Successful hospital-physician integration is considered a core element of any successful response to mounting demands for higher-quality, lower-cost patient care. Click on the following infographic to find a challenging—and rewarding—route to this still elusive destination. Also, scroll down for details and examples of the integration strategies that are highlighted in the infographic.
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The infographic highlights all of the following strategies and risks. See the correlating footnotes on the infographic.
A Fall 2012 Leadership article highlights a different type of compensation: Boston Children's is exploring the possibility of giving faculty or attending physicians continuing medical education credits or credits toward board certifications for participating in improvement projects.
St. Luke’s modeled its program after the safeguards laid out in the other OIG advisory opinions rather than applying for its own opinion. As a result of the program, St. Luke’s was able to save a total of $11.2 million over the program’s duration, from 2007 through 2012.
For example, Texas Health Physicians Group (THPG) felt that a separate MSO was critical to its future success, according to Sam Civello, vice president of operations, in a 2010 HFMA roundtable. “The MSO is physician-centered and structured by those knowledgeable with practice management, which greatly facilitates our talks with physicians. We were able to assure them that we have their intentions as practitioners at the forefront in building this organization. The MSO’s success can be attributed to having a common goal, common directives, and a shared technology base. Having a single operating and reporting platform allowed us to be consistent and efficient in deploying technology and processes.”
Some PHOs require physicians to meet certain quality targets before they are allowed to join the PHO.
"This will facilitate communication between providers, between the providers and the hospitals, and ultimately, between providers and patients," said Scott Eathorne, MD, medical director for the PHO. The goal is to have about 1,000 physicians connected electronically by 2013. All physicians who contract with insurers through the PHO will be expected to adopt technology that allows them to share patient data, although a range of options will be permitted. Those physicians who have their own EHR systems, for example, may use the HIE; others may only use the disease registry function. Within the limitations allowed by law, St. John Providence is subsidizing the cost of the ambulatory EHR system.
The agreement provides a base management fee and opportunities for surgeons who are shareholders to earn a clinical incentive fee tied to the hospital’s performance on various measures. The limited liability corporation distributes its profits to surgeons who are shareholders.
The academy offers a 12-month curriculum that combines self-paced, online courses with group, onsite education sessions that bring the physicians together once a quarter.
Dozens of disparate medical groups sent representatives to a special meeting to determine how to achieve this. “We brought in everyone in through a senate model so that the biggest group of 300 physicians did not overwhelm the little groups of 10 physicians or 50 physicians,” says Alan Kaplan, MD, president and CEO, UnityPoint Clinic. “We sat as equals. Instead of deciding which group we were going to merge into, we used a blank piece of paper to create the medical group that we would all aspire to be part of.”
The pilot has shown how improved care coordination of patients with chronic conditions, supported by IT, can help position a health system for success as payment increasingly rewards value rather than volume, as reported in a June 2011 hfm article.
In another example, Geisinger Health System uses a pay-for-performance formula, according to a Summer 2013 Leadership article. More than 800 Geisinger physicians receive a base salary that is about 80 percent of their expected total compensation. The other 20 percent—paid in two installments each year—reflects physicians’ individual performance on specialty-specific cost and quality goals that reflect Geisinger’s priorities.
Physicians receive incentives for adhering to evidence-based protocols, safety measures, and interventions that the program has identified for each key result area (116 measures in all; about two dozen measures apply to each specialty). All measures are approved by the Advocate Physician Partners board, which is comprised of physician and system members.
Education regarding new measures is provided through a web-based application, so that physicians can take part in the learning modules at their convenience. Adherence to the measures is tracked electronically through an online disease registry and reporting system, and physicians and their office managers receive a report each quarter from Advocate Physician Partners that provides information on their performance.
For the program to work, Blue Cross agreed to share data with Advocate so that Advocate could better manage the health of this patient population. Advocate invested in technologies and staff to support predictive modeling, so the health system could better determine which patients would most benefit from preventive care and interventions that could reduce admissions, readmissions, and emergency department (ED) visits. Advocate Physician Partners also hired care management coordinators to work with high-risk patients in physician offices, improved post-acute care transitions, enhanced patient access to care through expanded physician hours and new outpatient programs, and implemented evidence-based protocols for referrals and prescribing.
KeyBank: Offering Expertise in Tax-Exempt Financing to Give Health Systems Flexible Options for Growth
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
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.
Xtend Healthcare: Enabling Efficient Business Office Workflow
In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
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.
TriMedx: Elevating and Streamlining Clinical Engineering
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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.
McKesson: Leveraging Predictive Analytics to Rein in Operating Costs
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
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.
Accretive Health: Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
Conifer Health Solutions: Helping Providers and Employers Build a Foundation for Better Health
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
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.
Ontario Systems: Optimizing Accounts Receivable in a Rapidly Changing Environment
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
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.
Optum: Enabling Transformative Change
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
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.
Somnia: Bending the Healthcare Cost Curve Toward Improved Anesthesia Value
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
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.
PMMC: Navigating Revenue Cycle Management Challenges as Value Based Purchasing Emerges
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
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.
Burgess: Simplify the Business of Healthcare
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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.