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  • Video: EHR Considerations When Embarking on a Population Health Management Initiative
    of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY The Future of Online Patient Billing Portals This white paper written by Apex President Patrick Maurer discusses methods to increase patient adoption of online payments Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections This white paper shows why patient centric approaches to online payment portals are important complements to traditional provider centric approaches HFMA Business Profiles Optum Enabling Transformative Change Elena White vice president of risk quality and network solutions for Optum discusses how healthcare providers can leverage data and technology as they enable risk in their organization HFMA RESOURCE LIBRARY Payment Portals Can Improve Self Pay Collections and Support Meaningful Use Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs This article written by Apex Founder and CEO Brian Kueppers explores a number of strategies to create synergy between patient billing online payment portals and electronic health record EHR software to realize a high ROI in speed to payment patient satisfaction and portal adoption for meaningful

    Original URL path: http://www.hfma.org/Content.aspx?id=46039 (2016-02-10)
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  • Responding to the HIT Imperative: A Guide for Independent Hospitals
    amount to hundreds of millions of dollars e The troubling aspect of such IT focused partnerships is that the independent hospital more often than not is not interested in a full acquisition when it enters the initial IT partnership and is unaware of the larger health system s long term intentions Alternatives for Independent Organizations Practically speaking once an independent hospital has agreed to use the IT platform of a larger hospital system it has in essence chosen to become part of the larger system This is because the arrangement involves an extreme operational reliance on the larger partner that both thwarts any other parties strategic interest and makes the smaller hospital s prospect of withdrawal from the partnership or to use the colloquial expression unscrambling the egg untenable For this reason smaller hospitals around the country have begun proactively pursuing innovative strategies to acquire the IT benefits of a large system while maintaining their independence and avoiding a large system s bear hug These efforts often involve complex arrangements among several determined and committed players to find IT solutions via nontraditional channels A common approach involves the establishment of a health information exchange whereby several hospitals share healthcare data to meet their IT goals while maintaining their independence The sustainability of such exchanges remains to be seen Along with all the usual IT implementation obstacles shared information exchanges run into interoperability issues and the stress of balancing the interests of the collaboration s various parties Connecticut is home to another nontraditional solution There a group of several health systems Griffin Hospital St Vincent s Medical Center Lawrence and Memorial Health System Western Connecticut Health Network and Middlesex Hospital have entered a partnership to centralize and distribute their healthcare data The goal of the alliance is to acquire needed big data analytics while each health system is able to maintain its independence Thus far the alliance has proved to be a strong example of how independents can thrive in a data heavy population health based world In this way by creating a constellation of independent hospitals that each capitalize a central data utility shared among the hospitals smaller organizations may be able to successfully transition to a value based care environment supported by big data analytics Key Considerations for Hospital Executives In many ways the future of the U S healthcare system remains unclear But one thing is certain IT systems will only increase in importance Future HIT systems will need to be able to collect large amounts of reliable data that can be turned into actionable goals but getting there will be a capital and labor intensive process With that in mind the following are five practical recommendations for leadership teams of independent hospitals that want to take control of their organizations IT transitions based on the experiences of organizations that have effectively met this challenge Review the full range of options All too often in the fragmented not for profit hospital industry management teams and boards do not fully educate themselves on their full range of strategic alternatives Reviewing what others have done looking at the benefits and limitations inherent in their outcomes can be very helpful More often than not the comparable situations of other hospitals around the country can inform leadership s decision making Be realistic and acknowledge the importance of strong management Hospital executives should take into account both the strengths and limitations of their organizations data analytics capabilities recognizing that an IT system is only as good as the capacity of the local management team An IT system can lead to improved outcomes only to the extent that the management team is able to interpret information extract findings and act on those statistics Such expertise generally requires a sizable and experienced team Even if capital is available and the business logic is sound organizations often find themselves overwhelmed by a product s complexity or dramatically underutilizing its functionality Adhere to a budget Organizations that decide to go it alone in upgrading their IT systems should plan for the worst possible outcome and take steps to make sure they will be able to survive it Multiple scenarios should be stress tested and backup plans developed for situations where initial plans go awry It may be prudent to have hard budgets that cannot be extended even if it means abandoning an implementation or conversion Training staff on a new system alone can run into millions of dollars A runaway EHR implementation can be significantly more costly than the perceived advantages Reach out to independent peers Odds are that within or near every healthcare market there are a number of hospitals that share similar IT concerns As long as they can find common ground it s possible for these like minded independent hospitals to work together and achieve their IT goals Several alliances have sprouted up nationally to foster collaborative work among independent hospitals Shades of gray exist however with the forms and structures of these affiliation arrangements and with the degree to which ownership or control or both are exchanged Be wary of competitors offers to help In today s M A hungry healthcare landscape it pays to be cautious For any hospital looking to avoid a bear hug by acquisitive systems any offer to integrate IT systems should be viewed with heightened awareness More often than not these arrangements end in full consolidation and it is wise to keep this point in mind while giving full consideration to other options Rex Burgdorfer is vice president Juniper Advisory Chicago Jeff Simnick is an analyst Juniper Advisory Chicago and a member of HFMA s First Illinois Chapter Footnotes a Office of National Coordinator of Health IT and U S Department of Health and Human Services Report to Congress Update on the Adoption of HIT October 2014 b Davis J Technology Leads Hospital Expenditures Healthcare IT News Oct 29 2015 c Office of National Coordinator of Health IT Effects of Meaningful Use Functionalities on Health Care Quality Safety and Efficiency by Author Sentiment of Studies Systematic Review of Literature from 2007 2013 HealthIT gov 2013 d Innes S Banner Scrapping 115M UA Health Records System Arizona Daily Star Sept 5 2015 e Cerreta J and Shields J Protecting Corporate Value in Affiliation Transactions hfm April 2014 Publication Date Monday February 01 2016 BACK TO PAGINATION Independent hospitals and