Archive for the ‘Physician Practices’ Category

Predictors of PHO Longevity and Financial Success

April 15th, 2014 by Patricia Donovan

Today, value-based payment models encourage hospitals and physicians to work together and make each more accountable for the other's actions in a physician-hospital organization (PHO). But what are predictors of PHO longevity and financial success?

Here, Healthcare thought leaders Travis Ansel, MBA, manager of strategic services, Healthcare Strategy Group, and Greg Mertz, MBA, FACMPE, director of consulting operations, Healthcare Strategy Group, debate the question.

Response (Greg Mertz): It’s pretty evident that no one entity is going to be able to meet the needs of the population. If you’ve got a hospital that employs physicians, there’s an excellent chance that the employed physician network isn’t the total answer for caring for the population. They’re going to have to embrace non-employed physicians, other specialties, larger based primary care. Some entity is going to have to be created to make that happen.

But the PHO is an excellent model. Basically, it creates a collaborative entity that can bring in hospitals, employed physicians, non-employed physicians, ancillary providers. The PHO this time is something that is going to be necessary. Value is inevitable. I don’t see any reason that it would not have great longevity.

Response (Travis Ansel): I definitely agree. I think the biggest predictor of long-term success is the culture, but it’s going to be how the governance of the PHO is set up. It’s going to be giving the physicians, both employed and independent, a real voice in the organization and getting their expertise leveraged going forward. That’s going to be the biggest predictor. Beyond that, a willingness to experiment.

We’re in a situation now where organizations can’t really afford to sit on the sidelines for too long with all the different models that CMS and private payors are putting up in order to encourage shared risk between providers and hospitals. A willingness to experiment would be another key to success in my mind because it’s really the only way to learn how to be successful in this new environment, how to get involved in it and not hang on to the current FFS environment until it withers and dies.

Excerpted from Essential Guide to Physician-Hospital Organizations: 7 Key Elements for PHO Success.

How to Engage Specialists in the Patient-Centered Medical Home

April 1st, 2014 by Patricia Donovan

Primary care's relationship with specialists will influence quality and reimbursement.


Florida Blue's primary care focused pay-for-performance program transitioned in 2012 into a statewide patient-centered medical home (PCMH) initiative. Here, Barbara Haasis, RN, CCRN, senior clinical lead for quality reward and recognition programs at Florida Blue, describes the role of primary care in engaging specialists in the PCMH program.

Engagement of specialists happens through the primary care physician (PCP). The PCP will be judged on the total cost of care, and his percentage of the shared savings is based on working with specialists that are efficient, and that report back to him or her, so that they are aware of what is going on. That is the development between the PCP and the specialist. They have to go to a specialist in the network, but we are not specifying who.

There is a huge incentive for the PCP, because when we look at a member’s total cost of care, we are looking at inpatient/outpatient, specialty, primary, lab, x-ray, total cost of care—it is everything. If there are two specialists, and one orders every test under the sun, whether it is needed or not, and the other goes into the ER to see the member and takes care of them efficiently and effectively, that primary care doctor is going to change his referral pattern to go to the more efficient. That is the incentive.

We are setting up other arrangements with specialists that will marry up to the PCMH. For example, we may do some kind of preferred cardiology network in the Orlando area into which the PCPs will probably refer. We cannot do that here. We have contractual language with many of our facilities and physicians that prevent us from doing any steerage.

It is up to the physicians to work through relationships to find the most effective for their practice.

Excerpted from: New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care

HINfographic: 12 Questions to Guide a Physician Compensation Strategy

March 28th, 2014 by Jackie Lyons

A successful physician compensation strategy includes organizational goals, governance and physician engagement, according to Cynthia Kilroy, senior VP of provider strategy and business development at Optum.

This new infographic from the Healthcare Intelligence Network features 12 questions to guide the implementation of a physician compensation strategy for healthcare organizations. Addressing all three areas of the strategy can improve satisfaction while creating an environment and structure that supports transparency and enables quality and efficiency.

You may also be interested in this related resource: 6 Value-Based Reimbursement Models: Strategies for Selection, Alignment and Engagement. This 40-page resource examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.


