Get the E-newsletter
Some of the most transformative strategies in health care, including the transition to population health management and integrated care delivery networks, rely on achieving interoperability among stakeholders. Although significant progress has been made in recent years, the obstacles remain
For this edition of the Healthcare Challenge Roundtable, leaders with a medical group, health system, and health plan shared their thoughts on the latest trends, challenges, and signs of progress in the interoperability push. Participating were Keith Fernandez,
MD, national chief clinical officer, Privia Health; Stan Huff, MD, chief medical informatics officer, Intermountain Healthcare; and Kim Sinclair, chief information officer, BMC HealthNet Plan.
Stan Huff: The
best way probably is just by analogy. With a gaming system, I can buy a different controller than the one that came with my game. I just plug it in, and it’s aware of what system it’s being plugged into. I might need to tell it what my preferences are, whether I’m lefthanded or righthanded. But it works
out of the box.
In health care, the analogous situation is that I could have a piece of software, and it can be used in anybody’s electronic health record or any health system. It might need to be configured a little bit to know whether I’m an obstetrician or a cardiologist, for example, but it just works.
And it works because it knows and understands the data, and the workflow of the clinicians. That’s true interoperability.
Keith Fernandez: To
me, interoperability from a clinical standpoint refers to the ability to exchange information between data platforms in a way that makes that information first, available to providers; second, easily found; third, in the workflow of the user; and finally, able to trigger an outcome to create change
for the better.
There are people who judge progress towards interoperability a little bit differently. With many organizations having one or more of those capabilities but very few having all four, they would say if you had two of those things, you’d probably have a good case for having significant
interoperability. That’s a much less clinical definition because I’d say if I have two of those things, but I can’t impact an outcome, that’s great but it didn’t change anything that happened with the patient.
Kim Sinclair: I
think interoperability in health care is the ability to share and exchange data in a way that makes health care more efficient and meets the needs of the patient.
We will know we’re there when the discussion shifts from what data is available and what system it’s in to how we maximize the data and what we can learn from it. But I don’t feel like we’re there yet. It’s too much of a focus on specific data elements and what you can provide.
Fernandez: The companies that are succeeding here have a vision of the future that requires having a complete picture of the patient and making an impact on outcomes. That’s what’s driving the most successful groups, the vision of what their job
is—not just to sell an EMR or technology, but to sell a platform that can improve the health of individuals as well as populations.
At Privia Health, for example, we look at information a little bit differently. Is the information available, and can we locate it? But also, is it pertinent? One of the important distinctions is that there’s a huge mass of clinical data that may be very, very important in one situation but not
For example, you don’t need to know the minute-by-minute blood pressure obtained in the ICU when you are seeing the patient for follow-up in an ambulatory clinic. When you’re looking at a population and you want to ensure that all of the care needed in both sickness
and health has been accomplished, you do not want to sift through mountains of other information. That’s the kind of functionality we’re trying to accomplish.
Huff: One of the most exciting things is the HL7 FHIR [Fast Healthcare Interoperability Resources] standard. It’s a standard for how you store and retrieve data in a patient database, which could be an EHR or a quality registry or a report to the CDC.
Closely related to that is the HL7 Clinical Information Modeling Initiative. Full disclosure: I’m the co-chair, so I might have a favorably biased opinion of that.
There’s a very new initiative called the Clinical Information Interoperability Council, where a group of interested parties are trying to get together across all of medicine to say: When we share data, this is the logical structure of the data, and these are the exact codes that you’ll
use to represent clinical findings like blood pressures, heart rates, serum glucoses, the medications that the patient is on.
Sinclair: In Massachusetts, with the implementation of healthcare reform and the shift to accountable care organizations for Medicaid in March 2018, we’re having conversations—within our own health system, Boston Medical Center Health System; and with our ACO partners, MassHealth and the Massachusetts eHealth
Collaborative—to implement ADTs [patient administration messaging] for real-time event notification for ER visits, inpatient admissions, and discharges. Stakeholders from around the state are involved, as there is an important business need to exchange this information.
It may be a small step, but it will have big impact. Providers and health plans are going to have the information they need in real time instead of waiting for a paper census or finding out after a patient is discharged.
