Get the E-newsletter
Still in its infancy, the accountable care movement has yet to find its legs. It is growing rapidly, experimenting constantly, stumbling frequently—and unsure of exactly how things are going to work out. But the number and range of provider and payer organizations that are joining the movement shows that accountable care intends to make a stand in America’s healthcare history.
As of May, at least 626 accountable care organizations (ACOs) across the country were responsible for more than 20 million lives. Currently, nearly 6 million Medicare beneficiaries are attributed to an ACO: 5.3 million to organizations in the Medicare Shared Savings Program and 669,000 in Pioneer ACOs. Meanwhile, Medicaid ACOs in three states cover 2.1 million lives, and commercial ACO contracts account for 12.4 million lives (Peterson, M., et al., Growth and Dispersion of Accountable Care Organizations: June 2014 Update).
The government is the most prolific accountable care sponsor. Only 210 health systems or physician groups have commercial ACO contracts, while 329 organizations are in accountable care contracts for Medicare or Medicaid patients.
Early results have been mixed. The Centers for Medicare & Medicaid Services recently touted that its ACOs—both the Pioneer and Medicare Shared Savings Program—saved the Medicare Trust Fund $372 million in savings through Dec. 31, 2013. The provider organizations involved earned $445 million in shared savings payments during that time. Moreover, on average, the ACOs have improved on many quality measures. However, 13 of the original 32 ACOs in the Pioneer program have dropped out, some of the Pioneer ACOs have been unable to hit their financial targets, and quality improvement has been uneven.
While all ACOs share the goal of improving the value of care delivery, the organizations that are forming around the country are structured in different ways. The experiences of two ACOs demonstrate that there are multiple paths to ACO success. Coastal Carolina Quality Care, Inc. was created by a small medical practice, while the huge Banner Health Network is working with nearly 3,000 employed and independent physicians:
Coastal Carolina Quality Care is participating in the Advance Payment/Medicare Shared Savings Program, a government initiative to encourage physician-led ACOs in rural areas with underserved communities. The ACO, based in New Bern, N.C., is owned by Coastal Carolina Health Care, a multispecialty practice that consists of 44 physicians and 20 mid-level practitioners who work in 11 locations across five counties. The practice also has an urgent care center. All Coastal Carolina clinics feed into a single hospital that is unaffiliated with the practice.
The group chose to participate in the federal ACO program because the physicians who own Coastal Carolina fundamentally believe that care can be improved and costs controlled in a way that rewards high-value providers. “If the government shares that savings with us, it will help us financially,” says Kenneth Wilkins, MD, president of the medical group. “This promises to be a really good thing for everybody concerned—the country, the providers, and the patients.”
More than 11,000 Medicare patients are attributed to the Coastal Carolina ACO, accounting for about 30 percent of the medical practice’s patient population and nearly 50 percent of its revenue, says CEO Stephen Nuckolls. The ACO is responsible for all Medicare Part A and Part B claims, including post-acute care such as skilled nursing facility utilization, durable medical equipment, and hospice services.
Putting staff and services in place. The government’s Advance Payment ACO initiative is designed to help relatively small physician practices and rural providers participate in the Medicare Shared Savings Program even though they may not have the capital needed to adopt the ACO model. Through the Advance Payment program, Coastal Carolina ACO received approximately $3 million in advance payment funds over a 27-month period that ended in June. Eventually, the ACO will need to repay the advance payments out of the shared savings that it earns through the program.
While some ACOs are built around a tight alignment of hospital and outpatient providers, that is not the case for Coastal Carolina; in fact, it has no contract with the local hospital. Rather, its strategy is to limit hospital utilization by keeping patients healthy and increasing access to outpatient care.
About 85 percent of the ACO’s budget has been used to hire staff: 10 registered nurse (RN) care coordinators, a supervisor for the care coordination team, and a part-time physician who provides clinical leadership to the care coordinators. Each care coordinator is assigned a group of patients. If an assigned patient enters the hospital, the coordinator works with hospital discharge planners to help the patient successfully transition to home or another post-acute care setting. Care coordinators visit patients in their homes, if needed.