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Infographic: Timeline of the Patient Experience

March 24th, 2014 by Jackie Lyons

From the first encounter on a benefits enrollment website to hospital discharge, the healthcare industry is looking to improve care quality and patient satisfaction.

However, 83 percent of Americans do not follow treatment plans given by their doctor as prescribed, according to a new infographic from Codebaby. This infographic chronicles the average experience of Americans, from making an appointment to follow-up treatment and everywhere in between.

Looking to enhance the patient experience and better coordinate care? You may also be interested in this webinar replay: Integrating Mobile Health Remote Patient Monitoring with Telephonic Care Management for Improved Care Coordination Results. Improving care coordination improves the overall patient experience and satisfaction. During this webinar, Gail Miller, the vice president of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge, shared details of their telephonic care management program and how these remote monitoring pilots will enhance their care coordination efforts.

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Physician Group ACOs Value Specialists, Nurse Practitioners

March 19th, 2014 by Jessica Fornarotto

As the number of public and private accountable care organizations nears 500, participants are fine-tuning the ACO model. In the few years since the ACO model entered healthcare's consciousness, administration has shifted from hospital-led to physician-only leadership to PHO-helmed ACOs. In its third annual industry survey on ACOs, conducted in 2013, the Healthcare Intelligence Network captured how 138 healthcare organizations are participating in ACOs.

Drilling down to the multi-specialty physician group perspective, this survey analyzed the number of existing ACOs for this sector, which providers participate in the ACO, and more.

With their built-in cadre of healthcare providers, multi-specialty physician groups (referred to here as physician groups), which comprised about a tenth of survey respondents, would seem ideally placed to transition to accountable care organizations. Percentage-wise, this sector has the highest rate of existing ACOs (57 percent participating in ACOs versus 34 percent of overall respondents) and twice the rate of participants in the CMS Pioneer ACO program (25 percent versus 13 percent).

In other deviations from the norm, twice the number of physician group-reported ACOs favor the hybrid FFS + care coordination + shared savings payment model (75 percent of physician-group ACOs versus 37 percent of overall respondents).

More than half of ACOs in this sector are administered by independent physician associations (IPAs), and most are smaller than the hospital-sized ACOs reported in the survey, with three-quarters reporting a physician staff of less than 100. These ACOs benefit from having specialists on board in greater numbers to help with care coordination of the chronically ill (100 percent include specialists, versus 71 percent overall).

They also unanimously include nurse practitioners (versus 90 percent of overall respondents) and with 50 percent including clinical psychologists in the ACO (versus 42 percent overall), are a little further along on the path of integrating behavioral health into the accountable care initiative.

Cognizant of the full care continuum, these IPA-led ACOs are almost twice as likely as overall respondents to include skilled nursing facilities (50 percent versus 29 percent overall) and hospice (75 percent versus 42 percent overall) in their ACOs.

Excerpted from: 2013 Healthcare Benchmarks: Accountable Care Organizations

8 Challenges to Medical Home Success

March 12th, 2014 by Jessica Fornarotto

"What's important about patient-centered medical homes (PCMHs) is that they're patient-centered. PCMHs are a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients. And patients have the education and support they need," explains Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney lists below the eight challenges in successfully changing to a PCMH.

The first challenge to PCMH success is that many physicians are reluctant to change. Physicians have been trained to be change-averse and variable-averse to avoid making mistakes at two o’clock in the morning, etc. Second, physician leadership and physician champions are critical. Sometimes this has to be trained and taught.

Next, there's a culture that is very traditional in healthcare; we need to think and talk about that. There is also a culture within individual practices and health systems that creates barriers to successful transformation. Another challenge is that some providers are not able to function effectively in a team environment. This needs to be supported and transformed with the appropriate training provided.

The next challenge is communication, which is critical at multiple levels. Successful medical neighborhoods and clinically integrated neighborhoods (CINs) are built around communication, care plans, care that's delivered, data, quality metrics, lab data, etc. The sixth challenge is that there has to be trust between all of the entities as systems are transforming and payor data becomes more critical. Partnerships with payors around shared savings or shared risk are becoming more common. Trust is critical and that hasn’t always existed.

