Posts Tagged ‘hospital trends’

Infographic: The Hospital of the Future

November 5th, 2018 by Melanie Matthews

Hospital-based health systems face a tremendous deal of pressure just to sustain current performance levels, according to a new infographic by Oliver Wyman.

The infographic examines how healthcare organizations are innovating to bridge the gap between where the industry sits today and a differentiated health system tomorrow.

A New Vision for Remote Patient Monitoring: Creating Sustainable Financial, Operational and Clinical OutcomesAs healthcare moves out of the brick-and-mortar traditional setting into patients’ homes and their workplaces, and becomes much more proactive, the University of Pittsburgh Medical Center (UPMC) has been expanding its remote patient monitoring program. The remote patient monitoring program at UPMC has its roots in the heart failure program but has since expanded to additional disease states across the integrated delivery system’s continuum of care.

A New Vision for Remote Patient Monitoring: Creating Sustainable Financial, Operational and Clinical Outcomes delves into the evolution of UPMC’s remote patient monitoring program from its initial focus on heart failure to how the program was scaled vertically and horizontally. Click here for more information.

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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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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 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: 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: Rural Hospital Closures Since 2010

January 22nd, 2018 by Melanie Matthews

There have been 83 rural hospital closures since 2010 and 125 since 2005, according to a new infographic by Stroudwater.

The infographic breaks down the hospitals’ Medicare payment type, location, whether or not the hospitals are located in a Medicaid expansion state and the closure year.

2017 Healthcare Benchmarks: Community Health PartnershipsIncreasingly, healthcare organizations are forging community partnerships to bridge care gaps and improve population health status. This alignment of care and resources ranges from providing transportation to doctors’ appointments to scheduling EMT visits to visit the homebound elderly following their hospitalization. Working in tandem with community groups addresses social determinants of health (SDOH) and produces clinical and financial benefits that are recognized and rewarded by today’s value-based healthcare reimbursement models.

2017 Healthcare Benchmarks: Community Health Partnerships documents the efforts of 81 healthcare organizations to align clinical interventions with neighborhood collaborations to improve health, wellness and socioeconomic factors in the populations they serve. These metrics are compiled from responses to the October 2017 Community Health Partnerships survey by the Healthcare Intelligence Network. Click here for more information.

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Infographic: 2018 Healthcare Outlook

December 29th, 2017 by Melanie Matthews

Hospitals have experienced improvements in uncompensated care revenue due to the Affordable Care Act. But reform and economic uncertainty are creating a perfect storm that could erase this momentum, according to a new infographic by Navigant.

The infographic examines the factors that could reverse the improvements in uncompensated care and what this means for hospitals and health systems.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryGiven the powerful patterns disrupting healthcare, what will it take to succeed as a high-velocity healthcare organization in 2018?

Healthcare 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.

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: 3 Ways Hospitals Throw Away Money

October 10th, 2016 by Melanie Matthews

More than half of U.S. hospitals lose money on each patient they serve, according to a recent study published in Health Affairs.

A new infographic by SCI Solutions examines three key areas in which hospitals lose money and how to address them.

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.

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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