small health systems face a daunting challenge in developing their healthcare IT capabilities to meet the requirements of value based care But they must carefully weigh their options and proceed cautiously in meeting that challenge As recently as 2008 only 9 percent of acute care hospitals had adopted an electronic health record EHR that could provide such basic functionality as the ability to view patients medications or test results By 2013 this number increased to 59 percent a Congress prompted this growth in technological investment by passing two important pieces of legislation the Health Information Technology for Economics and Clinical Health HITECH Act in 2009 and the Affordable Care Act ACA of 2010 The HITECH Act created incentives for hospitals and health systems to adopt EHRs while the ACA set in motion the U S healthcare system s gradual shift in focus from fee for service to population health management and value based payment a transition that could be accomplished only through the use of sophisticated health IT HIT systems Experts agree that upgrading the nation s HIT systems will bring communities tremendous health benefits and is the necessary next step for health care as an industry Michael Alkire COO of Charlotte N C based Premier Inc has aptly expressed this point Investments in HIT data analytics and modern clinical infrastructure are foundational for providers to seamlessly deliver population health services b The findings of a literature review by the Office of the National Coordinator for Health IT identified a prevailing sentiment among authors of HIT focused content that the most common IT functionalities will have a positive effect on healthcare quality safety and medical efficiency c The clear consensus is that any hospital still lagging in EHR adoption must modernize to be able to continue delivering high quality health care to its community Driven by government regulation technological advances and market competition traditional inpatient focused acute care hospitals now view IT as critical to the future success of their business IT systems are needed for population health analytics meaningful use requirements value based care initiatives ICD 10 implementation accountable care organizations requirements narrow network navigation consumer driven health care and shifting local market dynamics Effects of Meaningful Use Functionalities on Healthcare Quality Safety and Efficiency Related Sidebar Health Care s New IT Realities and Challenges However such modernization as with all change must be approached carefully and the challenges are more acute for some organizations than for others Around the country smaller health systems and independent community hospitals that are struggling to transition to the new IT reality particularly those organizations with less than 1 billion in revenue are arriving at a difficult conclusion Given the requirements of the ACA and the HITECH Act hospitals require a comprehensive EHR to connect all components of their system but the costs of implementing such a system independently are prohibitive EHRs are costly regardless of the choice of vendor with a full implementation potentially running into the tens or hundreds of millions of dollars Runaway budgets are common and the fixed costs such as initial hardware and software purchases and variable costs such as implementation and training fees associated with an EHR implementation can quickly grow beyond management s expectations As an example of how damaging budget overruns can become one Midwestern hospital spent millions of dollars and several months of staff commitment upgrading its EHR to a top of the line system After these heavy investments the system failed to launch properly resulting in months of revenue cycle disruption increased bad debts and decreased government payment which greatly exacerbated the hospital s financial troubles Another example is the now infamous IT installation at the University of Arizona Health Network where budget overruns on the vendor s installation led to unprecedented losses for the system The health system was saved through an acquisition by Banner Health which promptly replaced the HIT system d Adapting to Change Meanwhile independent hospitals and small health systems that cannot afford to implement their own EHRs continue to fall behind To meet this challenge many small hospitals and health systems are creating a host of new innovative but also often not fully understood solutions Some are electing to partner with systems that have the capital and expertise to facilitate an EHR rollout Indeed the increasingly vital role IT systems play in a hospital s business operations has been a significant factor driving much of the hospital merger and acquisition M A activity occurring across the industry in recent years Often however in lieu of pursuing full business combinations e g joint venture merger or sale independent hospitals and small health systems have sought IT focused partnerships with large regional or national health systems that rent their platforms and expertise to the smaller independents As an example one fairly large southeastern system with about 700 million in revenue recently partnered with a larger regional competitor with 2 7 billion in revenue in exchange for a 20 percent cost break on its IT system Theoretically such arrangements are a mutually beneficial exchange of cash for services In practice however these partnerships expose the smaller system to unintended risk factors due to asymmetries in the partnership Problems arise in such IT partnerships because one party is providing the other with a fundamental operational need that cannot otherwise be acquired Whoever is in control of a hospital s IT system will have an outsized role in defining that organization s future Critics might suggest that this fact is the underlying motivation for larger hospital systems in lending their IT systems to smaller providers The partnership is not simply an exchange of goods for services but an opportunity for the large system to get its hooks into a future acquisition target In short although a business combination can be an effective means for an independent hospital to upgrade its HIT capabilities such organizations should be wary of potential pitfalls associated with such a strategy resulting from unanticipated changes to ownership control and governance Before pursuing mergers or affiliations for such a purpose independent hospitals should understand their vulnerabilities with respect to such transactions as well as the full range of alternative options available to them which includes unique partnerships that have been developed by some organizations Independent hospitals also should conduct a thorough assessment of the full implications of a HIT driven strategy including how a large health system tends to deal with a smaller player s IT system Benefits of Scale It would be myopic to view the IT transition only from the perspective of a small player The EHR transition is disrupting the strategy and decision making of large players as well For example in a recent conversation the CIO of one hospital system with more than 2 billion in revenue told us Appropriately rationalizing hospital IT is vital in the face of declining reimbursement increasing compliance concerns increasing regulation and an aging population The main attributes we seek in an EHR program are reliability consistency and the ability to create analytical insights These considerations play a key role in this hospital system s overall strategy and its executive leadership is fully aware that given current interoperability standards having disparate IT systems in a large health system is a burden The solutions are either to maintain a Gordian knot of an operating system that pulls data from several individual systems or to migrate all the system s hospitals to a single EHR Such considerations also are playing into how major systems view targets deals and future strategic moves The results of these strategies will have an impact on the future configuration of larger health systems Traditionally investor