Archive for the ‘Healthcare Administration’ Category

Infographic: How Hospital Acquired Conditions Can Impact a Hospital’s Bottom Line

June 1st, 2018 by Melanie Matthews

In 2018, an estimated 32 percent of large U.S. hospitals will occupy the lowest performing quartile for hospital acquired conditions (HACs), according to a new infographic by 3M.

The infographic examines how HACs impact a hospital’s bottom line and how to stay out of the bottom quartile.

Predictive Healthcare Analytics: Four Pillars for SuccessWith an increasing percentage of at-risk healthcare payments, the Allina Health System’s Minneapolis Heart Institute began to drill down on the reasons for clinical variations among its cardiovascular patients. The Heart Institute’s Center for Healthcare Delivery Innovation, charged with analyzing and reducing unnecessary clinical variation, has saved over $155 million by reducing this unnecessary clinical variation through its predictive analytics programs.

During Predictive Healthcare Analytics: Four Pillars for Success, a 45-minute webinar, available on-demand, Pam Rush, cardiovascular clinical service line program director at Allina Health, and Dr. Steven Bradley, cardiologist, Minneapolis Heart Institute (MHI) and associate director, MHI Healthcare Delivery Innovation Center, shared their organization’s four pillars of predictive analytics success…addressing population health issues, reducing clinical variation, testing new processes and leveraging an enterprise data warehouse. Click here for more information.

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Guest Post: 3 Steps to Successfully Model Hospital-Payer Contracts

May 24th, 2018 by Brad Olin

Allowing your healthcare organization time to prepare for modeling long-term contracts can be the difference in maintaining revenue integrity.

When a hospital’s financial success is largely based on its ability to accurately collect reimbursement, allowing your healthcare organization time to prepare for modeling long-term contracts can be the difference in maintaining revenue integrity.

But how can you be absolutely sure your organization isn’t leaving money on the table?

One way (and probably the most direct route to the answer) is to start with contract governance by establishing a foundation of accuracy to (re)evaluate the current process your organization has for modeling contracts. This allows your organization to take a deeper dive into your payer contracts and determine the root cause(s) of your current issues.

Because without accurate data and analytics supporting your current contracts, how can you be expected to confidently predict future reimbursement and outcomes?

Ask yourself these questions:

  • Do I understand my current contract composition?
  • Am I benchmarking against competing payers’ overall performance, current market rate, leadership dependencies, etc.?
  • Has my organization implemented a scorecard to measure its performance?

Initiating the Negotiation

Let’s begin with understanding the components within your current contracts.

Ask yourself “What don’t I know about my current contracts?”

While knowing which specific areas of care you need to address is certainly important to discuss prior to (re)negotiations, being aware of what you don’t know lets you gain a more comprehensive understanding of other aspects of care you may be neglecting, but have significant impact on your reimbursement rates (i.e. reimbursement rate schedule, claims adjustment schedule, etc.)

Before the negotiations begin, it’s important to look at all options for negotiating the conversation and identify any barriers that may hinder your organization’s ability to leverage any power in the negotiation. For example, some contracts include provisions with a notice window prior to its auto-renewal.

Keep in mind, however, that if both parties are on good terms and mutually agree to discuss payer contracts, negotiations can still take place despite what the contract may say.

The next step is to reassess the contract terms of the base agreement and its amendments, regardless of the date of those initial agreements. Take note that generic language and changes during prior negotiations do not necessarily dictate future contract terms. Then, you can isolate which areas of care within your organization are most important to your organization that is not a provision of the current contract.

Setting Benchmarks

After an organization has done their homework and prepared a list of objectives to achieve during the negotiations, the next step is to figure out with the payer how you’re currently performing under the current contracts.

Using a set of predetermined contract performance metrics, you can compare projected and current conditions side-by-side to determine what financial improvements you can realistically expect to see in the near future.

While every hospital comes with its own unique set of challenges, here is a list of common performance benchmarks any organization can use to establish a basis for how they should be performing in specific areas of care:

  • Benchmark against original projections—Comparing actual performance against what was projected when negotiated.
  • Benchmark against current/projected high-volume services—Mining your claims data and assess the current revenue value per service, particularly those that are growing in volume.
  • Benchmark against industry benchmarks—Convert proprietary contract reimbursements to a percentage or charge equivalent and a Medicare relativity to assess the playing field.
  • Benchmark against leadership dependencies—Establish what role this payer needs to play in supporting your organization.
  • Benchmark against competing payers’ overall performance—Revisit against competing payers’ overall performance.

