifically, the opportunity to "share savings" achieved for the payer.
Under the terms of its shared savings contract, Norton is expected to reduce the costs of caring for patients in the ACO by at least 2 percent in the first year. Norton and Humana share any savings beyond that amount. Norton-as the provider-receives 40 percent of the shared savings, and Norton and Humana-as the payers-receive the remaining 60 percent.
Norton expects its shared savings contract with Humana to be a financial winner for the health system, but the care delivered to ACO patients will not be any different than that for patients in the traditional payment system.
In fact, physicians do not know which patients are in the ACO. Wilson says physicians would consider it unethical to apply one standard of care to ACO patients and another to patients outside the ACO. "We apply all the new interventions to everybody," he says.
Gough believes the shared savings model-which incentivizes providers to focus on care coordination, quality, and efficiency- will help Norton transition to a future in which providers are paid for bundles of care. "We don't view the ACO as an end. We look at it as a means to the end," he says.
Both shared savings and bundled payment models reward providers for improving quality while holding down costs, explains Gough. But an ACO succeeds only if it can reduce the rate of healthcare cost growth year over year-and after a while, the opportunity to generate increasing savings will hit a plateau.
By contrast, in the bundled payment model, providers differentiate themselves in the marketplace by offering bundles of services for specific conditions-such as joint replacements or cardiac procedures-with price and quality guarantees, says Gough. Thus, the bundled payment model offers unlimited potential for a health system to compete for greater market share.Following Norton's lead. Gough advises health system executives not to jump on the ACO bandwagon too quickly because it can create an unnecessary level of risk. For just this reason, Norton decided not to contract as an ACO through the federal government's Medicare Shared Savings Program.
"It helps to start slow and not big," says Gough, who thinks that health systems should experiment with the ACO model using their own employees. "It helps to work out all the kinks before we go out into the marketplace."
Gough's second bit of advice: Recognize that changing the way care is delivered is more important than changing the way it is paid for. Norton's physician leaders worked with Humana's medical directors to design their ACO contract, with financial executives contributing on an as-needed basis. "If you ask me, the key to success is having physician leadership in place, because they have to change the care models," he says. "Administrators can't do that, and finance folks can't do that."
To date, many of the new healthcare models, such as ACOs and patient-centered medical homes, are being tested by health systems and physician groups that are bound together by common ownership or another close affiliation-making them mutually incentivized to improve patient care. Participating physicians are typically members of large groups that use standardized protocols and pay-for-performance plans to influence physician behavior.
But going forward, that arrangement may not always be the case. Michael Richter, MD, a pediatrician and internist in Queens, is one of 2,500 independent physicians participating in an electronic health record (EHR) initiative that is creating a "virtual" healthcare system in medically underserved areas of New York City. Collectively, participants in the Primary Care Information Project (PCIP) serve nearly 2 million patients, or one quarter of the city's population.
As a solo practitioner, Richter enjoys a level of independence that is rare in medical practice today. He makes house calls to homebound patients. His black Labrador, Bartlet, accompanies him to the office. And his vacation photographs and favorite poems are posted on his practice's website.
The suggestion that solo practice is a dying business model both surprises him and moves him to indignation. "Who is saying there will be no self-employed physicians?" says Richter. "I disagree with that 100 percent."
For one thing, patients "are currently knocking my door down here," he says, and when more patients get insurance or Medicaid coverage in 2014, demand for primary care services will only grow. For another, Richter expects that his practice will become even more financially successful in the years ahead-in many ways because of his robust use of PCIP's EHR system.
He is seeking recognition as a patient-centered medical home and working to become part of an independent physician association and an ACO. He recently received a check from the federal government for achieving EHR meaningful use in the first year of the incentive program.
He can prove to insurers that he is doing a good job of providing preventive care services to his patients-and how he compares with his peers. And he is helping New York City's public health department quickly identify flu outbreaks and monitor trends in HIV infection and other public health problems.