owned companies have been more likely than not for profit health systems to have geographically disparate hospitals in highly varied markets with the goal of achieving benefits from diversification Not for profits meanwhile have typically owned hospital facilities densely clustered in one region Experts believe that future success for hospital systems will depend on having hospitals both densely clustered in specific regions and widely distributed nationally Evolution of HIT System Configurations To transition to this new distribution model many growth oriented large health systems are competing in an IT arms race to partner with smaller hospitals using what could be characterized as a bear hug approach In this structure the smaller hospital enters into an IT sharing agreement and ultimately becomes part of the larger system in exchange for little or no economic consideration or market provisions that are customary for a merger or acquisition In essence a bear hug approach amounts to a slow giveaway on the part of the acquired hospital Historically this approach typically would occur between two not for profit hospitals where a independent hospital would be offered the opportunity to join the family of the larger system but would receive no consideration for its enterprise which could amount to hundreds of millions of dollars e The troubling aspect of such IT focused partnerships is that the independent hospital more often than not is not interested in a full acquisition when it enters the initial IT partnership and is unaware of the larger health system s long term intentions Alternatives for Independent Organizations Practically speaking once an independent hospital has agreed to use the IT platform of a larger hospital system it has in essence chosen to become part of the larger system This is because the arrangement involves an extreme operational reliance on the larger partner that both thwarts any other parties strategic interest and makes the smaller hospital s prospect of withdrawal from the partnership or to use the colloquial expression unscrambling the egg untenable For this reason smaller hospitals around the country have begun proactively pursuing innovative strategies to acquire the IT benefits of a large system while maintaining their independence and avoiding a large system s bear hug These efforts often involve complex arrangements among several determined and committed players to find IT solutions via nontraditional channels A common approach involves the establishment of a health information exchange whereby several hospitals share healthcare data to meet their IT goals while maintaining their independence The sustainability of such exchanges remains to be seen Along with all the usual IT implementation obstacles shared information exchanges run into interoperability issues and the stress of balancing the interests of the collaboration s various parties Connecticut is home to another nontraditional solution There a group of several health systems Griffin Hospital St Vincent s Medical Center Lawrence and Memorial Health System Western Connecticut Health Network and Middlesex Hospital have entered a partnership to centralize and distribute their healthcare data The goal of the alliance is to acquire needed big data analytics while each health system is able to maintain its independence Thus far the alliance has proved to be a strong example of how independents can thrive in a data heavy population health based world In this way by creating a constellation of independent hospitals that each capitalize a central data utility shared among the hospitals smaller organizations may be able to successfully transition to a value based care environment supported by big data analytics Key Considerations for Hospital Executives In many ways the future of the U S healthcare system remains unclear But one thing is certain IT systems will only increase in importance Future HIT systems will need to be able to collect large amounts of reliable data that can be turned into actionable goals but getting there will be a capital and labor intensive process With that in mind the following are five practical recommendations for leadership teams of independent hospitals that want to take control of

    Original URL path: http://www.hfma.org/Content.aspx?id=45991 (2016-02-10)
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  • Shedding Light on Physician Performance Transparency
    the bulk of those patients relying on their primary care physicians for advice about whom to see Unfortunately as primary care practices are acquired or new physicians are brought on board these physicians often don t have the institutional knowledge they need to keep referrals within their health system Transparency allows a health system to uncover outside referrals educate providers and reduce patient leakage Moreover by helping to retain patients within the health system it also will result in a welcome change for these patients who can benefit from the convenience and continuity of care inherent in staying within one health system If patients are leaving a health system because it does not deliver the care the patients require transparency will identify that problem too Information about where patients go for care can be enormously instructive to help health systems identify areas that are missing or programs whose quality needs beefing up relative to the competition Referral data of this type are available from third parties that track physician performance outside of a health system s four walls enabling the organization to get an entirely new view of the market beyond its own data Using Performance Transparency to Improve Care Patients want the best physicians for their particular conditions and physicians want to be the best providers for their patients Performance transparency empowers patients to choose the most appropriate providers and it informs physicians about the quality of the care they give A meaningful evaluation of performance with transparency therefore can help improve patient outcomes avoid costly readmissions and mitigate other costs Unfortunately performance data are not always made available internally Physician quality performance data tend to be shrouded in secrecy in all likelihood because it all too often is thought to be punitive A bad online review or a journalistic hit piece is rolled into the same category as fact based performance quality data This situation is unfortunate because factual performance data can be inordinately helpful to physicians Performance transparency allows physicians to better understand and improve their own outcomes Like a football player watching footage of plays post game performance transparency allows a provider to appreciate his or her strengths and visualize what needs improving And in creating opportunities for physicians to review their performance hospital leaders can reinforce this idea with physicians and encourage them to view the data as a valuable tool for self evaluation Performance transparency also gives both the physician and the health system a better understanding of what is happening after patients receive treatment that can make a significant difference in terms of quality and cost If a physician sees lower than average postsurgical infection rates for instance what is he or she doing that others can learn from to reduce their rates as well If another physician is seeing higher than average readmission rates for one particular procedure what steps or continuing education programs might help improve outcomes Ultimately everything in health care comes down to the patients and performance transparency is no exception Before placing their health and wellness and often their lives in the hands of any given physician patients want to know as much as possible about the physician and the treatment they will undergo At this time not much information is available Some websites list a physician s educational background Some include bios with fellowship and board certification information But in this era of big data such meager online offerings are hardly sufficient