Posts Tagged ‘Hospitals’

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.

Infographic: 3 Simplified Hospital Case Costing Methods

January 24th, 2018 by Melanie Matthews

To assess hospital profitability, you must know your hospital costs, according to a new infographic by MediSolv.

The infographic highlights three common hospital case costing methodologies.

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: Hospitals Coordinate Care to Serve Patients

February 3rd, 2016 by Melanie Matthews

Hospitals are working together and with physicians and other community caregivers to provide patients with convenient, high quality and affordable care, according to a new infographic by the American Hospital Association.

The infographic looks at hospitals’ effort to coordinate care.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO’s cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO’s highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann’s carefully executed journey to quality and the culmination of the ACO’s community-based care management program.

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PHOs Let Quality, Cost Guide Them Toward Value-Based Reimbursement

April 16th, 2015 by Cheryl Miller

Instead of focusing on volume, physician-hospital organizations (PHOs) are concentrating on value-based care, says Travis Ansel, senior manager with the Healthcare Strategy Group. The once revenue-based organizations are now focused on quality and cost, realizing that if they can’t manage those two things, their reimbursement will go down.

Why is the PHO model going to work now? We always get this question. This comes more from doctors than it does from administrators: why are PHOs going to work now, when they didn’t work before? The simple answer is that before, PHOs were revenue-focused. They were about getting the biggest number of physicians into the model regardless of their quality. It was run by the hospital as a methodology for increasing rates. Then fee-for-service (FFS) didn’t really give anybody the incentive to work together.

They gave everybody the incentive to sign their name on the contract and hope for better rates. What we’re seeing PHOs focus on now is quality and cost, with the idea that if they can’t manage those two things, their reimbursement is going to go down. We have clinical integration guidance from the Federal Trade Commission (FTC), which gives everybody the framework for developing joint contracting capabilities and defines legally how we can work together. What we’re seeing now, since there’s more of a clinical than a revenue focus for PHOs, is that they are more dominated by physician leadership. The hospital keeps control over the purse strings, but gives the governance of the group to physicians. They are letting them take the leadership on the cost and quality protocols that they need to develop to be successful.

There is also the way that payment reform is transitioning the incentives. They’re focused on getting quality and cost across populations or across episodes of care. They’re giving the right incentives for collaboration, which the PHO model provides the forum for.

Source: Physician-Hospital Organizations: Framework for Clinical Integration and Value-Based Reimbursement

Home Visits

Physician-Hospital Organizations: Framework for Clinical Integration and Value-Based Reimbursement describes the relevance of the PHO model to today’s healthcare market, offering strategies to leverage the physician-hospital organization for maximum clinical outcomes, competencies and value-based reimbursement.

Hospitals: Chronic Disease Leading Cause of Avoidable ER Visits in 2014

December 4th, 2014 by Cheryl Miller

High utilizers continue to be responsible for the majority of avoidable emergency room (ER) visits, with chronic disease edging out pain management as the top complaint among this population, according to respondents to the third comprehensive survey on reducing avoidable ER visits, conducted in August 2014 by the Healthcare Intelligence Network (HIN). A total of 125 healthcare organizations described tactics employed; nearly one third (32 percent) of which were identified as hospitals/health systems. A sampling of this sector’s results follows.

While the majority of hospitals/health systems were likely to have such a program in place (53 percent versus 69 percent of all respondents), of those that didn’t, just 25 percent planned a future program, compared to 47 percent of all respondents. Less than one half of hospital respondents (47 percent) felt that eased telehealth regulations would curb avoidable ER use.

This sector was twice as likely to find high utilizers generating the majority of avoidable ER visits (78 percent versus 31 percent of all respondents) and least likely to target Medicaid (10 percent versus 28 percent of all respondents). Chronic disease was the most frequently presented problem among this sector’s high utilizers (78 percent versus 54 percent).

In terms of patient level solutions, this sector was half as likely to utilize telephonic outreach (33 percent versus 60 percent), and twice as likely not to conduct follow-up phone calls with those discharged from the hospital (30 percent versus 15 percent). In terms of staff level solutions, this sector was more likely to use hospitalists (22 percent versus 10 percent for all respondents) and onsite educators/coaches (22 percent versus 11 percent for all respondents) and least likely to use disease-specific care coordination (11 percent versus 38 percent for all respondents). This sector was also least likely to notify PCPs of care gaps (22 percent versus 41 percent).

When asked to identify the greatest impact on overall ER efficiency, 70 percent of hospital respondents cited fast-tracking of non-urgent care, versus 33 percent of all respondents. Among the challenges of reducing avoidable ER visits, redirecting the non-urgent was considered a top obstacle for 3 percent of hospital/health system respondents, versus 18 percent of all respondents.

And 40 percent of this sector saw reductions in avoidable ER visits of between 0 to 5 percent, versus 26 percent of all respondents.