By combining industry benchmarks with accurate data to gain a clearer understanding of your projected financial impact, the hospital can gain a clearer understanding of how they’ll execute their goals and eventually develop a consistent routine for modeling future payer contracts as well.

Using Scorecards to Measure Payer Performance

After you’ve established set goals and a realistic plan for executing those goals, the final step involves measuring the success of your payer contracts using a variety of standardized metrics. These metrics include:

  • Year-over-year collections
  • Collections by payer
  • Collections by month
  • Collections by service code

Through the use of a scorecard, hospitals can engage in more proactive negotiations with the payer by presenting accurate data metrics to justify future contracts and mapping out any areas that are falling short of expectations. Then, hospitals can focus on why it did not meet expectations and use that information to be better prepared for the next set of payer negotiations.

Any organization can make a list of things they need to improve on for future contract negotiations, but without accurate data driving each negotiation, hospitals can’t confidently make realistic predictions on how it will affect their financial standing, say, a year from now.

At the end of the day, what all the negotiations really comes down to is whether or not your organization is able to maintain revenue integrity year-in and year-out. Building on a foundation of accurate data, hospitals can prepare for negotiations by learning how to properly initiate the negotiation, set benchmarks, and measure the payer performance. This, in turn, will allow your organization to meet their financial goals and produce more predictable results.

Brad Olin

Brad Olin

About the Author:

Brad Olin is the Marketing Communications Specialist at PMMC, a leading provider of revenue cycle management solutions for hospitals and healthcare systems across the U.S. Brad offers a modern outlook into the evolution of the healthcare industry and general practices used to grow an organization’s revenue integrity.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remains with them. The company accepts no liability for any errors, omissions or representations.

Infographic: Health Systems Rely on Distribution

May 11th, 2018 by Melanie Matthews

Nearly all hospitals and health systems rely on healthcare distributors to optimize their supply chain, according to a new infographic by the Health Industry Distributors Association.

The infographic details supply chain executives’ satisfaction with distributors’ expertise, and other healthcare supply chain trends.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

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Infographic: Hospital Leadership’s Top Perioperative Priorities

April 11th, 2018 by Melanie Matthews

U.S. hospital leaders are reporting low surgical block utilization and high costs associated with suboptimal surgical staffing, according to a new infographic by Hospital IQ, Inc. As hospital leaders project ambitious surgical revenue targets over the next three years, they will need to leverage the vast amounts of data they have from existing IT infrastructure to fully capture revenue and margin opportunities.

The infographic explores the top perioperative priorities for hospital leadership, the key operating room (OR) challenges and the data and technology trends for OR leadership.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryHealthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

HIN’s highly anticipated annual strategic playbook opens with perspectives from industry thought leader Brian Sanderson, managing principal, healthcare services, Crowe Horwath, who outlines a roadmap to healthcare provider success by examining the key issues, challenges and opportunities facing providers in the year to come. Following Sanderson’s outlook is guidance for healthcare payors from David Buchanan, president, Buchanan Strategies, on navigating seven hot button areas for insurers, from the future of Obamacare to the changing face of telehealth to the surprising role grocery stores might one day play in healthcare delivery. Click here for more information.

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Infographic: How Your Hospital Can Curb Rework and Burnout

March 19th, 2018 by Melanie Matthews

Hospital staff burnout is fueled by documentation rework and retrospective queries and burnout leads to an exponential rise in medical errors, denials, and increased costs, according to a new infographic by Nuance Communications, Inc.

The infographic examines how staff burnout impacts medical errors and contributes to increased financial costs to healthcare organizations.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryHealthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

HIN’s highly anticipated annual strategic playbook opens with perspectives from industry thought leader Brian Sanderson, managing principal, healthcare services, Crowe Horwath, who outlines a roadmap to healthcare provider success by examining the key issues, challenges and opportunities facing providers in the year to come. Following Sanderson’s outlook is guidance for healthcare payors from David Buchanan, president, Buchanan Strategies, on navigating seven hot button areas for insurers, from the future of Obamacare to the changing face of telehealth to the surprising role grocery stores might one day play in healthcare delivery. Click here for more information.

