Archive for the ‘Hospitals’ Category

Infographic: The Healthcare Value Initiative

June 11th, 2018 by Melanie Matthews

Hospitals are taking the lead in addressing healthcare affordability, according to a new infographic by the American Hospital Association.

The infographic examines how hospitals and health systems have been able to hold price increases to under 2 percent in each of the last four years.

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 in March 2018, now available for replay, 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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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: Hospital Adoption of Alternative Payment and Delivery Models

May 18th, 2018 by Melanie Matthews

Hospitals and health systems continue to test and adopt alternative payment and delivery models, such as ACOs, medical homes, and performance-based payment, according to a new infographic by the American Hospital Association.

The infographic examines market trends for value-based payment and delivery models.

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.

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: 340B Hospitals Provide Healthcare Safety Net for Low-Income Americans

March 30th, 2018 by Melanie Matthews

340B hospitals treat significantly more low-income patients and provide a greater percentage of uncompensated and unreimbursed care, according to a new infographic by 340B Health.

The infographic examines the critical services 340B hospitals provide to low-income hospitals.

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.

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.

Essentia Health Virtual Telemedicine Services Support Rural Hospitals and Clinics

March 13th, 2018 by Patricia Donovan

Essentia Health conducts 5,000 virtual visits annually.

There may be some challenges associated with Essentia Health’s comprehensive telemedicine program, but provider engagement isn’t one of them.

“In the seven years I have been with Essentia Health, I have not gone to any provider to ask them to do telehealth,” notes Maureen Ideker, RN, BSN, MBA, the organization’s senior advisor for telehealth. Instead, physicians seek out Ms. Ideker, asking to be connected to any of Essentia Health’s six hospital-based and more than 20 clinic-based telehealth services.

Such robust telemedicine adoption among Essentia Health’s more than 800 physicians may be one reason why the organization averages 5,000 virtual visits annually, and why it has another 10 to 20 new telehealth offerings in development, according to Ms. Ideker’s presentation during Telemedicine Across the Care Continuum: Boosting Health Clinic Revenue and Closing Care Gaps.

The largely rural footprint of Essentia Health, which touches the three states of Minnesota, Wisconsin and North Dakota, is ideally suited to telehealth implementation. During this March 2018 webinar, which is now available for rebroadcast, Ms. Ideker outlined her organization’s telehealth program models, history of program development, and equipment and staffing requirements. She also shared key program outcomes, such as the impact of remote patient monitoring on hospital readmissions and clinic ROI from telehealth.

For example, the 30-day readmission rate for Essentia Health patients with heart failure remotely monitored at home is 2 percent, versus its non-monitored heart failure patients (9 percent) and the national 30-day readmissions average of 24 percent.

Essentia Health’s hospital-based telemedicine began with an emergency room platform, which includes pediatric ER and pharmacy and toxicology and a soon-to-be-added behavioral health component. Today, hospitalist and stroke care are the largest of Essentia Health’s hospital-based telemedicine programs, explained Ms. Ideker. These virtual services support Essentia Health’s rural hospitals in five key ways, including the avoidance of unnecessary patient transfers.

On the outpatient side, the 20-something tele-clinic based services developed by Essentia Health over the last seven years run the gamut from allergy and infant audiology to urology and vascular conditions, she explained. Her organization’s telemedicine approach to opioid tapering is catching on across Minnesota, she added.

And while it is appreciative of its providers’ enthusiasm, Essentia Health approaches telehealth development with precision, consulting data analytics such as metrics on annual health screenings to create target groups for new services. The launching of a new telemedicine service can take up to twelve weeks, using a 75-item checklist and an implementation retreat and walk-through, Ms. Ideker explained.

In closing, Ms. Ideker shared several innovation stories from its portfolio of telehealth offerings, including Code Weather, employed during hazardous weather for patient safety reasons and to reduce cancellations of appointments, and a gastroenterology initiative designed to reduce no-show rates.

Listen to Maureen Ideker explain how Essentia Health pairs remote patients with hospital- and clinic-based telehealth services.

Infographic: Hospital Mobile Technology

February 28th, 2018 by Melanie Matthews

Mobile technology in the hospital is elevating patient care, empowering clinicians and enhancing workflows, according to Zebra’s 2022 Hospital Vision Study.

Survey results are highlighted in a new infographic by Zebra, including details on the growing use of mobile devices, the impact of technology on performance improvement, the emergence of tech-savy patients and transformative technology trends.