Next, we need to make sure there are aligned incentives; you can't ask people to do more work for the same compensation. You can't ask them to assume more risk for the same compensation. Incentives need to be aligned around what is now called 'value-proposition' or 'pay-for-value,' or to where there is an expectation to improve quality and lower cost.

The final challenge is there needs to be full recognition that PCMH transformation is not easy. It's very difficult and time consuming, but in the end it's highly rewarding.

Excerpted from: Driving Value-Based Reimbursement with Integrated Care Models

HINfographic: 9 Measures of ACO Success

March 12th, 2014 by Jackie Lyons

What is the mark of a successful accountable care organization (ACO)? For healthcare organizations, clinical outcomes topped the list of ACO success metrics.

This HINfographic depicts nine key ACO metrics identified by 138 healthcare companies. Also among the top three measures was patient satisfaction and health utilization.

9 Measures of ACO Success

 title= You may also be interested in this related resource: Guide to Accountable Care Organizations. This 160-page resource lays the groundwork for an ACO program. It includes a framework for clinical integration, a key ACO prerequisite that puts participating providers on the same performance and payment page, and much more.

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Infographic: The Pros, Cons and Costs of ICD-10

March 7th, 2014 by Jackie Lyons

The shift from ICD-9 to ICD-10 that will occur on October 1, 2014 will transition 14,000 codes to more than 68,000 codes.

Ninety-two percent of physicians are concerned with the overall cost of converting to ICD-10, according to a new infographic from Greenway. This infographic shows the pros, cons and costs of ICD-10 as well as the specific problems it presents.

You may also be interested in this related resource: A Best Practice Roadmap to ICD-10 Readiness. Want to learn more about how to make ICD-10 simple? This 24-page report documents the process BCBSM has established to resolve discrepancies between ICD-9 and ICD-10 codes, a milestone that has allowed the payor to complete its version of the General Equivalence Mappings (GEMs) — referred to as the Blue GEM Encyclopedia.


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7 Provider Predictions for 2014: Larger Players Will Exert Presence

March 4th, 2014 by Patricia Donovan

Assessing the industry landscape for healthcare providers, Steven T. Valentine, president of The Camden Group, predicts that the big will get bigger in the year to come in healthcare.

providers 2014

In evaluating the environment around us, what do we look for in 2014? We’re looking at continued consolidation with hospitals. Second, we fully expect to see that some hospitals are going to be repurposed and will move from acute-care into post-acute. They might do it a floor at a time, two floors at a time—an abandoned smaller hospital that they can convert to ambulatory, rehab, or skilled nursing facility (SNF).

Moving forward, we fully expect inpatient utilization to continue the trend of being flat to down. Fourth, we would fully expect bigger providers to get bigger, and the smaller facilities in the suburban areas to struggle more on the volume side. The bigger are going to exert their market presence and try to continue to grow with the critical mass that they have.

Next, we do not expect reimbursement will keep up with the cost that the hospitals and health systems are experiencing. With organized labor, the heavy regulation, the rich paying benefits, the hospital employees greater than outside the hospital, these are some tough areas that the COO’s of many hospitals and health systems are dealing with.

Sixth, hospitals will continue to be capital intensive; everybody wants more money for their IT, as well as for facilities. We fully expect hospitals to continue with physician employment, doing the plan-to-plan so that health systems would pursue plan-to-plan contracting. Lastly, we see geographic concentration; where geography doesn’t really fit, you would let that go.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

Infographic: 7 Reasons to Engage With Patients Before Their Appointments

February 26th, 2014 by Jackie Lyons

The need to engage patients by preparing them before their appointments is rapidly growing. Positives include efficiency and increased patient satisfaction due to less manual data entry and shorter patient wait times among other benefits, according to a new infographic from Leading Reach.

This infographic provides the top seven reasons to engage with patients before their appointments and 10 examples of information that can be sent to patients before their appointment to ensure satisfaction.

You may also be interested in this related resource: Healthcare Innovation in Action: 19 Transformative Trends. Need more ways to increase patient satisfaction? This 40-page resource examines a set of pioneering efforts supporting the industry's seismic shift from a volume-based culture to one rewarding value and patient-centeredness.


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