Providing care in the most appropriate setting. Beyond that, Coastal Carolina has made several changes to support the move from fee-for-service incentives to accountable care. For example, to reduce hospital referrals, Coastal Carolina upgraded its urgent care center. Lab tests can now be performed, and urgent care staff can provide intravenous fluids and antibiotic infusions to patients.
“In a fee-for-service world, when we can’t make a margin on a patient’s lab test, we send those patients to the hospital,” Nuckolls says. “But, as an ACO, it’s very expensive to send patients to the hospital because we get hit with the facility fees and everything else. Plus, if I was a patient, and I could be seen quickly in an outpatient setting, that’s what I would prefer.”
The practice also set up a 24-hour triage line that encourages patients to call a nurse rather than head to the emergency department (ED). The triage line is staffed by RN care coordinators who can access patients’ medical records via iPad or computer so they can respond to patients’ requests—even while working at home. The nurses are also supported by triage software, which provides standardized care recommendations for specific symptoms.
In addition, Coastal Carolina increased the hours at its urgent care clinic. At every opportunity, the practice reminds patients that they can get next-day appointments as an alternative to seeking ED care. An RN care coordinator from Coastal Carolina is also stationed in the hospital’s ED during busy hours to remind the physician of that option. “We point out to the ED physician that we can offer a next- day appointment in lieu of admission, if that’s what the doctor chooses to recommend to the patient,” Nuckolls says.
Outside the ACO budget, the physician group hired extra staff to help the primary care teams, freeing up clinicians’ time for patient care and clinical quality improvement activities. This included hiring scribes— generally medical assistants or nurses—who document patient visits in the electronic health record (EHR), allowing physicians to spend more time interacting with patients and less time on administrative work. Nurse practitioners were also hired to help with annual wellness visits, which are important to eliminating gaps in preventive care that keep patients healthy.
“As we added resources to the primary care teams, the physicians were able to expand their schedules to see a few more patients a day,” Nuckolls says. “And by expanding their schedules, we were able to pay for additional clinical personnel, which made this a self- funding proposition.”
Upgrading technology. In addition to hiring staff, Coastal Carolina used its Advanced Payment funds to upgrade its EHR system to support population health management. For instance, the ACO is able to sort EHR data to generate lists of patients who are due for preventive care, such as colonoscopies and mammograms. The lists are sent to each practice site, and staff devote time to calling patients to schedule preventive care appointments.
Nuckolls’ staff can also use the EHR’s advanced reporting capabilities to create reports that document each clinician’s performance on quality metrics. “When you start comparing their performance, the doctors definitely become more engaged,” he says.
The EHR also has a point-of-care dashboard, which makes it easy for physicians to see how to improve their performance. The dashboard provides a daily list of the patients each clinical team will see, along with pertinent quality measures and prompts, such as a reminder that a diabetic foot exam is overdue.
In addition to the daily view, clinicians can sort their patient data to see, for example, a list of patients with coronary artery disease who have not been prescribed a daily low-dose aspirin. “Just sitting at my desk now, I can find patients who are not getting the care they should be getting and take steps to make sure that gets changed,” Wilkins says.
Reducing costs. ED visits and hospital admissions in Coastal Carolina’s ACO population fell by at least 10 percent between 2011 and March 31, 2013, which was the end of the program’s first interim reporting year. Furthermore, costs for Medicare/Medicaid dual-eligible patients declined by 19 percent, or $2,635 per patient, during that same time period. Meanwhile, the percentage of diabetic patients with high blood sugar levels fell from approximately 18 percent to just 8 percent.
The practice showed savings during the first evaluation period, but not enough to receive a shared-savings check. Nuckolls attributes that to the way Centers for Medicare & Medicaid Services (CMS) benchmarks ACO performance.
