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Ted Wymyslo, MD, has a tough task. As chief medical officer of the Ohio Association of Community Health Centers, his central role is to enhance the workforce at the state’s 49 federally qualified health centers and to expand use of the patient-centered medical home (PCMH) model of care.
“What’s my biggest challenge? It’s finding primary care providers,” Wymyslo says. “It’s the weak link in this whole chain. All these great ideas, new care models, and payment reforms don’t turn into anything if primary care workforce needs aren’t met. And providers are much more effective if they’re practicing comprehensive primary care.”
Indeed, as the healthcare industry continues to shift from volume to value, the workforce has to evolve as well, particularly with cost and care quality in mind. New models of care and payment, a focus on population health management, a growing emphasis on behavioral health, and an aging, more diverse population are changing workforce requirements, necessitating the development or repositioning of traditional roles in primary care.
In addition to the challenge of providing appropriate education and training for healthcare professionals, healthcare organizations also face issues with clinician shortages (see the exhibit below) and funding that may hamper their ability to optimize their workforce. Organizations can use various strategies to prepare their workforce for value, but stakeholders say long-term solutions involve improving collaboration across the spectrum of health care, including among providers, health plans, state and federal agencies, and educators.
Projected Physician Shortage Through 2025
The drive to lower costs while providing better care and meeting the needs of a diverse group of patients has required a reengineering of care. Value-based care models such as the PCMH are designed to provide seamless care via teams of providers who coordinate care along the continuum.
Processes and tasks that once were the domain of physicians only or were not part of primary care at all are being delegated to physician assistants and nurse practitioners, along with case managers, clinical care managers, and relatively new roles such as patient navigators, health coaches, and community health workers.
Physician assistants and nurse practitioners. These roles have become more prevalent as providers seek ways to enhance the quality of care and patient satisfaction in addition to making care more cost-effective According to the Bureau of Labor Statistics (BLS), nurse practitioners (grouped with nurse anesthetists and certified nurse midwives) and physician assistants are among the fastest-growing occupations nationwide, with expected growth between 2014 and 2024 of 35 percent and 30 percent, respectively.a
Patient navigators. This role has become more prominent at both primary care and specialty practices as a resource for patients winding their way through an often complex and confusing healthcare system.
“The most important characteristic of a patient navigator is the ability to effectively serve as a broker between the patient and the system,” says Mandi Pratt-Chapman, MA, associate center director of the GW Cancer Center, part of the GW School of Medicine and Health Sciences at The George Washington University in Washington, D.C. “Your ideal navigator would be someone who understands the culture of many of their patients, what their lives are like, and also understands the needs of the healthcare team.”
Although registered nurses fill many patient navigator roles, non-licensed staff are becoming a more significant part of the care team, especially for logistical coordination, patient advocacy, and support. At the GW Cancer Center, patient navigators help identify insurance plans and co-pay assistance for eligible patients, arrange transportation to appointments, obtain missing information on referrals so patients are not turned away, and smooth the authorization process for patients to receive necessary treatments.
Other patient-support roles. These roles include health educators, who teach and promote community wellness; and community health workers, who work on health issues with specific populations or communities. According to BLS, the number of health educators and community health workers is expected to grow by 15,600, or about 13 percent, from 2014 to 2024.b
“The other important roles for non-licensed team members would be parent advocates and peer advocates,” says Jean Carlevale, RN, a healthcare consultant with Commonwealth Medicine, the public service consulting and operations division of UMass Medical School, Shrewsbury, Mass. “There’s an incredible value to be gained by adding peer support for individuals and families coping with severe and persistent mental illness to the primary care team. To have with you a peer or a parent advocate who’s been through it, there’s a tremendous amount of evidence that the outcomes are better and your experience of care is better.”
Telehealth. Skill in virtual care is also becoming more important as telehealth gains momentum in the drive to enhance the value of care.
“We believe a significant portion of our workforce must be retrained to do virtual care,” says Randy Moore, MD, MBA, president of Mercy Virtual, the telehealth organization of Chesterfield, Mo.-based Mercy. Moore predicts that in five years, about 30 to 50 percent of primary care encounters at large organizations such as Mercy will be virtual-based.
About 500 FTEs at Mercy Virtual—ranging from physicians, nurse practitioners, registered nurses, and patient navigators to those in nonclinical roles—work primarily in virtual care. The telehealth employee learns how to effectively integrate data and analytics supplied by technology that monitors patients, how to work collaboratively with a team member who is in a separate location—and even how to be effective on camera, the communication vehicle used for patient encounters and clinical collaborations.