"The solo practitioner who is part of a group-with or without walls-is going to be fine," says Richter. "And I'll tell you what else. There are initiatives coming down the line for doctors to actually be the organizers and be the insurers. Doctors are getting more and more involved in the business of medicine."Networking virtually. The PCIP, a New York City mayoral initiative, is run by the city's Department of Health and Mental Hygiene. The project, which won a 2011 Davies Award from HIMSS, has created what it calls a "virtually integrated healthcare system" of more than 470 independent small practices, 34 community health centers, and four hospitals (see the exhibit below).
Through the PCIP, Richter-like his 2,500 colleagues-was able to purchase an off-the-shelf EHR system at a big discount. He also received extensive EHR training and support, which has helped ensure that he and his staff members can take full advantage of the EHR's functionality.
PCIP physicians each maintain their own EHR system; they cannot access patient records from other PCIP providers. But the virtual network enables physicians to communicate easily and coordinate care- either by automatically faxing medical summaries, laboratory values, and progress notes to one another or by sending structured data directly into another physician's progress notes when a referral is made. Additionally, the patient portal feature of the EHR allows patients to access their medical information from any Internet-connected computer.
"If a patient is in a specialist's office and the specialist has a question, the patient can go to the patient portal and say, 'Here is my information,'" says Richter. "The doctor can see whatever he or she needs to see."
The PCIP is designed to improve patient care through the EHR's clinical decision support function that prompts physicians to remember preventive and chronic care recommendations, particularly for hypertension, diabetes, and smoking. Physicians can also see how their performance compares to their peers' on various quality and EHR meaningful use metrics via personalized performance dashboards they receive from PCIP (see the exhibit below).
Since its inception in 2007, the project has cost more than $85 million and has been funded by local, state, and federal governments and philanthropic grants. A formal ROI analysis has not yet been completed, but data indicate that patients served by PCIP providers are now more likely to receive recommended preventive and chronic care. Compliance with six evidence-based recommendations-such as blood sugar screening for diabetic patients and blood pressure control for patients with hypertension-has increased by at least 5 percentage points among PCIP physicians. PCIP staff members estimate that the improvement in just one measure-blood pressure control-is averting heart attacks and strokes that reduce costs by $17.16 per patient per year.
The PCIP project is also encouraging electronic prescribing among physicians, which is known to reduce adverse drug events. In addition, because the system prompts physicians to consider generics when appropriate, electronic prescribing is estimated to reduce costs by $39 per patient per year.Bringing solo practitioners on board. The PCIP's most impressive accomplishment might be in figuring out the mix of financial and logistical support needed to turn independent physicians into robust users of EHR technology. When he attended the PCIP's first presentation, Richter was not particularly swayed that computerization was essential. But the fact that the city was putting so much effort into the initiative did get his attention.
"I went to another meeting, and I thought to myself, 'If the city is spending that kind of money to get doctors to adopt electronic records, this is probably something that is important,'" he says. "I found out that I was not only getting a discount of $4,000 for the software, the training, and a two-year license, but also that the insurance companies were going to reimburse me for some of that cost."
Jonathan Mohrer, MD, another primary care physician in Queens, was among the first PCIP participants to meet the federal government's criteria for meaningful use of EHR technology and to earn the incentive check that brings.
The logistical support from PCIP staff that he received was essential to his success. "Without them, I don't think I would have been able to do this," he says. "They spent a lot of time with me, sending out people just to make sure that I'm doing the right thing, making sure that I'm sending electronic prescriptions properly, and that I'm connecting and giving reports in certain ways."
Effective Oct. 1, 2013, hospitals with higher-than-expected readmission rates for patients with certain conditions will face financial penalties. When that day comes, Bassett Medical Center, a 180-bed teaching hospital in Cooperstown, N.Y., will be ready. Beginning in late 2009, a multidisciplinary team at Bassett began devising and implementing strategies to help high-risk patients make a smooth transition when they leave the hospital.