He considers the Coastal Carolina ACO a financial success to date. Another ACO operating in the same market as Coastal Carolina saw its costs increase by 7 percent during the first interim evaluation period, despite efforts to control costs. “I would argue that CMS saved a lot of money because of our participation in this program,” he says. “If we had not done this, I believe our costs would have been much higher.”
Nuckolls believes Coastal Carolina ACO’s high-touch delivery model is sustainable even now that the advance payments have stopped. “These payments have been adequate for our ACO and could have been lower for a commercial contract covering a healthier population of patients who do not require as much care coordination,” he says. This suggests that payers that offer upfront financial support will be rewarded by cost containment in the long run.
Medicare also plans to begin paying physicians monthly care coordination fees—$41.92 for each patient with two or more chronic conditions—in January 2015, according to the proposed 2015 Physician Fee Schedule. Nuckolls is hopeful the care coordination payments will help the ACO break even, even if it does not receive shared-savings payments.
Banner Health Network is an ACO that is governed jointly by its four partners:
Altogether, the three physician groups include nearly 3,000 physicians who contract together with the health system and share risk in value-oriented contracts.
Aiming for more risk. Banner Health Network participates in the government’s Pioneer ACO program and has risk-based contracts with four Medicare Advantage plans and six commercial health plans. Together, those contracts—which include full capitation, shared savings/losses, and limited risk arrangements—account for about 10 percent of Banner Health’s total business.
And it is just getting started, says Chuck Lehn, CEO of Banner Health Network. The ACO is preparing for more risk-based contracts with higher levels of risk and reward—and for more experiments with different care delivery methods that can help the ACO succeed in those contracts.
“We’re not there yet, but we’re pretty bullish on the care delivery capabilities that we are developing,” he says. “We’re trying to drive more of our insurance contracts to include significant financial risk because that allows us to succeed through reducing high-cost utilization.”
The enthusiasm among Banner leaders is based not on having figured out the complete formula for ACO success, but rather its commitment to keep trying until it does so. “It is important to realize we are in a transformational period and that an open mind will be needed,” says Nishant “Shaun” Anand, MD, medical director. “There will be strategies that lead to great success, and others that simply will not work. It is important to not allow history—how we have always done it— be a limiting factor.”
In the first year of its Pioneer participation, Banner generated $13 million in shared savings, thanks largely to managing two key metrics: Avoidable admissions fell by 18 percent during the year, while its all-cause, 30-day readmission rate fell from 18 percent to 12.8 percent. Furthermore, average length of stay decreased by 14.4 percent and the use of radiology services by 6.7 percent.
Intensifying ambulatory care. The network’s first goal is to get patients bonded with a primary care physician (PCP) to reduce urgent care and ED use. Using lists of patients provided by health plans, the ACO calls members who have not had a primary care visit to ask them to establish a relationship with a PCP. For those patients who have not seen their regular PCP in some time, the PCP is expected to proactively schedule an annual visit.
Banner Health analyzes claims data to identify subsets of patients who might benefit from disease management, case management, home health, or other targeted services. “We have a whole plethora of approaches for helping patients manage their health conditions,” Lehn says. “We call it an air traffic control system—trying to watch and figure out what kind of resources you need to put with what kinds of patients.”
For very high-risk patients—about 500 patients at any given time—Banner Health uses what it calls intensive ambulatory care. A non-licensed health coach visits these patients at home every day to ensure they are taking medications properly, have scheduled needed medical appointments, and are not deteriorating. Meanwhile, telehealth technology connects the high-risk patients to RNs who track the patients’ vital signs, and allows PCPs to visually connect with the patients every day.
In addition, Banner places case managers—nurses or social workers—in EDs to identify appropriate community resources that can help patients avoid hospitalizations. “We consider an unplanned hospitalization to be a failure,” Lehn says.