Even clinicians in Mercy’s intensive care unit (ICU) rotate through virtual care as part of their training. “During their training rotations within the tele-ICU unit, they progressively learn how virtual care complements care at the bedside,” Moore says. “And when they’re at the bedside, they’re also interacting with the virtual care team.”
Mercy has added virtual care to bedside-nursing roles. Onboarding an ICU nurse in virtual care, for example, requires about two months of training. This concurrent experience enables nurses to determine which functions are best performed at the bedside and which are best done virtually, Moore says.
Incorporating these new and reengineered roles into the healthcare workforce can be challenging given issues such as training requirements, clinician shortages, and funding deficiencies.
If value-based care demands coordinated, team-based care, but physicians, care managers, and social workers are schooled only in the fee-for-service (FFS) model, then value cannot be achieved. Those skills are often lacking in clinical education.
Carlevale says medical, social work, and nursing schools, along with other clinical institutions that provide education for healthcare professionals, have not embraced interdisciplinary training despite evidence that team-based education is critical for enhanced care. “Our learning institutions aren’t producing clinicians at every level who actually are trained in a team-based model,” she says.
As an example, Carlevale says, nurses are generally trained in a specialty such as psychiatry or geriatrics. “But these newer models are demanding that you understand chronic diseases and the patient’s needs as they move through the continuum of care,” she says.
That may leave the education of care coordinators to the provider organizations. “Health systems have taken on a commitment to the education of providers, including nurses—specifically targeting the skills that are needed to work in this new kind of environment, where performance is linked to a series of patient-related quality metrics and ultimately to payment,” says Bobbie Berkowitz, PhD, RN, NEA-BC, FAAN, dean of Columbia University School of Nursing, New York City.
Perhaps the issue felt most acutely across healthcare organizations is how to fund these new roles and approaches. Breaking down the silos of FFS care to deliver care across a continuum may improve quality, but it also leaves a funding gap. Many of the new roles have no billing codes associated with them and are not reimbursed.
“I don’t advocate for billing piecemeal for those services,” Pratt-Chapman says. “I don’t think going back to a fee-for-service model where volume is rewarded is the way to go. But I do think we need to pay attention to research results showing the impact of patient navigation, the impact of patient-centered care. It does save money and improve the quality of care. Creating adequate bundled payments or global payment structures that compensate providers for the real costs of patient navigation and care coordination is what we need to ensure sustainable infrastructure for value-based care.”
Staffing, training, and funding may present considerable obstacles to securing a value-ready workforce, but healthcare organizations are pursuing various strategies for surmounting those obstacles.
A telehealth workforce may solve some of the clinician shortage issues. Mercy Virtual employs “electronic” sitters who monitor patients across multiple locations. One trained technician can monitor four to 10 patients virtually as opposed to a single patient at the bedside, Moore says.
“We believe as the market goes toward value that our ability to really drive significant increase in efficiencies and effectiveness is going to go up significantly, as is the impact of each team, which may significantly mitigate what people see as the looming shortages in different areas,” he says.
The use of advanced practice registered nurses such as nurse practitioners can help relieve the shortage of primary care physicians, Berkowitz says. Utilizing nurse practitioners to the full scope of their license can improve patient outcomes and optimize the healthcare workforce, she says, but the state-by-state approach to regulating scope-of-practice remains a challenge.
Pratt-Chapman says using non-licensed healthcare workers also can help clinicians work at the top of their license and produce more cost-efficient care. She references a study recently published online in JAMA Oncology showing that nonclinical navigators used by the University of Alabama Health System’s Cancer Community Network for geriatric patients saved the system about $780 per patient per quarter, for an estimated $19 million in annual savings.c “At GW Cancer Center,” Pratt-Chapman says, “our patient navigators often identify insurance products that patients do not know they are eligible for, reducing uncompensated care for the cancer center and putting treatment within the reach of patients.”
Ensuring that patient navigators are trained to effectively serve as brokers between patients and the healthcare system has been a top priority for Pratt-Chapman. “These allied health professions, these support roles, are critical to help make physicians and nursing roles more efficient, but they need training. For patient navigators, we developed free competency-based training that anyone with Internet access can complete to ensure their foundational knowledge as a patient navigator,” she says.
