Get the E-newsletter
An anesthesiologist communicates handoff with a physician to coordinate care for a postoperative patient. (Photo: TeamHealth Anesthesia)
Missing lab work and last-minute diagnostic tests no longer derail the surgical schedule at Martin Health System, Stuart, Fla. For the past six months, the three-hospital health system has been using a perioperative surgical home (PSH) model to better coordinate surgical care for its patients.
“Hospital executives and surgeons dread having a surgery cancelled, particularly on the same day the surgery is scheduled,” says Sharon Andre, RN, MS, FACHE, assistant vice president and administrator for the perioperative service line. “It’s not good for the patient, the surgeon, or the hospital. Through our perioperative surgical home, we have been able to virtually eliminate same-day surgery cancellations.” The PSH model also has reduced unnecessary testing and improved pain scores and other clinical outcomes.
Originally proposed by the American Society of Anesthesiologists (ASA), the PSH model is designed to be an alternative to the disjointed perioperative system that persists in the United States. It is a physician-led, patient-centered approach to coordinate care across the entire continuum—from the moment the decision to have surgery is made through surgery, recovery, and 30 days post-discharge.
“The perioperative surgical home sets up a framework and a model to ensure there is a system for optimizing the care of the surgical patient,” Andre says. “It includes evidence-based processes to ensure the standard of care is provided and that excellent outcomes are achieved for the patient as well as for the efficiency of the healthcare system.”
The Perioperative Surgical Home Model
Martin Health is one of 44 organizations participating in a PSH pilot launched by ASA with a national healthcare performance improvement alliance. An outsourcing anesthesia and pain management service organization—that is assisting Martin Health with its PSH model—has implemented and currently maintains seven of the PSH pilot sites within the collaborative.
To roll out the PSH model, leaders at Martin Health followed a series of steps.
Identify a physician champion. The physician champion is responsible for leading the perioperative team that will manage patient care during the surgical episode (as soon as surgery is planned through 30 days after the patient leaves the hospital). The leader can be an anesthesiologist, surgeon, hospitalist, or primary care physician.
The physician champion should possess a strong desire to improve patient care, exceptional communication and change management skills, and keen emotional intelligence. At Martin Health, the physician champion is a facility medical director employed by the outsourced anesthesia service organization.
Select an operational champion. This leader should have the authority to help assemble resources, such as IT and PI teams, to support the work of the PSH team. An operational champion may be a COO, perioperative services director, or senior nursing leader. For example, at Martin Health, Andre is that champion, and she has the influence to bring different operational groups together.
Other members of the PSH team include leaders from finance, nursing, laboratory, pharmacy, radiology, IT, central supply, and social services.
Focus on the “burning platform” to build credibility and momentum. The PSH team should prioritize initiatives based on physicians’ biggest concerns. For example, two surgeons at Martin Health were passionate about revamping how preadmission tests were ordered through the electronic health record (EHR). Before the model was in place, primary care physicians were responsible for ordering tests, which sometimes led to redundant or unnecessary testing prior to surgery. Now, when surgeons order a surgical procedure through the EHR, they simply check a box for preadmission testing. This launches a preadmission testing workflow led by an anesthesiologist, who can access decision support tools in the EHR to determine which tests the patient needs.
To gain buy-in from primary care physicians before launching the new process, the director of anesthesiology visited primary care practices and explained how the PSH model would standardize patient care and improve efficiency. Prior to the model’s implementation, even low-risk patients were required to visit a primary care physician for a history and physical before surgery, which bogged down physicians’ schedules. Now, low-risk patients have a “fast track” to preadmission testing, and an anesthesiologist can order any tests the patients may need prior to surgery. Primary care physicians have more time to better optimize high-risk patients and can see post-acute care patients quicker to help prevent readmissions.
Having anesthesiologists coordinate preadmission testing has reduced unnecessary tests and eliminated same-day surgery cancellations due to missing tests. To manage this process, Martin Health added another anesthesiologist FTE to its roster.
Implement new order sets for postoperative care. Borrowing lessons from population health management, PSH models use risk stratification to focus on patients who are at the greatest risk for complications, readmission, or other negative outcomes.
For example, the PSH team at Martin Health developed a risk assessment and order set to manage patients with postoperative nausea before they have surgery. The results have been significant: The percentage of patients who need anti-emetics in the recovery room has dropped from 65 percent to less than 30 percent.
Similar order sets have been hardwired into the EHR to standardize care for surgical patients with obstructive sleep apnea, multimodal pain, and other conditions.
Enlist the pharmacy. At Martin Health, pharmacists review surgical patients’ pain medications and pain scores, and design alternative pain-management strategies when needed.
A pharmacist also reviews the medication reconciliation for every surgical patient prior to discharge. In addition, pharmacists and pharmacy students provide one-to-one medication counseling for patients at high risk for readmission. The PSH team worked with IT to build prompts into the EHR to trigger these activities, so care is consistent across the surgical population.
Engage social workers and care managers early on. In a PSH model, the team starts planning postoperative care before the patient has surgery. At Martin Health, social workers, financial counselors, and care managers are prompted by the EHR to identify community resources that patients need upon discharge, weeks before the actual surgery.
Build on early results. In addition to eliminating same-day surgery cancellations, Martin Health has improved its on-time starts since implementing the PSH model. In addition, they have achieved almost 100 percent chart completion 24 hours prior to surgery.
The PSH team also reduced blood utilization in surgical patients by 20 percent and improved pain scores. Patient experience scores also have improved. “The perioperative surgical home model has been a big win for me and my patients,” says Matthew Peebles, MD, chief of surgery at Martin Health System. “The pre-op process has grown into a robust screening, optimization, and patient engagement program, and the perioperative enhanced recovery aspects have improved outcomes and patient satisfaction significantly.”
ASA’s nationwide PSH pilot runs through the end of this year. The collaborative plans to analyze financial and clinical data from preoperative, intraoperative, and postoperative care in all 44 organizations.
Early anecdotal evidence suggests the PSH model is improving performance at other organizations as well. One Arkansas hospital has increased the number of discharged surgical patients entering home health, as opposed to nursing homes, by 20 percent. Another provider decreased the LOS for pediatric spine surgery patients by 1.5 days in the first 30 days of implementing a PSH model.
By re-engineering the perioperative process, providers can help reduce variability across the continuum and be better positioned as the industry moves toward value-based care. “All health systems are going to be paid less in the future, so improved efficiency is critical,” says Robert L. Lord, Jr., COO, Martin Health. “Also critical are better coordination of care and the involvement of the entire care team to achieve improved outcomes. This program does all of those things. That is the reason we view it as critical to our mission.”
Perioperative Surgical Home Executive Dashboard for Lower Extremity Joint Replacement
Successful Physician-Hospital Alignment
Admission Plan Eases Patient Transition and Care Coordination
Sonya Pease, MD, is CMO, TeamHealth Anesthesia, Palm Beach Gardens, Fla.
Mike Schweitzer, MD, MBA, is vice president of healthcare delivery system transformation, VHA Southeast, Tampa, Fla.
This article is based in part on a presentation at the Congress of the American College of Healthcare Executives in Chicago in March 2015.
Quoted in this article:
Sharon Andre, RN, MS, FACHE, is assistant vice president and administrator for the perioperative service line, Martin Health System, Stuart, Fla.
Matthew Peebles, MD, is chief of surgery, Martin Health System, Stuart. Fla.
Robert L. Lord, Jr., is COO, Martin Health System, Stuart, Fla.
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.
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.
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.