Archive for the ‘Healthcare Administration’ Category

Infographic: Aligning Infrastructure Decisions with Healthcare Business Plans

August 10th, 2018 by Melanie Matthews

Healthcare organizations need to align their infrastructure process and business models, according to a new infographic by Fitzemeyer & Tocci Associates, Inc.

The infographic drills down on how healthcare organizations spend their capital and key goals for good infrastructure options.

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: 3 Key Steps To Healthcare Success

July 25th, 2018 by Melanie Matthews

Healthcare leaders have sought to improve healthcare quality, delivery, efficiency, and customer service by using organizational change as a mechanism for success, according to a new infographic by Optimum Healthcare IT.

The infographic examines the three key steps that can lead to change success for 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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Infographic: Tackling Hospital Staffing Problems

July 18th, 2018 by Melanie Matthews

Healthcare staffing remains a problem for hospitals. Thirty-one percent of hospitals cannot find enough candidates to fill open positions. Only slightly more than 25 percent of leadership positions are being filled within three months. Medium and large hospitals spend between $10,000 and $30,000 to hire leadership positions, according to a new infographic by TargetRecruit.

The infographic examines healthcare staffing trends and how healthcare organizations can tackle these problems.

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.

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Infographic: When it Comes to Coding, Accuracy Matters

July 11th, 2018 by Melanie Matthews

Medical coding errors are one of the top reasons claims are denied. Denials are expensive to rework, and they can lead to delays in reimbursement—or no payment at all, according to a new infographic by Change Healthcare.

The infographic provides details about the top coding challenges.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM RevenueSince 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: Relieving the Burden of Prior Authorizations

June 27th, 2018 by Melanie Matthews

Prior authorizations are necessary and unavoidable, costing healthcare organizations time and money and contributing to physician burnout, according to a new infographic by athenahealth, Inc.

The infographic provides options for managing prior authorizations and best practices for handling them.

Proactive Care Management in a Top-Performing ACO: Closing Quality and Care Gaps in High-Risk, High-Utilization PopulationsAs one of 2016’s top 10 performing MSSP accountable care organizations, UT Southwestern Accountable Care Network (UTSACN) generated nearly $17.5 million in shared savings.

Proactive Care Management in a Top-Performing ACO: Closing Quality and Care Gaps in High-Risk, High-Utilization Populations divulges some of the secrets behind UTSACN’s success in the Medicare Shared Savings Program (MSSP) for ACOs. Winning strategies of the UTSACN ACO include a commitment to data analytics to inform programming and improve utilization and quality as well as holding its healthcare providers accountable for clinical and fiscal decisions. Click here for more information.

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Infographic: Clinical Documentation to Optimize Value-Based Care in the Outpatient Setting

June 22nd, 2018 by Melanie Matthews

A strong commitment to clinical documentation improvement (CDI) can help healthcare organizations maximize claims reimbursement while improving quality of care, according to a new infographic by Galen Healthcare Solutions.

The infographic examines CDI goals and the impact of improved CDI on the healthcare bottom line.

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).

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.

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).

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.

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.

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.