Addressing the root of the problem, however, most likely requires innovative collaboration among providers, health plans, academic institutions, and state and federal agencies.
On the health plan side, Humana provides physician practices with support in areas such as care coordination, value-based capabilities, wellness, care delivery, and behavioral health, says Mike Funk, vice president for thought leadership in the Provider Development Center of Excellence at Humana.
“We have been focused on a number of initiatives to assist physicians and their office staff in meeting the demands of today’s workplace,” Funk says. “While it may still appear very disconnected, there is a tremendous amount of work taking place to develop a more connected, seamless, efficient, and effective healthcare system that simplifies and integrates healthcare delivery.”
For example, Humana reimburses telehealth services under certain plans in some rural areas and some areas that are experiencing clinician shortages.
Carlevale strongly advocates incorporating interdisciplinary team-care training at medical schools and in other clinical educational and training programs. She also supports the idea of establishing a consortium integrating multiple stakeholders to address the need for value-based training and the funding of such training and roles in the clinical setting.
“I would really encourage everyone to think outside the box,” Carlevale says.
Wymyslo used a $2.68 million state subsidy to fund training for medical and other clinical students who work at Ohio community health centers that are also qualified PCMHs. In the first year of the subsidized program, 900 students were trained at 35 health centers, Wymyslo says.
“Students are getting the chance to see comprehensive team care provided to patients that considers their biological, psychological, and social needs,” says Wymyslo, a former director of the Ohio Department of Health and a practicing physician who ran a family practice residency program for about 20 years. Medical students in the training program work not only with physicians but also with advanced practice nurses, dentists, social workers, and even front- and back-office staff to attain a holistic understanding of the clinical and operational aspects of a practice, he says.
Wymyslo says the next step is for graduate medical school education to incorporate comprehensive primary care training.
Berkowitz says graduate-level nursing education, the focus of nursing education programs at Columbia, often encompasses such training. The school of nursing has recently developed a tailored master’s program for its partners at NewYork-Presbyterian. The program is designed specifically to focus on evidence-based nursing practice and on preparation for care coordination, team-based care, and care transitions.
“Those partnerships are really ideal because we can work together to make sure we’re creating clinicians who are relevant to current practice,” she says. “It’s a challenge, of course, but I think it’s a new direction that is essential.”
Karen Wagner is a freelance healthcare writer based in Forest Lake, Ill.
Bobbie Berkowitz, PhD, RN, NEW-BC, FAAN, dean and professor, Columbia University School of Nursing and Sr. Vice President of the Columbia University Medical Center, Columbia University, New York City;
Jean Carlevale, RN, program support, Commonwealth Medicine, UMass (University of Massachusetts) Medical School, Shrewsbury, Mass.; Mike Funk, vice president, Thought Leadership, Provider Development Center of Excellence, Humana, Louisville, Ky.;
Randy Moore, MD, MBA, president, Mercy Virtual, Chesterfield, Mo.;
Mandi Pratt-Chapman, MA, associate center director, Patient-Centered Initiatives & Health Equity, GW Cancer Center, GW School of Medical and Health Science, The George Washington University, Washington, D.C.;
Ted Wymyslo, CMO, Ohio Association of Community Health Centers, Columbus, Ohio.
a. “Fastest Growing Occupations,” Occupational Outlook Handbook, 2016-17 Edition, Bureau of Labor Statistics, U.S. Department of Labor, Dec. 17, 2015.
b. “Health Educators and Community Health Workers,” Occupational Outlook Handbook, 2016-17
Edition, Bureau of Labor Statistics, U.S. Department of Labor, Dec. 17, 2015.
c. Rocque, G.B., Pisu, M., Jackson, B.E., et al., “Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer,” JAMA Oncology, Jan. 26, 2017.
Change Healthcare: Accelerating Revenue Cycle Transformation
Jason Williams, vice president for strategy and business analytics, Change Healthcare, discusses the importance of technology and technology-enabled services in reinventing the revenue cycle.
Ensemble Health Partners: Driving Revenue Cycle Innovation
Judson Ivy, president of Ensemble Health Partners, discusses the value of revenue cycle outsourcing and the importance of selecting the right partner.
Grant Thornton: Facilitating EAM
Priority Advantage: Helping Organizations Optimize Their Medicare Advantage Plans
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
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5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
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5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
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Providers Focus Too Much On Revenue Cycle Management
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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
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Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
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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.
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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.
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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.
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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.