Patients lament the fact that they can learn more about the quality of a door handle than about the quality of their physicians Health systems that do not heed these complaints will find themselves losing patients and revenue Making performance transparency available publicly in the form of a physician score for instance enables patients to choose the physicians who are most appropriate for them increasing the likelihood of a positive outcome and a lower cost recovery period In fact patients are largely the ones demanding performance transparency setting the stage for a shifting world in which high quality performance transparency becomes the standard for health systems which organizations can ignore only at their peril Patients are demanding more information better data and a quantifiable assurance that the person they are relying on for treatment is the appropriate care provider for them This conversation currently is being dominated by websites best known for restaurant reviews and misguided journalistic endeavors that tell only a fraction of the story and that lack the perspective of healthcare providers It shouldn t be this way and it does a disservice to both patients and health systems to allow such subjectivity to dominate The healthcare industry amasses mind boggling amounts of data every day With the right analysis rows and rows of data can be turned into actionable information that helps drive down costs and improve patient care It is time for healthcare systems and hospitals to regain control of the performance transparency conversation to replace the noise of opinion with irrefutable facts and to give patients verifiable data that will help elevate the quality of care in this nation The healthcare industry has a unique opportunity to drive the flow of information and dictate its uses With more data becoming available performance transparency will either happen with health systems or to them It is their choice but the time to decide is now For the health system finance executive the transition from fee for service to value based delivery is a significant change especially from a financial risk point of view Physician performance transparency is the key to enabling a fiscally responsible transition that enables new business models and offerings while clearly understanding the business risk Finance executives should play a leading role in helping their organizations take the first steps on the journey to performance transparency This journey will enable their organizations to deliver higher quality care at a lower cost with clarity of risk David Norris is CEO MD Insider Santa Monica Calif Footnotes a Accenture 2013 Consumer Survey on Patient Engagement b The Digital Journey to Wellness Google and Compete Inc 2012 c Contracting for Population Health Management The Advisory Board Company June 2 2014 d Global Patient Safety Challenge 2005 2006 World Alliance for Patient Safety World Health Organization 2005 Publication Date Monday February 01 2016 BACK TO PAGINATION Health systems have an important opportunity one that they should not miss to use big data to help optimize performance reduce risk and increase profits But performance transparency to a health system can mean many different things It can mean how a physician assesses his or her own outcomes It can mean how a health system understands why it is losing patients and to which competitors It can mean the ability to mitigate risks and optimize revenue In this new world of big data performance transparency has value even when it doesn t directly reach the patient By shifting focus to performance transparency a health system can better analyze and understand what happens within its walls and within the community it serves Performance transparency can increase patient loyalty improve patient care and inspire the kind of fact based creative thinking that identifies efficiencies while improving outcomes Using Performance Transparency to Increase Revenue and Improve Patient Experience The use of big data to evaluate and communicate physician performance transparency enables health systems to improve the patient experience function more efficiently and increase patient conversions all while delivering better care To better understand how let s start where a health system s patients start with the call center Health systems spend millions of dollars to drive potential patients to their call centers but all too often calls fail to convert to appointments and revenue Call center agents must rely upon antiquated technology and often refer patients to providers without knowing a physician s particular expertise outcomes or availability The result is frustrated patients incomplete calls and failed conversions to appointments By contrast call center agents who have a deep transparent view into a health system s clinical resources and capabilities can direct patients to the most appropriate providers for them A caller with a torn meniscus for instance doesn t want a list of 45 orthopedic surgeons The caller wants to know which surgeons on a hospital s roster specialize in the particular condition and which of those surgeons have demonstrated the best outcomes the shortest recovery times and have the most immediate availability A health system with a call center that drills deep into a hospital s roster to deliver that level of information is in a strong position to turn callers into patients and to begin lifelong relationships with patients stretching well beyond the initial need In addition to strengthening call centers the use of big data to provide performance transparency can move health systems websites toward the consumer oriented model that patients have come to expect of all their online experiences For example today prospective homebuyers can take virtual tours and harried parents can have diapers delivered to their doorsteps Potential buyers can easily find everything they want to know about a car from safety to comfort and performance secure a loan and make a purchase with nothing more than their fingers and a phone Health systems by comparison are generally lagging in this area In fact a recent report issued by the global professional services company Accenture found that less than 10 percent of U S health systems currently offer patients the ability to digitally self schedule a With Google Think surveys finding that 76 percent of patients begin their healthcare research on hospital websites this limitation of these websites represents an enormous lost opportunity b Imagine the airline industry operating this way Before booking a flight you d have to call to find out if the airline flies to a certain location when flights are scheduled if any seats are available and how much a ticket costs You d then have to repeat this several times before finding the right airline and booking a flight That sounds aggravating and time consuming but it is exactly how consumers view finding physicians and booking appointments Integrating real time information about providers availability on health system websites can turn those websites into scheduling tools helping patients to find the right physician and empowering them to make their own appointments on mobile devices and desktops This level of transparency can significantly improve conversion rates and relieve the burden on the call center further enabling call center agents to provide a better patient experience Using Performance Transparency to Reduce Risk The Affordable Care Act ACA has promoted increased participation in accountable care organizations ACOs with the aim of improving the safety and quality of care while reducing costs The goal of an ACO is to deliver seamless high quality care by creating a value based payment model that holds providers financially accountable for the cost and quality of care they deliver But a key consideration for a health system that participates in an ACO is knowing which physicians to include in the ACO and which ones to not include Because the health system is taking financial risk based on the performance of its physicians in the ACO it is critical to select the best