“Another significant challenge in accountable care is managing patients who are not engaged partners, or are generally non-compliant,” Anand says. “It is definitely possible to support the future health of these individuals, though it may be difficult.”
Sidebar: Aetna’s Accountable Care Approach
The ACO leaders interviewed agree that two elements—good data systems and physician engagement—are essential for the accountable care model to deliver its promise of better patient outcomes at lower costs. But exactly what makes a data system effective or what gets physicians to embrace a new way of practice differs according to the type of ACO.
Data quandaries. “A lot of vendors say you must merge clinical data and claims data,” says Nuckolls, CEO of the physician-led ACO in North Carolina. “There may be some benefits of doing that, but we have not seen them.”
At his 50-provider practice, the EHR system serves as the central database for monitoring patients and physicians, and it drives most performance improvement activities. That said, Coastal Carolina uses claims data to inform some quality initiatives.
For example, a claims review found that many Coastal Carolina ACO patients who had fractures were not receiving optimal bone health therapy. That is because those fractures were treated by orthopedists, who assumed that PCPs would prescribe the therapy. But many times the PCPs did not know that a fracture had occurred. So the group is beginning to use the claims data to identify the patients who have suffered fractures and is setting up reminders that show up on the point-of-care dashboard when the patient visits his or her PCP.
By contrast, an enterprise data warehouse that includes claims data is central to Banner’s population health management activities. That information allows Banner to stratify patients into three categories that reflect the intensity of healthcare resources they have used in the recent past. “If you’re in the top 5 percent of utilization, we try to make sure that you’re covered by case management and that you have the right support systems so you get care in the right setting and can avoid hospitalization,” Lehn says.
Other protocols are in place for the second highest utilizers (i.e., those that fall in the top 5 percent to 20 percent of resource use) and for the 80 percent of patients who use few resources but need preventive care to maintain good health.
Physician participation. Seeing an unplanned inpatient admission as a “failure”—as opposed to a revenue- generating resource that helps patients recover from illness—is one of many huge changes that physicians are being asked to embrace. Traditionally expected to work independently, they now must collaborate with others to find the best solutions for their patients.
“The way to succeed as an ACO is also the biggest challenge. That is, to engage the other physicians who are not the leaders,” Wilkins says.
Although he and his colleagues practice in 11 Coastal Carolina locations, they saw themselves as a single group long before the ACO concept emerged. “We make decisions together. We have one electronic record. Just the whole culture of being one group has been a big thing for us,” he says. “If you had disparate groups using different systems, it would be much more difficult to pull this off.”
That is Banner Health’s situation. Its 3,000 physicians are spread among three large groups working in dozens of sites. The primary engagement strategies have been providing physicians with data that allow them to improve patient care and creating a pay structure that supports the ACO’s goals.
“Aligning the economic incentives as best you can is a longer-term, harder thing, but having a plan for that is important,” says Lehn, the Banner Health Network CEO. “It’s not always just an incentive that works. Sometimes it requires a different way of getting paid. If we want physicians to spend more time doing a comprehensive annual exam—which is going to take the equivalent of two or three regular office visits—then you’ve got to finance it appropriately.”
Leaders at Coastal Carolina and Banner Health Network share some other challenges they are finding their way around:
Team and individual incentives help. After Coastal Carolina staff spent several months improving patients’ blood pressure levels, they saw performance start to plateau. So the practice introduced a formal carrot-and-stick incentive program to encourage the use of appropriate interventions and follow up with hypertensive patients.
Every month, each department creates an incentive compensation pool. The pool is used to provide incentives to departments and individual physician/nurse/scribe teams. The goal is to reward individuals and teams for following agreed-to clinical pathways.
The top five physician/nurse/scribe teams are recognized and given movie tickets. Departments that perform at average have their pool contributions returned, while departments that perform below average lose money to those that do well. “Doctors are competitive by nature so they want to make sure that their numbers look good,” Nuckolls says.