Huff: The single biggest thing is the lack of incentives for systems to be interoperable. The current fee-for-service payment structure actually incentivizes organizations to not share information—to repeat studies rather than ask for results of a study that was done yesterday in a different
There are also other business reasons. Although they protest loudly, there are companies that make a lot of money making interfaces. The fact that each one is different and that they’re doing individual mapping of codes leads to revenue for a bunch of
The second thing is the need to coordinate across a number of groups. There are groups that are working on interoperability having to do with quality registries, and people who are working on it to be able to submit data to government agencies. There
are activities within every company that vends software, every professional association. To get true interoperability, you have to coordinate across those organizations. Just knowing what everybody’s doing and trying to ensure standardization, while not obstructing the good work that they’re doing, is a
Sinclair: The money and the time it takes to transition to newer technology platforms that might be out there is daunting to a lot of organizations. Even if those platforms exist and are in place, there is the challenge of getting everyone doing things the same way and speaking the same language.
Many organizations have other priorities, including keeping their business running, that prevent interoperability from being the focus. I think interoperability will have great benefits in the long term, but it just isn’t everyone’s focus right now.
Fernandez: It’s kind of a stark truth that a lot of the stuff we’re seeing that promotes interoperability and the exchange of information is aspirational, and not real. It muddies the conversation a little bit, it diverts a lot of money into places
where the money doesn’t belong, and it is exhausting the workforce, including doctors and CMOs. I’d just caution everyone to be very careful when there appears to be a wonderful solution available. Make sure that it’s been tested somewhere in an environment like the one you live in before you buy it.
Generally speaking, it’s all very expensive stuff. In my career, I have overseen millions of dollars spent on trying to make these data sources interchangeable, and I’m going to guess that the vast majority of those dollars did not lead to any conclusive improvement.
I participate in population health forums in a number of different settings, and I think there is a very common perception among population health providers that most of the stuff that they’re sold doesn’t yet work, or works only in a specific environment. It becomes very, very
difficult to go to your CFO for another several million dollars when your last request didn’t pan out and there is little proof that the next one will be any different.
Fernandez: We all need to be in it. But it’s very hard to have a trusting relationship with your most intense competitor—people who perhaps want to take your clients, and suddenly you have to develop a trust that you can work together on interoperability, and you can exchange information safely. Trust requires each
group to make sure their competition succeeds.
That’s a tough one, but I think it’s necessary. The thing that binds us in that is the patient. If you’re not really focused on providing high-quality care for your patients, then you’re not doing your job.
Sinclair: The government may need to nudge the discussion along in some ways. But I think if it’s truly going to work and truly be transformative, the stakeholders across the industry really need to be focused on this as a shared goal and priority—possibly working with entrepreneurs from outside the industry who can
apply different expertise to help solve the problem.
Huff: CHIME [the College of Healthcare Information Management Executives] recommended that we establish a new government agency that’s charged with creating healthcare interoperability. It would involve private organizations, the standards-development organizations.
The way the government is going about it now is not effective, and it won’t be effective unless they change. It’s just not specific enough, and nobody has authority. It’s not that they’re bad ideas, but it’s not constructed in a way that you’re going to get to the objective.
It would still be a public-private initiative, but a new, properly funded, and properly governed agency would be the very best thing to do. I don’t think it has a chance of getting through the current political process, but that doesn’t mean it’s not the right thing to do.
Sinclair: The first thing is that barriers and silos among the stakeholder groups need to come down. This isn’t about a competitive advantage if you’re a healthcare provider or a health plan. It’s just an important component of doing business.
I think the health plans and health systems, as well as larger provider groups and hospitals, are going to continue to make progress. But we need to find a way to get the smaller providers and independent providers involved. These include LTSS [long-term services and support]
providers, long-term care facilities, and behavioral health providers. Without these providers, you don’t have a complete view of the patient and can’t deliver the best care or care management.
Health plans, ACOs, and delivery systems, as major stakeholders, need to think more about how to include these smaller, independent providers. We need their information and they need our information if we’re truly going to continue to improve quality and lower costs.
Fernandez: There are many collaborations going on. For example, there’s CommonWell and Carequality. One of them is backed mostly by vendors, the other is a combination of vendors and providers. Both of those seem to be good efforts, and they seem to be highly engaged in this proposition about benefiting the
patient. Their goals are not necessarily to corner the market, but to get to interoperability for the benefit of the people we serve.
It’s a little bit market-specific, and a little bit about how you view your competition. We’ve got hospital systems in some of our Privia Medical Group markets that do want to share information with us. The goal of the system is the same as ours, which is to take really good care of patients.
For that to happen, the ambulatory care provider needs to have all of the information from the hospital, and in a timely fashion. When a patient gets admitted, the ambulatory provider needs to know right away so that they can add information to the care of the patient. When a patient is
discharged, the ambulatory provider needs to know the moment that happens; in fact, we prefer to know even in advance of it happening, and there are tools that allow that exchange of information without going through a lot of human beings.