performing physicians but how Health systems struggle to measure physician performance especially from a financial efficiency point of view Using physician performance transparency health systems can solve this problem by evaluating physicians performance using outcomes as well as cost and efficiency Then physicians can be compared decisions made and ACO selections finalized all while giving the health system confidence that it has made a solid financial decision Using big data to achieve performance transparency offers a consistent solution for measuring quality and helps health systems identify which physicians present the greatest probability of producing positive clinical outcomes The need for such a solution couldn t be greater Half of providers responding to a recent survey by the Health Care Advisory Board said they anticipate that at least 50 percent of their business will come from risk based contracts in the next three years such as an ACO or managed care organization c As more health systems wade into these uncharted waters this change will drive narrow networks to align with the highest quality providers At the same time many health systems also are seeking to increase market share by expanding geographically and adding new physicians With each of these ventures health systems increase the potential for revenue but they also take on additional risk By tapping into performance information health systems are now able to evaluate how the performance of individual physicians groups of physicians and centers of excellence stacks up against that of their peers And by analyzing key performance markers such as readmission rates post surgical complication rates and length of stay a health system can pinpoint high cost high risk performance areas that need to be addressed For example one health system could benchmark its orthopedic department against its main competitors specifically looking at surgical outcomes and quality By using physician performance data the health system could identify how its quality and outcomes stack up Does it have lower complication rates or readmission rates Shorter lengths of stay This performance information then can be immediately leveraged by marketing to help differentiate the health system as a higher quality facility making it more attractive to prospective patients Without the data such differentiation is difficult For instance patients who are treated by inexperienced physicians are more likely to experience poorer outcomes and longer hospital stays than are patients cared for by physicians with more expertise and proficiency But determining experience can be tricky A neurosurgeon who has been out of medical school for 20 years is not necessarily more experienced at pituitary tumor surgery a very rare type of surgery than a younger physician who specializes in this particular field By using physician performance data showing the actual number of times each physician has performed each procedure over the past 10 years patients can be matched with the physicians who have the demonstrated experience in this particular area Big data can capture each physician s share of practice and total experience for any given procedure Such a data combination serves as the most concrete proof of experience and the most useful solution for health systems and for patients hoping to find the physicians that can best meet their needs This type of performance transparency helps ensure patients are referred to the most appropriate physicians and gives providers increased opportunities to shine at what they do best and equally important it allows health systems to make better decisions about which physicians to add to their rosters and which ACOs to add to their groups Using Performance Transparency to Modify Behavior Performance data also can help uncover procedural problems within a hospital and health system and target simple and cost effective systemic improvements Possible solutions include implementing checklists for physicians or teams whose error rates are higher than average and enforcing the hospital s hand washing program for those groups who are seeing an increase in infection rates Such small moves can result in enormous benefits both to hospital costs and to patient health Approximately 80 000 people in the United States die every year from hospital acquired illnesses d This situation is not only tragic but also preventable and performance transparency can serve as the key to help identify those areas in a hospital system that could benefit from incentive programs and strong reminders Moreover by providing a means for evaluating physician practices across different health systems performance transparency provides unprecedented insight into where patients go for follow up care By looking for patterns in patient migration performance transparency tools allow health systems to fix a problem vexing all hospitals today loss of patients Looking at big data for example health systems now can see that one of the reasons patients seek other providers for follow up care is that they are following their physician s orders More than one third of U S patients are referred to specialists each year with the bulk of those patients relying on their primary care physicians for advice about whom to see Unfortunately as primary care practices are acquired or new physicians are brought on board these physicians often don t have the institutional knowledge they need to keep referrals within their health system Transparency allows a health system to uncover outside referrals educate providers and reduce patient leakage Moreover by helping to retain patients within the health system it also will result in a welcome change for these patients who can benefit from the convenience and continuity of care inherent in staying within one health system If patients are leaving a health system because it does not deliver the care the patients require transparency will identify that problem too Information about where patients go for care can be enormously instructive to help health systems identify areas that are missing or programs whose quality needs beefing up relative to the competition Referral data of this type are available from third parties that track physician performance outside of a health system s four walls enabling the organization to get an entirely new view of the market beyond its own data Using Performance Transparency to Improve Care Patients want the best physicians for their particular conditions and physicians want to be the best providers for their patients Performance transparency empowers patients to choose the most appropriate providers and it informs physicians about the quality of the care they give A meaningful evaluation of performance with transparency therefore can help improve patient outcomes avoid costly readmissions and mitigate other costs Unfortunately performance data are not always made available internally Physician quality performance data tend to be shrouded in secrecy in all likelihood because it all too often is thought to be punitive A bad online review or a journalistic hit piece is rolled into the same category as fact based performance

    Original URL path: http://www.hfma.org/physicianperformance/ (2016-02-10)
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  • Invest in Your Data: How Clinical Mobility Solutions Liberate Data and Drive Cost Savings