Data must be usable. With numbers pouring into its data warehouse, Banner risks becoming “data-rich and information-poor,” Lehn says. Careful analysis is needed to know what data is actionable and when it should be presented.
“We must be able to tell physicians information about their panels of patients: Who hasn’t had office visits? Who has gaps in care and risk factors that aren’t being addressed?” he says.
“The importance of getting the data flow right and turning data into information that’s useful for the clinicians—I just couldn’t stress that enough.”
Printouts are sometimes needed. Just because data is readily available in the computer does not mean busy physicians will use it. When administrators at Coastal Carolina discovered that clinicians were not accessing their performance data on desktop computers, they produced paper reports that allowed physicians to compare their own performance over time and with the performance of their colleagues.
Similarly, ED physicians—contracted by the hospital, not Coastal Carolina—are often too busy to check a patient’s EHR data, even though they have access to it. That’s why the ACO’s RN care manager, who is embedded in the ED, prints out relevant patient data to give to the ED physicians. “If somebody hands them a med list or another piece of information, it makes their job easier,” Nuckolls says.
Strategies need to be flexible. Banner originally sought to convert all its primary care practices into patient-centered medical homes that used a team—physician, advanced practice nurse, case manager, social worker, and quality specialist—to deliver care. While that works well for large practices with sophisticated management, small physician offices struggled. “We backed off that in favor of providing more centralized support services,” Lehn says.
For example, one case manager may be assigned to support five practices, and a quality specialist might cover three sites. “Practices adopt change at different speeds, so we have to balance what we expect to have at the practice and what we need to provide in centralized services,” Lehn says.
Incremental changes add up. Rather than insisting that all physician practices adopt new protocols in lock step, Banner found that some care delivery changes are best implemented in bite-sized chunks with centralized support. For example, to reduce avoidable readmissions, Banner wants hospitalized patients to see their PCPs within five days of discharge. To ensure this happens, the ACO offers financial assistance to the PCPs.
“We say to the physicians, ‘We are going to send an email to let you know which of your patients have been hospitalized, and here’s the assessment tool that we want you to complete for each patient,’” Lehn says. “And, if you do that, here’s a payment for that. That is a good way to start to get everybody going, but it takes time.”
At the helm of Banner Health Network, one of the largest ACOs in the country, Lehn does not think the size of an ACO is important to its success. What matters, he says, is a culture of commitment.
“Some things we have done have worked, some things haven’t, and you have to adapt accordingly,” he says. “But we believe that the current system is not sustainable, and we need to find the path to sustainability. So that’s what motivates us—this is for the long-term, not today.”
Lola Butcher is a freelance writer and editor based in Missouri and a contributing writer/editor to Leadership.
Quoted in this article:Nishant “Shaun” Anand, MD, is medical director, Banner Health Network, Mesa, Ariz.Chuck Lehn is CEO, Banner Health Network, Mesa, Ariz.Stephen Nuckolls is CEO, Coastal Carolina Quality Care Inc., New Bern, N.C.Kenneth Wilkins, MD, is president, Coastal Carolina Quality Care, Inc., New Bern, N.C.
Grant Thornton: Helping Organizations Embrace Robotic Process Automation
Two senior leaders at Grant Thornton talk about the advantages of robotic process automation to improve office efficiency, reduce costs, and mitigate risk.
VitalWare: Creating a Transparency Strategy: Meeting the Mandate to Post Standard Hospital Pricing
A senior leader of VitalWare talks about the need to create a comprehensive pricing strategy for consumers and how to get started.
HealthTrust: Solving Workforce Management Challenges
Two of HealthTrust’s senior leaders talk about strategies for optimizing the hospital workforce to improve productivity and reduce waste.
Grant Thornton: Optimizing the Ambulatory Workforce
One of Grant Thornton’s senior healthcare consultants addresses the topic of workforce management and the importance of a data-driven approach.
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.