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Guest Post: How U.S. Healthcare Mega-Mergers Hurt Patients

March 14th, 2018 by Robert E. Grant, Founder/CEO, CONCIERGE KEY Health

From the National Economic Council to the healthcare public policy experts at Harvard University, leading medical advisors and economists alike continue to invoke the words of Adam Smith, the eighteenth century British political economist and author of The Wealth of Nations who stated some 300 years ago, “Seldom do businessmen (companies) of the same trade get together but that it results in some detriment to the general public.”

Take the colossal U.S. financial collapse in 2008, for example, which followed an all-time mergers-and-acquisitions (M&A) high of $4.3 trillion in deals. Not more than five years passed before companies were willing to hedge their bets again—especially in the healthcare sector—but with markedly higher stakes. The same year the Journal of the American Medical Association released a thoughtful examination of hospital consolidation, penned by leading medical authorities from the Harvard School of Public Health who opposed the notion of mega-mergers, Teva Pharmaceuticals announced its plan to acquire Allergan’s generics business, Actavis Generics, for $66 billion.

According to data from the financial information firm Dealogic, that was just the tip of the iceberg. The close of 2017 bore witness to the consolidation of private practices, private equity funds and pharmaceutical companies at the current and future expense of the American healthcare patient, who in turn, experiences fewer choices and a decreased quality of care—all for a higher price.

Healthcare’s Merger Epidemic

In 2015, global M&As skyrocketed and set new records by exceeding $5 trillion. It was no surprise that the healthcare sector emerged a frontrunner, leading the charge that year with a total of $723.7 billion in deals. Gaining even more momentum with Abbott Laboratories announcing its definitive agreement to acquire St. Jude Medical for $25 billion in 2016, and a 2017 announcement by CVS to acquire the health insurance giant, Aetna, for roughly $70 billion, the industry innocuously sent a clear message that there was no longer a sky—or an effective governing body—to set any limits.

As the world heads toward the fourth industrial revolution, where artificial intelligence and automation are taking organizations to new heights, health systems and hospitals are falling in line to compete and retain a market share. In 2017 alone, consulting firm Kaufman Hall and Associates reported 115 hospital and health system mergers, which represented a 13 percent increase from 2016. Many experts believe part of the consolidation epidemic stems from the enactment of the Affordable Care Act (Obamacare) in 2010. Even Bob Kocher—the only medical doctor on the National Economic Council advising President Obama—recanted his support of consolidating hospitals, health systems and doctors into larger groups in an effort he believed could drastically improve the delivery of patient care. In 2016, he laid bare his soul in a Wall Street Journal op-ed titled, How I Was Wrong About ObamaCare.

But it’s not just the architects of Obamacare that have failed to heed the words of economists who, like Adam Smith, understand how fewer market participants and less competition are very likely to result in higher prices for consumers, without an improvement in quality.

Not All Mergers are Alike

It is important to note that not all mergers are considered equal. Consolidation driven by organic and natural forces of the market can undoubtedly decrease costs for consumers while improving the quality of a product or service. But if escalating healthcare costs and insurance premiums—along with a flawed system where seeing a specialist requires a referral protocol that can delay a visit by weeks or months—are any indication of the manic consolidations taking place today, it should be proof enough that we are headed for a reckoning.

Demanding More for Less

Even in a growing on-demand, digital economy where consumers can influence the decisions of others through multiple channels and social media platforms, the patient experience has yet to be addressed. In addition to soaring healthcare insurance premiums, in just three years the average new patient doctor appointment wait times in the U.S. increased by 30 percent, according to a 2017 Merritt Hawkins survey. In large markets, the average wait time to see a doctor was 24.1 days (up 30 percent from 2014), with average wait times to see a family medicine doctor up 50 percent. That may not mean much to a healthy individual relocating and searching for a new doctor, but for someone facing a potentially life-threatening illness, it could become a matter of life and death. Furthermore, prior studies such as the 2004 analysis of the 1996 Aetna acquisition of U.S. Healthcare put forth by University of California, Berkeley health economist, James C. Robinson, offer solid evidence that hospital and insurance mergers, in particular, almost always lead to higher costs, less efficiency and less innovation. Why? Because, as Adam Smith warned, mergers reduce competition, which is the driving factor of a free market.