    shared efficiently when it is needed As a result clinicians are using their personal smartphones due to their ability to communicate and share contextual information within those messages uniting the care team These unsecured smartphones and networks create the potential for the unauthorized disclosure of PHI and penalties of as much as 50 000 per violation i By contrast all aspects of smart point of care mobile solutions are built on secure communication protocols specifically designed to safeguard sensitive information Making sure all members of the care team communicate through the designated smart point of care mobile solution ensures the protection of PHI Related Sidebar More Effective Communication Improves Attitudes and Accuracy Mobile Bridges Gaps and Delivers Context Smart point of care mobile solutions can help address inefficient EHR driven workflows and improve patient safety through better care team communication and data capture for charting These tools deliver the data and physician orders from the EHR and enable timely clinical documentation by staff in addition to the notifications that clinicians need at the point of care to prevent adverse events and drive safe cost effective care decisions Mobile solutions also enable clinicians to capture data more easily and accurately at the point of care instead of after the round or shift When all clinicians and data are connected on the same mobile platform they can quickly determine who is on the patient s care team and each team member s role resulting in better responsiveness in messages between clinicians and to patient calls As communication between care teams improves clinical care protocols become standardized Mobile solutions bring convenience and responsiveness to the type of short duration high frequency care clinicians deliver at any given moment to help guide physicians through the decision points based on the hospital s evidence based guidelines Necessary variations in care due to unique patient characteristics can be easily documented at the point of care within the mobile technology for quality and safety audits All of the above enable not only safer clinical workflows but also more efficient and predictable workflows Smart point of care mobile solutions can unify these crucial data management and communication functions onto a single device If built on a configurable platform the tool can also help clinicians administer medication using an embedded scanner for barcoded administration as well as collecting specimens The mobile systems also offer executive leadership a powerful tool for assessing clinician productivity more accurately and effectively a consideration that 88 percent of the health system executives responding to the previously cited 2014 survey regard as being important for achieving cost savings With better insight into which times and units clinicians are most productive scheduling becomes more stable and predictable Managers can better assign their clinicians to the units and shifts where and when they are most productive and efficient This insight derived from mobile technology allows hospitals to use fewer costly staffing agency resources or use them more efficiently Among executives responding to the survey 69 percent reported that labor and schedule redesign contributed to savings and 66 percent similarly attributed savings to core staffing flex staffing changes Shifts are more likely to finish on time when charting can be completed by clinicians at the point of care not at the end of the shift When Care Is Standardized Waste Is Eliminated As government and commercial payers increasingly move toward bundled payment for providers services providers must become more willing to accept more financial risk for the care they deliver j Just as payers use actuarial tables to determine providers payment hospitals can leverage evidence based standardized care plans to ensure that costs will remain within the bundled payment limit To this end they must analyze every line item including clinician hours required labs tests medication consumed and supply usage When costs are consistently less than the payer s bundled payment and outcomes are consistently positive a provider organization not only becomes more profitable but also is able to exert greater influence over future value based compensation programs with payers Hoag Orthopedic Institute in Irvine Calif for example is a CMS Five Star organization that has achieved such outstanding cost effective outcomes that its providers are consistently favored by its health insurers in fee schedule negotiations Hoag heavily emphasizes care standardization and efficiency and uses smart point of care mobile solutions to support its clinicians workflows This standardization is enabled by liberating data from the EHR and unifying care interprofessional team communications onto a single mobile platform Because the intuitive technology operates like the smartphone platforms to which clinicians are already accustomed adoption is swift unlike the adoption rates seen with EHRs Furthermore training may take only an hour instead of the days or weeks often required for training with EHR implementations Best of all instead of investing more in their EHRs organizations can leverage these point of care mobile solutions to improve workflow efficiency and standardize care protocols for significant safety financial and care quality performance improvements Si Luo is president of PatientSafe Solutions San Diego and a member of HFMA s San Diego Imperial Chapter Footnotes a CMS Fiscal Year 2015 Results for the CMS Hospital Acquired Condition Reduction Program and Hospital Value Based Purchasing Program Dec 18 2014 b Rajaram R Barnard C Bilimoria K Y Concerns About Using the Patient Safety Indicator 90 Composite in Pay for Performance Programs JAMA March 3 2015 Online c Noteboom M Flawed Technology Flawed Humans Healthcare IT News June 1 2015 d Malkary G Healthcare Without Bounds Point of Care Communications for Nursing 2014 Spyglass Consulting Group March 2014 e Parallon Executive Survey Financing the Era of Accountable Care Survey Report 2014 f Stokowski L A The Missed List Revelations of Busy NICU Nurses Medscape Nurses Viewpoints Jan 12 2015 g Kahn S et al Improving Process Quality and Reducing Total Expense Associated with Specimen Mislabeling in an Academic Medical Center poster session 2005 Institute for Quality in Laboratory Medicine Conference Recognizing Excellence in Practice April 28 2005 h ECRI Institute Top 10 Patient Safety Concerns for Healthcare Organizations June 2015 i American Medical Association HIPAA Violations and Enforcement accessed Dec 23 2015 j KPMG More Healthcare Providers Using Bundled Payment Systems But Some Still Undecided Ahead of CMS Application Deadline press release April 15 2014 Publication Date Monday February 01 2016 BACK TO PAGINATION Healthcare quality and financial performance have never been more closely linked And new clinical mobility data solutions provide an unprecedented means to further strengthen that linkage The healthcare industry had high hopes that moving to electronic health records EHRs would lead to big improvements in safety and efficiency As to be expected with any major shift in foundational technology however efforts to integrate EHRs into the ongoing business activities of delivering health care hit some snags An effective solution to the problems providers are encountering with EHRs may lie with an emerging new technology smart point of care mobile communication systems see sidebar below These new systems meet the need for intuitive mobile solutions that connect patients and providers while also tangibly remaining logical and intuitive But to fully appreciate how powerful this solution might be it is helpful first to review current conditions Related Sidebar Hardware Purpose built for Health Care or BYOD The Basis for Payment Is Shifting In years past hospitals always strived for safety by voluntarily collecting data for internal improvement and risk management Hospitals were required only to report certain quality related information to the Centers for Medicare Medicaid Services CMS out of transparency requirements and to participate in electronic reporting programs mostly without financial repercussions Over the past three years however CMS has begun basing more payment mechanisms on the patient safety and quality performance of healthcare providers Two programs in particular the Hospital Acquired Condition HAC Reduction program and the Hospital Value Based Purchasing VBP program affect 2 5 percent of a hospital s CMS payments and lower payment rates for any claims associated with treating preventable adverse events a In addition CMS has adopted a composite measure developed by the Agency for Healthcare Quality and Research i e Patient Safety for Selected