Huff: There has to be that kind of collaboration. We’re seeing that, speaking from Intermountain’s experience, because of some of the reimbursement changes that are coming about with accountable care organizations and healthcare bundles, where more than one organization holds the risk in providing for a population.
Those changes create a financial incentive to provide high-quality, low-cost care across organizations. That pushes people together to pursue interoperability.
We’ve got a long way to go because there are a lot of challenges. People don’t trust each other in the relationship; they’re worried about their own business interests. It’s hard, but it’s obviously in the best interest of the patient, and there are some encouraging signs because of those
new payment reform strategies.
Sinclair: The health plans and large health systems will have made a lot more progress. There are many discussions occurring, and it’s a topic everyone is interested in, so that will continue to move it along. Here in Massachusetts there is a lot of focus
on this topic, so I am hopeful we’ll start to see results in the next couple of years.
Once most organizations are sharing data, we’ll likely see the desire to expand on the data that is exchanged, as everyone recognizes the value. And then the focus will shift more to sharing outcomes data.
Fernandez: We’ll have pockets around the country where we are achieving significant interoperability, where the government and the vendors and the providers have gotten together and said: Enough is enough, we’re going to make this happen. Organizations like Carequality and CommonWell may be winners in this space in
the long run.
We’ll be better off in five years, but we won’t be done. The current uncertainty in government with the withdrawal or weakening of value-based care programs, including a pullback on bundled payments, may slow us down and cause appropriate investment in technology to decelerate. That
said, we will continue to forge ahead to serve our patients in the best way possible.
Huff: I can say where I hope we are. I hope that in five years, we’ve solved big areas of interoperability, that we can exchange lab data, we can exchange problem lists, we can exchange medication lists and prescriptions, we can exchange genetic
And we’d be working in specialty areas, so that instead of those large domains, we’re working very specifically on the data elements that we need to support cardiologists, obstetricians and gynecologists, physical therapy, diabetes clinics. That we’ve taken care of the core data elements, and
now we’re going to work forever on the remaining 1 percent so that we get to the other important but less common elements, and interoperability around those areas.
Sinclair: I’m a member of the HealthCare Executive Group, and we had our annual forum in Nashville in September. The topic of interoperability came up in every panel discussion that we had, from the opioid epidemic to provider directories to population health. This topic is getting a lot of attention, even though
everyone may not be labeling it as “interoperability.”
One of the conference attendees actually counted the number of times interoperability came up during the first two hours, and he stopped counting after 25 mentions. That just shows how prevalent the topic is now in everybody’s day-to-day conversations.
Huff: I don’t think people understand the incredible impact that true interoperability could have on health care. People estimate that we’re killing somewhere between 200,000 and 400,000 people a year through medical error. If you compare that to
the number of people who die in automobile accidents, we’re killing up to 10 times more people through medical error, and for some reason people don’t see it as an epidemic—we’re not investing even $5 million in interoperability solutions as a country.
It’s a subject that, somehow, we’ve got to approach in a different way to legislators and policy makers, to get them to understand that this is a solvable problem. How much money have we spent on research on seatbelts, shoulder harnesses, collapsible bumpers, collapsing steering
columns, padded dashboards? Yet we’re not making even 1 percent of the investment that we make in that kind of safety equipment to prevent those kinds of medical errors.
Interoperability is the thing that will make a quantum change in the quality of medicine that we provide. Better medical schools, zero-harm programs—those things will have a measurable but small impact. Interoperability, where we could share knowledge as executable programs, will
make a 20, 30, 50 percent change in the quality of medicine that we provide. And somehow people don’t understand that, and we don’t invest in it.
Nick Hut is managing editor of Leadership.
for this article:
Keith Fernandez, MD, national chief clinical officer, Privia Health; Stan Huff, MD, chief medical informatics officer, Intermountain Healthcare;
Kim Sinclair, chief information officer, BMC HealthNet Plan.
Check out previous installments of the Healthcare Challenge Roundtable:
How to Optimize Ambulatory Care
Integrating Behavioral Health Care and Primary Care
Assessing the Value of Care
Optimizing the Preauthorization Process
Working Together to Make APMs Succeed
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.
HealthTrust: Optimizing Purchased Services
Andrew Motz, assistant vice president, supply chain consulting at HealthTrust, discusses the value of a data-driven approach when procuring purchased services.
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.