Perhaps the greatest irony in all of human healthcare is that organizations came into existence for the very purpose of helping people get and stay well, yet it seems the survival of the organization has taken priority over the patient and obscured who the consumer actually is. Never before have health consumers been asked to pay so much for so little. It’s time to allow the invisible hand of the U.S. economy to operate as intended. It’s time to look past the bottom line and look to new business models that put patients at the center of the healthcare experience.

Robert E. Grant, Founder/CEO of CONCIERGE KEY Health

About the Author: Robert E. Grant is founder and chief executive officer of CONCIERGE KEY Health, the world’s first mobile app for on-demand access to elite doctors, including specialists and care facilities. An entrepreneur, inventor and investor, he has played a pivotal role for more than 20 years in successful technology and business development in pharmaceutical, medical device and healthcare markets. In addition to founding CONCIERGE KEY, Grant is founder and vice chairman of ALPHAEON Corporation, as well as founder, chairman and managing partner of its parent company, Strathspey Crown Holdings, LLC.

Most recently, Grant was CEO and president of Bausch+Lomb Surgical, leading the significant growth of its product portfolio. From 2006 to 2010, he served as president of Allergan Medical; Grant also served as director, board chairman, CEO, president, COO and CFO of Biolase Technology from 2003 to 2006.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remains with them. The company accepts no liability for any errors, omissions or representations.

Infographic: How Nursing Leadership Styles Can Impact Patient Outcomes

February 2nd, 2018 by Melanie Matthews

Transformational nursing leadership is associated with reductions in medication errors, lower patient mortalities, increased patient satisfaction and lower staff turnover, according to a new infographic by Bradley University.

The infographic examines five nursing leadership styles and their impact on patient outcomes.

UnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs.

Armed with data from its Press Ganey and CAHPS® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a 45-minute webinar on July 27th, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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Infographic: Reducing Healthcare Supply Chain Expenses

October 25th, 2017 by Melanie Matthews

The pressure on hospitals and health systems to simultaneously improve quality and reduce costs will only intensify, no matter the outcome of healthcare reform, according to a new infographic by Navigant.

The infographic examines the substantial savings opportunities within the healthcare supply chain.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

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2016 ACO Results: Majority of Next Generation and Pioneer ACOs Earn Shared Savings

October 20th, 2017 by Patricia Donovan

Six of eight Pioneer ACOs and eleven of eighteen Next Generation ACOs earned shared savings in separate initiatives in 2016, according to newly released quality and financial data from the Centers for Medicare and Medicaid Services (CMS).

In 2016 Performance Year Five of the Pioneer ACO program, one of several new accountable care organization (ACO) payment and service delivery models introduced by CMS to serve a range of provider organizations, only Monarch HealthCare and Partners HealthCare were not among shared savings earners.

Banner Health Network emerged as the top 2016 Pioneer ACO performer, earning nearly $11 million in shared savings based on care provided to its more than 42,000 beneficiaries.

In order to receive savings or owe losses in a given year, Pioneer ACO expenditures must be outside a minimum corridor set by the ACO’s minimum savings rate (MSR) and minimum loss rate (MLR).

The Pioneer ACO model is designed for healthcare organizations and providers already experienced in coordinating care for patients across care settings. It allowed these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with but separate from the Medicare Shared Savings Program (MSSP).

The Pioneer ACO Model began with 32 ACOs in 2012 and concluded December 31, 2016 with eight ACOs participating.

Meanwhile, at the conclusion of 2016 Performance Year One of the Next Generation ACO model, Baroma, Triad and Iowa Health topped the list of ACO earners in this program, with each organization accumulating more than $10 million shared savings.

Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, CMS’s Next Generation ACO Model sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.

According to a CMS fact sheet, 18 ACOs participated in the Next Generation ACO Model for the 2016 performance year, and 28 ACOs are joining the Model for 2017, bringing the total number of Next Generation ACOs to 45. The Next Generation ACO Model will consist of three initial performance years and two optional one-year extensions.

CMS’s ACO models are one of seven Innovation categories designed to incentivize healthcare providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.

Infographic: Using Technology-Enabled Communications To Address Revenue Cycle Challenges

September 22nd, 2017 by Melanie Matthews

Healthcare providers are missing opportunities to drive timely payments, grow revenue and maximize reimbursements, according to a new infographic by Televox.

The infographic examines the revenue opportunities that healthcare providers are missing and how providers can avoid penalties and earn additional reimbursement.

Since the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM. Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare’s existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

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