Indicators PSI 90 to play a significant role in determining HAC and VBP ratings b A relatively new metric for CMS the PSI 90 is a composite score based on the occurrence of eight adverse events including pressure ulcers and sepsis CMS s HAC Reduction program bases 35 percent of its overall score on PSI 90 Hospitals with the highest HAC scores which indicate a higher rate of the adverse incidents receive a 1 percent payment reduction for all discharges For VBP CMS will reallocate 1 5 percent of its DRG payments to hospitals according to their overall score 30 percent of which comprises PSI 90 and four other outcome measures Hospitals some of which receive 50 percent or more of their total payments from CMS cannot afford to ignore their performance on the HAC Reduction and VBP programs As commercial payers follow CMS s example and begin basing more of their payment on safety incidents and outcomes preventing adverse events eliminating clinical inefficiencies and improving quality become even more crucial to financial viability The Effect of EHRs on Health Delivery Meanwhile healthcare provider organizations have been implementing EHRs with one of the chief goals being to improve safety by delivering actionable data to clinicians at the point of care All too often however EHRs have unintentionally created additional user experience friction and technology distraction c A limitation posed by EHRs is that they frequently pull clinicians out of their natural efficient workflows and inhibit the clinicians ability to view and capture patient context holistically One often can find clinicians sitting in front of computers hitting refresh buttons while waiting for physician orders to appear or looking up data to support their decisions What also adds to the inefficiencies of EHRs are the myriad logins and lag times resulting from systems with virtualized platforms Given these limitations of EHRs many clinicians still use scraps of paper as reminders or to build context around a patient s condition Clinicians also have created workarounds to adjust for the inefficiencies of their outdated hospital issued communication tools by using their personal smartphones to more efficiently collaborate with the care team Recent survey results show that 67 percent of registered nurses use their smartphones for patient care activities which puts the hospital at risk for HIPAA violations and associated financial penalties d Patient privacy and security also are put at risk when protected health information PHI is shared through a personal smartphone s unsecured cellular networks A smart intuitive and reliable point of care mobile solution can help meet the challenges posed by EHRs mobile device proliferation inefficiencies of legacy communication tools and the ever pressing need to improve safety and quality at the point of care Such technology provides the means to connect clinicians to their patients and care teams while integrating with existing communications and IT infrastructure from telephony to EHRs Regardless of the clinician s location a smart point of care mobile solution can deliver care plan context order notifications and care team communications onto a single unified smartphone application These tools can also be expanded to support clinicians in performing their rounds such as administering medication collecting lab specimens verifying mother baby identification for breast milk feeding and educating patients The result Data are liberated from the EHR into the hands of clinicians for reliably executed processes and efficient communications Liberating the data also supports standardized care protocols improved productivity as well as clinical team and patient satisfaction By fostering consistent use of mobile enabled protocols and checklists hospitals and health systems stand to achieve clinical efficiencies and improve quality and safety Such technology also holds the promise of increased revenue reduced costs and improved safety in patient care The Effect of EHRs on Workflows Organizations that have spent millions of dollars on their EHR systems deserve a significant ROI Consider for example that 72 percent of health system executives responding to a 2014 survey reported that their organizations had invested in upgrading their IT systems yet these executives also reported that the biggest savings they had experienced were due to labor scheduling and workflow adjustments e EHRs instead of improving productivity have made clinicians less efficient forcing organizations to redesign workflows to accommodate the technology These executives discovered improvements in efficiency are achieved not just by technology alone but also by staffing and workflow adjustments that result in less wasteful processes and more productive interprofessional care teams Moreover even with redesigned workflows EHRs continue to pull clinicians away from the bedside In fact it is not unusual for clinicians to spend the end of their shift completing their charting hours after care is delivered In one study of nurses in the neonatal intensive care unit 26 percent reported that they skipped documenting directly after caring for a patient due to interruptions and other issues f Even worse for patient safety are slips of paper lost in the various tasks and travel of day to day operations For example a handwritten note to turn a patient every two to six hours or to change a catheter may be lost or forgotten leading to a potential HAC EHR reminders also can be all too easily missed away from the bedside with a similar potential to result in a HAC medication error or unnecessary test New York Presbyterian Healthcare System for example discovered that by equipping its phlebotomists with a smart point of care mobile solution to collect specimens erroneous or duplicative collections were reduced by 20 percent The significance of this result is underscored by findings of a Loyola University study which calculated the average cost of a single misidentified specimen at 712 g Added to this benefit is the avoidance of a negative impact on HCAHPS survey scores due to patient discomfort and anxiety caused by inaccurate test results or repeated unnecessary blood collections Furthermore the potential errors caused by retroactive charting can affect data integrity which the ECRI Institute recently noted as one of its top 10 patient safety concerns h Nurses and other clinicians who have the most contact with patients during a hospital stay need to have mobile efficient tools so they can capture the crucial granular data at the point of care that may be forgotten or incorrectly recalled during charting conducted hours later Retroactive charting also leaves physicians who may be off site when checking on a patient s status largely uninformed impacting care decisions quality and safety A Focus on Safety and Quality and Impact on Payment The organizational struggle between unintended consequences of poor EHR usability and heightened demands for efficient clinical workflows and safety and quality improvement at the point of care are now a matter of financial concern Strategic conversations concerning these issues are starting to happen at the CFO level Senior finance executives are sitting with clinical and quality leaders to examine the impact of VBP the PSI 90 HCAHPS and other process of care measures Finance leaders recognize that safety incidences and clinical inefficiencies now hit both the top line and bottom line doubling the previous impact Standardized clinical protocols such as preventing and responding to falls or pressure ulcers are essential in preventing the adverse events highlighted in the HAC Reduction and VBP programs and improving clinical efficiencies To ensure standardized protocols are followed hospitals require a means to help clinicians rely less on their memory or an EHR that is away from the bedside Clinicians have a compelling need for actionable information on these protocols that is easily accessible when and where they need it They also need the right mix of communication technology in their work environment to help them collaborate across the care