2018 Healthcare Benchmarks: Telehealth & Remote Patient MonitoringArtificial intelligence. Automation. Blockchain. Robotics. Once the domain of science fiction, these telehealth technologies have begun to transform the fabric of healthcare delivery systems.
As further proof of telehealth’s explosive growth, the use of wearable health-tracking devices and remote patient monitoring has proliferated, and the Centers for Medicare and Medicaid Services (CMS) has added several new provider telehealth billing codes for calendar year 2018.

2018 Healthcare Benchmarks: Telehealth & Remote Patient Monitoring delivers the latest actionable telehealth and remote patient monitoring metrics on tools, applications, challenges, successes and ROI from healthcare organizations across the care spectrum. This 60-page report, now in its fifth edition, documents benchmarks on current and planned telehealth and remote patient monitoring initiatives as well as the use of emerging technologies in the healthcare space.

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Guest Post: Real-Time Data Analytics Key to Decreasing Denial Rates, Saving Time and Lowering Costs

February 22nd, 2018 by Jonathan Farr, Senior Vice President, North America, EFFY

For hospital and health system leaders, financial challenges pose some of the most insurmountable hurdles, with claim denials a significant contributor. Consider the numbers: annual losses from denial write-offs average 5 percent, and up to 15 to 20 percent of initial denials occur with the first billing. The burden of reworking denials not only impedes the revenue cycle process, but can also compromise care quality.

Furthermore, the number of hospital mergers and acquisitions surged by 15 percent between 2016 and 2017. This has generated massive sets of disparate data that must be reconciled and reviewed, creating an environment where the revenue cycle management (RCM) process can be fraught with missteps. As a result, today’s hospital leaders seek new opportunities for maximizing revenue, and identifying solutions that enhance both financial and clinical performance.

Optimizing Revenue Cycle Management

Issues that lead to denials occur throughout the revenue cycle. Certain best practices are helpful for hospitals of every kind and size, such as taking steps to minimize denials up front, managing them through efficient workflows and processes, and analyzing denials after the fact to identify common causes.

Perhaps the most important step hospitals can take is to find the right RCM solution to optimize financial performance—one that doesn’t require replacing an existing and often expensive operating system (OS). The best option is to find a partner that offers an actionable real-time or near real-time data analytics platform that overlays or integrates with the current installations.

Actionable Real-Time Data Analytics

An actionable real-time data analytics platform, especially one powered by an RCM optimization tool that has been proven effective across leading healthcare systems, telecom companies, utilities, retail and other complex industries, can help hospitals significantly minimize denials, and save time and money.

How does an RCM optimization tool work? It can audit and trigger efficiency actions in a way that is non-intrusive to the day-to-day work of the revenue cycle clerical staff. What’s more, this type of solution offers an efficiency platform that overlays an existing system to help healthcare organizations compare massive amounts of data across their total enterprise, detect exceptions and problems, and guide actions and interventions to improve efficiency.

An actionable RCM solution has the reconciliation and analytical tools that help organizations gather and compare data enterprise-wide, detect deviations, issue alerts and offer an integrated workflow to guide the ‘fixes’ they need.

With this solution, hospitals do not have to discard their OS because the RCM solution overlays the current installation, provides the necessary analytics and drives the corrective actions needed. Even better news for hospital leaders, this type of innovative RCM solution eliminates the need for large up-front acquisition costs, representing a financial transaction that does not compromise the bottom line.

Impressive Returns

An RCM solution that uses actionable real-time data analytics and powerful action-driven analytic tools has seen proven results: for one not-for-profit hospital, savings related to denials and write-offs continued to accrue and reached upwards of $800,000 in the first six months of operation.

Furthermore, back-end processes were streamlined, relieving stress and time constraints imposed on the clinical staff. Inadequate documentation of medical necessity was addressed, allowing the hospital to transition charges to patient self-pay or to initiate a change in the course of treatment.

This type of RCM solution represents the future of data analytics, helping hospitals increase net revenue by 3 to 4 percent, with ROI multiples of between eight and ten. It also allows a hospital to use any data from any OS to set up sophisticated validations to detect issues immediately.

By simply overlaying an actionable real-time data analytics system, RCM managers can quickly gain control of aggregated data, and detect/resolve issues that impact revenue integrity, as well as clinical and operational performance, in a way that is truly cost-effective.

About the Author: Jonathan Farr, MHA, is Senior Vice President, North America, for EFFY. Jon has prior experience managing general acute hospitals, surgical hospitals, emergency centric hospitals, behavior health hospitals, and a large physician practice, both for-profit and not for profit, urban and rural, domestic and international. He is highly respected for his ability to work with physicians, boards, committees, regulatory agencies, third party payors, vendors, patients and all levels of personnel. Jon earned a Master’s in hospital administration from the Medical College of Virginia and is a member of the American College of Healthcare Executives.

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.