Archive for the ‘Healthcare Administration’ Category

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.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

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.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

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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Infographic: 3 Steps to Achieving Document Efficiency in Healthcare

September 4th, 2017 by Melanie Matthews

Even with the use of electronic health records, printing documents continues to be one of the highest expenses for hospitals. In fact, the average 1,500-bed hospital prints over 8 million pages per month, resulting in annual costs of $3.8 million on average. There are numerous opportunities to increase efficiency in print environments, thereby reducing costs, according to a new infographic by CynergisTek.

The infographic details three steps hospitals should take to increase their print environment efficiency.

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.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

5-Part Framework for MIPS Success Under MACRA

March 2nd, 2017 by Patricia Donovan

Before picking MACRA pace, physician practices should construct a framework for MIPS success.

Along with picking a MACRA pace, physician practices should construct a framework for MIPS success.

Regardless of the pace a healthcare organization sets for Quality Payment Program participation, there are some key tactics that should form the framework of any MACRA initiative. Here, William Holding, consultant with PDA Inc., outlines the critical elements organizations need to achieve “MACRA-readiness.”

  • The first component for success is perhaps the most important, and that’s having a culture of provider support. A willingness to explore new options. This component is free, so if you don’t have that culture in place today, before going and investing in analytics products, performance improvement or new staffing, you’ve got to put this culture in place. We have seen organizations do this successfully, and make the journey into accountable care organizations (ACOs) or value-based programs by working on this piece first.
  • Second is strategic planning. Set measurable goals. That’s important. Look ahead one year, two years, three years. Set goals that have timelines, and goals that are reasonably achievable.
  • The next piece is strong leadership. If you don’t have a quality committee or a Merit-Based Incentive Payment System (MIPS) committee, consider establishing one, and establishing a position lead in that program. It should be a multidisciplinary effort. Pull physicians, mid-levels, nursing leadership, IT and program management into that program. You should have tailored reporting strategies that align with your planning efforts.

    I’ve experienced teams that didn’t work well. In working with large systems, even with the support of clinical leadership and with the right analytical skills, efforts, I have witnessed efforts that were slower than they should have been until they brought in the right team member. This team member possessed in-depth knowledge of clinical workflows, had clout within the organization, knew personnel across IT, could talk to providers, and was a good communicator. When that person was on the team, the efforts began to move forward much faster. You’ve got to find the right people to be involved.

  • Next, data analytics is key. This starts with an individual with the right skills. It doesn’t mean you have to buy the most expensive solution for this. Sometimes ad hoc solutions work just fine for certain organizations. However, you need the right individual who knows the data, who knows how to respond to requests from leadership, and who can really own it.
  • Lastly, clinical documentation is essential. Doing that well will improve your position in this program.

Source: Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance

social determinants of health

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal—Quality Resource Use Reports (QRURs) and other analyses providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

2016 Healthcare Headlines: MACRA Monopolizes News Until Election Shake-Up

December 26th, 2016 by Patricia Donovan
top 2016 news stories

The unexpected election of Donald J. Trump to the U.S. presidency threatened some healthcare initiatives from the Obama administration, including the Affordable Care Act.

There was only one thing capable of distracting the healthcare industry in 2016 from MACRA’s imminent rollout: the election of Donald J. Trump to the presidency of the United States.

Nevertheless, the majority of the last twelve months was spent on healthcare business as usual—the business of transitioning to value-based models of care delivery and reimbursement.

Here are the headlines that dominated the news feeds of healthcare executives in 2016:

New CMS ‘Accountable Health Communities’ Model Aims to Improve Patients’ Health by Addressing Social Needs

January 2016: In a first-ever CMS Innovation Center pilot project to test improving patients’ health by addressing their social needs, the HHS appropriated $157 million in funding to bridge clinical care with social services.

The new pilot will test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid. Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals’ health, yet they may not be detected or addressed during typical healthcare-related visits.

Medicare Shares 6 Core Principles for 21 New ‘Next Generation ACOs’

January 2016: The Centers for Medicare & Medicaid Services (CMS) made waves when it launched a new accountable care organization (ACO) model called the Next Generation ACO Model (NGACO Model). The twenty-one ACOs participating in the NGACO Model in 2016 have significant experience coordinating care for populations of patients through initiatives, including, but not limited to, the Medicare Shared Savings Program and the Pioneer ACO Model.

Providers Slow to Adopt Population Health, Value-Based Models of Care: Study

February 2016: Most healthcare providers continue to lag in implementing population health management despite broad agreement it will be important for future market success, according to a national study by healthcare strategy consultancy Numerof & Associates. The study synthesized survey responses from more than 300 executives and in-depth interviews with over 100 key decision-makers across U.S. healthcare delivery organizations. It provided the first in-depth, national look at the pace of transition from fee-for-service to models based on fixed payments linked to outcomes.

Horizon BCBSNJ ‘Episodes of Care’ Program Pays $3 Million in Shared Savings to Specialty Medical Practice

February 2016: Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced that it paid out approximately $3 million to 51 specialty medical practices as part of shared savings generated through the company’s innovative Episodes of Care (EOC) Program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. The EOC model, also known as bundled payments, is one in which specialists manage the full spectrum of care related to a specific procedure, disease diagnosis or health event—such as a joint replacement or pregnancy.

Bundled Payments Improve Care for Medicare Joint Replacement Patients: NYU Langone Study

March 2016: Implementing bundled payments for total joint replacements resulted in year-over-year improvements in quality of care and patient outcomes while reducing overall costs, according to a new three-year study from NYU Langone Medical Center. The three-year pilot at the medical center reported reductions in patient length-of-stay and readmission rates.

CMS to Test New SNF Payment Model to Curb Readmissions, Foster Multidisciplinary Care

March 2016: The Centers for Medicare & Medicaid Services (CMS) today announced it would test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing facility residents. This next phase of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents seeks to reduce avoidable hospitalizations among beneficiaries eligible for Medicare and/or Medicaid by providing new payments to practitioners for engagement in multidisciplinary care planning activities.

Proposed MACRA Rule Would Streamline Medicare Value-Based Payment Models

May 2016: In issuing a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians, the Department of Health & Human Services took the first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 2016: As they digested the HHS’s momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations began assembling arsenals of educational tools to de-mystify MACRA. The federal government’s first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

CMS Releases MACRA Final Rule; Creates Two Pathways for Clinician Value-Based Payments

October 2016: The Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the administration’s progress in reforming how the healthcare system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care.

ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 2016: If U.S. President-elect Donald J. Trump delivers on his campaign promises, the ‘repeal and replacement’ of the Affordable Care Act (ACA) should be an early priority for the nation’s chief executive-in-waiting. That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts, Determine ACA Fate

November 2016: Calling his nominees “the dream team that will transform our healthcare system for the benefit of all Americans,” President-elect Donald J. Trump announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

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