Ronette Wiley, vice president of performance improvement and care coordination, says the group's focus was more on improving patient care than on reducing readmissions. But it seems the two go hand-in-hand: Bassett's 30-day readmission rate for high-risk patients fell from 13.4 percent in 2009 to 3.1 percent in 2010.
And that success comes with a bonus: On the HCAHPS survey question about discharge planning, Bassett consistently scores within the 98th percentile compared to hospitals nationally.Targeting specific patients. Bassett started improving care transitions by targeting a specific population of patients. At the time of admission, nurses administer a screening tool-developed by the Society of Hospital Medicine-to identify patients who are at high risk of being readmitted within 30 days. The screening tool evaluates eight specific points:
All high-risk patients receive two interventions that have been proven effective in reducing readmissions: a follow-up phone call within 72 hours of discharge and a follow-up appointment with a physician within seven days of leaving the hospital. Bassett nurses have also been trained in teach-back methods, which is a patient education approach that encourages patients to repeat back healthcare instructions in their own words. This approach helps nurses verify that patients understand their care plans and what they need to do after discharge.
Bassett also created a new position-patient services coordinator-to make the phone calls, using a script designed to elicit information about whether patients have filled their prescriptions, are using their medicines correctly, and have a primary care visit scheduled. If the coordinator identifies potential problems, he intervenes.
Komron Ostovar, MD, the hospitalist in charge of Bassett's Care Transitions program, says the coordinator previously worked in an administrative position at the hospital. He was chosen because his work experience at Bassett has allowed him to develop a network of relationships that can benefit patients. "The coordinator uses that network to help make appointments and navigate for these patients," says Ostovar. "Most important, the patient services coordinator was able to establish a relationship with some of the schedulers in primary care clinics to help get patients seen sooner than they otherwise would have been."
Two other discharge supports:
Getting started. Despite Bassett's impressive results, reducing readmission rates is difficult work and hospitals should expect slow but steady progress, says Wiley. She encourages hospitals to establish process goals-for example, the percentage of patients who already have a physician's appointment scheduled at discharge and the percentage of patients who receive a follow-up call within 72 hours-to stay focused on continual improvement.
Another key to success, she says, is finding the right physician leader. In Bassett's case, Komron Ostovar, MD, has been a tireless champion for the program to his hospitalist colleagues and everyone else in the organization. "It certainly helped us get a lot of credibility for this project upfront with our board of trustees and our senior leaders," she says. "It helps keep the enthusiasm for the work alive."
When hospital patients go to a skilled nursing facility before they return home, coordinating their care becomes more complex because another set of caregivers gets involved. Recognizing that nursing facilities can be a differentiating factor in a patient's successful recovery, Aetna and Genesis HealthCare, a post-acute care provider, are using a shared savings quality incentive program designed to prevent avoidable readmissions to the hospital.Focusing on care transitions. The contract builds on Genesis' transition-to-home program, in which case workers follow patients for 30 days after they are discharged from the nursing facility at many locations. "For acute care health systems to be successful, they are going to need post-acute providers that can partner with them in meeting their clinical objectives-and of course, rehospitalization reduction is No. 1 on the list," says Paul Bach, Genesis HealthCare's Central Area president. "By positioning our services to focus more attention on rehospitalization reduction and care transitions, we give the hospital and health systems a reason to partner with Genesis in caring for its patients."
That sounds good to Aetna. The contract, which went into effect last spring, covers 141 Genesis skilled nursing facilities in seven eastern states. Aetna and Genesis intend to decrease the number of patient readmissions from these facilities by 10 percent to 20 percent over the next several years. That would translate into up to $2 million in medical costs saved each year.
Genesis' performance will be based on Aetna's claims data, says Bach. A preliminary review of Genesis' own data suggests that the initiative is working. "We're optimistic, from what we can see internally, that we are beginning to reduce the rate of rehospitalizations."Keeping patients out of the hospital. As part of this relationship, Genesis made infrastructure improvements that include establishing a cardiac care management services program for patients with heart disease and congestive heart failure and expanding its rehabilitation services to either six or seven days a week. Both efforts are designed to speed patients' recovery, which decreases the likelihood of a return to an acute-care facility.