Source: 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Reducing-Avoidable-ER-Visits-_p_4942.html

2014 Healthcare Benchmarks: Reducing Avoidable ER Visits delivers actionable metrics from 125 healthcare organizations on their efforts to foster appropriate use of hospital emergency departments. Enhanced with more than 50 easy-to-follow graphs and tables, this third edition of comprehensive data points presents year-over-year trends and best practices for engaging ER and hospital staff, primary care physicians, community providers and patients in reducing avoidable ED utilization.

4 Factors Driving Resurgence in the Physician-Hospital Organization Model Today

October 10th, 2014 by Cheryl Miller

As healthcare organizations seek the infrastructure to respond to emerging payment models like accountable care organizations (ACOs), bundled payments, narrow networks and direct contracts, the physician-hospital organization (PHO) model is experiencing a resurgence nationwide.

But will it work this time? Four factors make the PHO attractive, says Travis Ansel, senior manager with the Healthcare Strategy Group, during Preparing for Value-Based Reimbursement Models: PHO Development for ACOs, Bundled Payments and Direct Contracting, a 45-minute webinar from the Healthcare Intelligence Network (HIN) now available for replay.

The first most immediate driver is independent physician alignment, says Mr. Ansel. While most markets are mature in terms of employment, there are still a number of markets where there are a significant number of independent physicians in key specialties. In these areas, the PHO model is more of an initial catchall type of alignment model, one that creates a loose tie between the hospital and the physicians in the market, and provides value to the physicians in terms of being protected as part of a larger group without having to become employed. One benefit for the hospitals is that they can align independent physicians en masse and create common incentives, instead of having to negotiate alignment models or arrangements with all independent physicians in their market.

The second driver is the increasing mutual accountability for quality and cost across providers. In the wake of transitioning payment models under payment and insurance reform, insurers and payors are trying to drive mutual accountability for patient costs to physicians and hospitals. The PHO is an appropriate response for those providers to work together to manage the cost of a population and of an episode of care in order to make sure everybody’s successful.

The third factor driving resurgence in PHO activity is the consolidation and distribution of resources that will allow providers to be successful in managing quality and cost. As healthcare reform and payment reform mature, information technology (IT) competencies, clinical competencies, care coordination practices, and exploring the patient-centered medical home (PCMH) concept are often unrealistic at the individual practice level. The PHO gives physicians and hospitals the platform to work on those care competencies together, build them in one place and then distribute them to PHO members — a “win-win for everybody,” Mr. Ansel says.

The final driver is the need for an effective framework for clinical integration. While there are already a number of clinically integrated organizations around the country, “For the bottom 90 percent of healthcare organizations in the country, clinical integration is still that thing that’s on our to-do list, but it always gets bumped to the back of the to-do list; because, we have more immediate needs, or more immediate strategic priorities,” Mr. Ansel says. Clinically integrated models are needed as a strategy to respond to payment reform, to allow joint contracts between physicians and hospitals, and to enable sharing of payments effectively, whether those are shared savings payments, bundled payments, etc. Adds Mr. Ansel:

“The PHO model provides a great initial step to building that clinically integrated network platform, and gives providers and the hospital a great model for working together to start building the competencies towards a clinically integrated network.”

Click here for an interview with Mr. Ansel.

Infographic: How Certified Case Managers Navigate the Healthcare Landscape

March 17th, 2014 by Jackie Lyons

Board-certified case managers (CCMs) work in a variety of healthcare settings. The top three are hospitals (24 percent), worker’s compensation organizations (18 percent) and health plans (17 percent), according to a new infographic from the Commission for Case Management Certification (CCMC) and Health2 Resources.

This infographic also illustrates the roles of CCMs, the content and value of their knowledge, where CCMs are located in the United States and more.

You may also be interested in this related resource: 2013 Healthcare Benchmarks: Case Management. This 78-page resource provides actionable information from 118 healthcare organizations on the prominence, placement and responsibilities of case managers as well as case management-driven outcomes in healthcare utilization, cost and compliance.


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4 Pillars of SNF/Hospital Partnerships

March 13th, 2014 by Cheryl Miller

Maintaining contact with patients long after the 30-day discharge period when the penalty phase ends for hospitals is one of the four pillars of Torrance Memorial Health System’s post-acute network philosophy, says Josh Luke, Ph.D., FACHE, vice president post-acute services at Torrance Memorial Health System and founder of the California Readmission Prevention Collaborative and the National Readmission Prevention. This can be done telephonically or in-person, and is usually conducted by an ambulatory case manager.

The main component of our post-acute network is to go into each of the seven SNFS once a week and meet with them for a half hour at the most, covering four tactics. The first is to review a list of all of the patients that have been sent from the hospital over to the SNF, specifically focussing on which ones are discharging that week.

The second tactic is to discuss their discharge disposition, and see if they’re going to a home health agency, and if so, if it’s one that we own, or another one in the community. We distinguish this so we can do what’s called ambulatory case management of the patient, which means we want to case manage them once they go home. We don’t just want to forget about them. We want to keep an eye on them and check in on them, whether it’s telephonically or in person, making sure that they continue to do well, not just through the end of the 30-day episode after discharging from the hospital when the penalty phase ends for hospitals, but also for their long term well-being.