Additionally, Genesis is selectively employing physicians and nurse practitioners rather than contracting out for those services, which is typical for skilled nursing facilities, says Bach. Its goal is to better control the level of care that those professionals provide to Genesis patients.
By employing physicians and nurse practitioners, Genesis increases its ability to diagnose and treat patients onsite, says Bill Stout, Aetna's head of national contracting. "Say we have a post-acute joint replacement patient with pneumonia comorbidity. Rather than sending that person to the hospital for treatment, we expect that patient to get treated right there at the Genesis facility, rather than having to do a transfer," he says.
Genesis also recently started accepting admissions around-the-clock. "If one of our members hits the emergency department but does not meet acute care criteria for admission, we want the Genesis facility to be available on a subacute basis, so that the member gets to the right place for the right level of care," says Stout.
Meanwhile, Aetna and Genesis worked together to develop an expanded discharge planning and education program. The goal is to ensure that patients and their families know what to expect after discharge-and have arranged for the support needed for a successful transition to home.
Genesis ensures that, before a patient is discharged from a nursing facility, community-based services have been arranged and an appointment with the patient's primary care physician has been scheduled. After discharge, patients receive calls from a Genesis nurse to ensure that there are no gaps in services or additional needs.
"We want to see how they're doing in transitioning to home and make sure the arrangement for home care and medical equipment was satisfactory," says Bach.
Highly coordinated care has long been linked to better patient outcomes, and now the business rationale for investing in care coordination is strengthening as healthcare organizations identify ways to reduce costs per patient encounter. "Over time, if we are doing the right thing for patients, that is how we will be known and that will become a key driver in terms of business," says Norton Healthcare's Ken Wilson, MD. "In my opinion, we providers will become increasingly accountable, not only for the quality and safety of care, but for at least some portion of the cost of that care. All of those things fit together."
Interviewed for this article (in order of appearance):
Michael Gough is CFO, Norton Healthcare, Louisville, Ky. (email@example.com).
Ken Wilson, MD, is vice president of effectiveness and quality, Norton Healthcare (Ken.Wilson@nortonhealthcare.org).
Michael Richter, MD, is a pediatrician and internist, Queens, N.Y. (firstname.lastname@example.org).
Jonathan Mohrer, MD, is a primary care physician, Queens, N.Y. (email@example.com).
Ronette Wiley is vice president of performance improvement and care coordination, Bassett Medical Center, Cooperstown, N.Y. (firstname.lastname@example.org).
Komron Ostovar, MD, is a hospitalist, Bassett Medical Center (email@example.com).
Paul Bach is central area president, Genesis HealthCare, Kennett Square, Penn. (Paul.firstname.lastname@example.org).
Bill Stout is head of national contracting, Aetna, Hartford, Conn.
The Claro Group: Partnering for Performance Improvement
In this Business Profile, Larry Volkmar, a managing director in the performance improvement
practice at The Claro Group, discusses key strategies for improving
clinical and financial performance.
Deloitte: Taking Data Analytics to the Next Level
In this Business Profile, Christine Santos, chief of strategic business analytics for
Providence Health Services and Chris DeBeer, principal at Deloitte
Consulting LLP explain the value of enterprise data analytics.
PatientMatters: A Patient-Centered Financial Experience
In this Business Profile, Sheila Schweitzer, founder and CEO of PatientMatters, offers insights
on ways hospitals and healthcare systems can address rising patient
Cerner RevWorks: Helping Providers Boost their Bottom Line
In this business profile, Jason Rawlings, vice president ambulatory
and revenue cycle for Cerner talks about leveraging third-party
management services to improve revenue cycle health.
The Claro Group: Transforming Clinical Documentation Improvement
In this business profile, Tim Marshall, managing director at The
Claro Group, discusses the value of rethinking and retooling clinical
Ontario Systems: Maximizing Self Pay Collections
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.