The third tactic is to encourage each of our patients going home from the hospital and SNF to make an appointment at our post-acute clinic (CCC) with the physician who does medication reconciliation. She asks the patients to bring in all the medications they were on before they went to the hospital and all those they were prescribed at the hospital. They then sit and have a 45 minute conversation, including guidelines on what their medication plans are moving forward, which ones they should be taking, and which ones they shouldn’t, and making sure, with teach back methodology, that the patient has a clear understanding of what is expected from them in terms of consuming medication once they return home later that day. Those appointments normally take place within the last 72 hours.

The fourth tactic is to review what we call the ‘return to emergency room’ log. In the industry the common term is ‘return to acute’. We don’t allow our SNFs to use that term because we feel they’re responsible for the ‘return to the emergency department (ED)’. What we mean by that is we’re challenging our SNFs to say, “Take charge of what you can control. And what you can control is making sure that patient doesn’t leave your SNF unnecessarily.” We’re not here to say, “Did the patient get admitted or not to the hospital?” We’re here to ask the SNFs if they followed the guidelines that several organizations nationwide have provided that help avoid unnecessary transfers out to the hospital.

Excerpted from 5 Best Practice Prevention Protocols for Reducing Readmissions.

Infographic: American Hospitals Are Prepared to Care

January 31st, 2014 by Jackie Lyons

There were 26 million more emergency department (ED) visits in 2011 than in 2000, yet there are 189 fewer EDs, according to a new infographic from the American Hospital Association. Payment gaps in hospitals reached a total of $71 billion for uncompensated care, Medicare and Medicaid patients.

This infographic also details access to care, necessary hospital treatments and staffing areas, levels of emergency readiness and more.

American Hospitals are Prepared to Care

You may also be interested in this related resource: 2014 Healthcare Benchmarks: Reducing Hospital Readmissions. With fewer EDs and more ED visits, it is vital for hospitals to keep readmissions down. This resource documents the latest key initiatives and partnerships to reduce readmissions by patients with these costly conditions and others by more than 100 healthcare organizations.


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Healthcare Business Week in Review: Meaningful Use, Hospital Pricing, Telehealth, Health Insurance Marketplaces

December 20th, 2013 by Cheryl Miller

CMS has proposed delaying the start of Stage 3 of the meaningful use program for the Medicare and Medicaid EHR Incentive Programs, while the Office of the National Coordinator for Health Information Technology (ONC) has proposed adjustments to its certification process, according to a December 6th post on the HHS blog site Health IT Buzz.

Under CMS’ revised meaningful use timeline, the start of Stage 2 has not been changed, but it has been extended through 2016; and the start of Stage 3 has been postponed, and will begin in 2017 for healthcare providers who have completed at least two years in Stage 2 of the program.

Whether this delay sways hospital executives looking at implementing an accountable care organization (ACO) remains to be seen. EHR utilization is among the reasons nearly half of the hospital executives recently surveyed have no plans to implement the care model in the near future, according to a new survey from Purdue Healthcare Advisors. The respondents, who were categorized according to their progress with meaningful use implementation, voiced concern about the technology, particularly its interoperability with other providers, and staff readiness and training. .

Interoperability of sorts is at the core of a qualitative study by the Center for Studying Health System Change (HSC), which focused on the effects of California’s reference pricing initiative to guide consumers to hospitals that provide routine hip and knee replacements below a certain price threshold. Researchers found that the cost of these surgeries ranged from as little as $15,000 to as much as $110,000.

While the initiative was effective in setting a threshold for hospital facility payments for both procedures and designating certain hospitals that met certain quality standards, whether it contributed to overall healthcare savings was debated in the study.

But sometimes the high cost is well worth it, as in the area of telehealth and telemedicine services, according to our latest market research data.

Despite the significant financial costs of remote monitoring technologies, adopters report impressive gains in medication adherence and care of remote and rural patients, as well as a decrease in health complications. Active users of telehealth and telemedicine also experience fewer hospitalizations, hospital readmissions, ER visits and bed days.

And speaking of technology, nearly 365,000 Americans selected plans in the Health Insurance Marketplace (HIM) in October and November, and enrollment in November was more than four times greater than October’s reported federal enrollment number, according to HHS Secretary Kathleen Sebelius.

The numbers reflect the technical improvements to HealthCare.gov, which has been unreliable since its launch in October. The open enrollment period is six months long and continues to March 31, 2014.

And lastly, don’t forget to take our current e-survey, Reducing Hospital Readmissions in 2013. Describe how your organization is working to reduce hospital readmissions by taking HIN’s fourth comprehensive Reducing Hospital Readmissions Benchmark Survey. Respond by January 3, 2014 and receive an e-summary of the results once they are compiled.