team much more efficiently and effectively But for many hospitals this protocol information is buried in three ring binders or in the EHR system Both formats are easily ignored or hard to access during a clinician s busy rounds and neither helps the clinician respond efficiently or effectively at the point of care Both offer checkbox solutions instead of meaningfully changing the way care is delivered Similarly many communication tools even in some technologically advanced hospitals are inconvenient and inefficient Clinicians use VoIP phones pagers walkie talkies overhead paging systems and the EHR for text messages None of the existing tools unite the care team around the patient so context is delivered with the text messages helping inform decisions so they are faster but also safer and less wasteful These multiple tools also lack the ability to connect interprofessional care teams wherever they may be located so relevant safety or care information that may not be in a chart can be shared efficiently when it is needed As a result clinicians are using their personal smartphones due to their ability to communicate and share contextual information within those messages uniting the care team These unsecured smartphones and networks create the potential for the unauthorized disclosure of PHI and penalties of as much as 50 000 per violation i By contrast all aspects of smart point of care mobile solutions are built on secure communication protocols specifically designed to safeguard sensitive information Making sure all members of the care team communicate through the designated smart point of care mobile solution ensures the protection of PHI Related Sidebar More Effective Communication Improves Attitudes and Accuracy Mobile Bridges Gaps and Delivers Context Smart point of care mobile solutions can help address inefficient EHR driven workflows and improve patient safety through better care team communication and data capture for charting These tools deliver the data and physician orders from the EHR and enable timely clinical documentation by staff in addition to the notifications that clinicians need at the point of care to prevent adverse events and drive safe cost effective care decisions Mobile solutions also enable clinicians to capture data more easily and accurately at the point of care

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  • How Streamlining Telecommunications Can Cut IT Expense
    but finding the issues often is easier than resolving them with the service provider Any change made to contracts or services takes two to three billing cycles at a minimum for the providers to bill it accurately and continual monitoring and management of the changes is required long after changes are made Nonetheless such efforts are well worthwhile in that they can be an additional source of significant savings Optimize Rates and Streamline Design The final step in the process is to optimize rates and design a system for continual improvement Once all items are cleaned up a better telecommunications system design should be researched If the services haven t changed in the past three to five years there s likely a better design to get more performance for the same cost or less The organization should investigate whether a more cost effective efficient and resilient design is possible for the full range of wire line services including local long distance hosted solutions and the wide area network WAN The following are the key questions for this investigation Are the wireless devices being used the best ones for the organization Are the rate plans the most efficient and cost effective Do policies need to be updated If significant design changes are necessary it is often best to undertake a request for proposal process with the service provider with detailed specifications even if the desire is to maintain services with the same provider Existing contracts also should be thoroughly reviewed to ensure the organization will not incur major penalties in the event it decides not to continue its contract with its existing service provider Typically this step yields about 25 percent of the total return of the process These savings are substantial but generally not as much as can be gleaned from the other two steps together as rates often are negotiated over time This step takes significant industry and marketplace acumen to achieve the greatest yield The entire process is shown in the exhibit below Telecom Audit and Optimization Process Keep It Clean and Optimal Although undertaking these steps may be viewed as a one time project for larger enterprises it should be a continual process to ensure maximum efficiency For smaller organizations the expense associated with a continual process and ongoing monitoring may be cost prohibitive making it more practical to go through the steps in separate projects performed within set time frames every few years Effective systems require expertise in telecommunications systems and billing Three basic elements are required whether the process is outsourced or managed in house Expert people who are well versed and experienced in telecom systems carriers equipment and contracts A process design that includes standard best practices and automations across the enterprise A systems database with accurate and extensive line item detail for all telecom equipment and contracted rates Dedicating the required experienced personnel resources to such an undertaking often is difficult but in house staffing may be the best option for organizations that do not have a complex IT enterprise Typically the latter means fewer than 10 locations and less than 40 000 per month in total telecommunications expense If an organization has only a few locations and 10 to 20 invoices it can use spreadsheets Microsoft Access database or SharePoint and work with accounts payable A P at a deeper level to track expenses and proactively keep them in line Among the committed resources the organization will require a knowledgeable IT telecom team member who can delve into the details of telecom bills Staff requirements also include a few hours per week to review detailed line item billing and handle dispute resolution These organizations may benefit from a one time telecommunications audit to help put them on the right track to managing it themselves For most medium size to large healthcare organizations managing telecommunications expense in house can be a complex undertaking require a significant investment of staff time and financial resources First and foremost it requires specific processes and knowledgeable dedicated staff An industry rule of thumb is at least one dedicated full time employee for every 400 000 per month of telecom expense Skills needed include IT knowledge of the enterprise system as well as expertise in telecom technology telecom charges and dispute resolution An in house solution also will require new business processes to be put into place as well as a centralized system for visibility of circuits devices management of changes and tracking of individual charges With an IT labor shortage facing the healthcare industry and spiraling technology requirements it makes sense to consider outsourcing of business processes for IT projects that are not specifically related to healthcare delivery The clear advantages are access to dedicated firms with subject matter experts experienced in identifying fraudulent and inaccurate billing resolving disputes deploying specialized knowledge of marketplace rates and analyzing customized carrier contracts Again whichever approach an organization chooses the critical components are committed highly experienced personnel an efficient process and a unique centralized database system to take on the continuous project of technology communications optimization Process Design An effective telecommunications expense management process follows a straightforward sequence involving three broad phases that are performed continually The exhibit below shows the essential tasks for each these three phases which set the stage for ongoing improvement and a potentially significant reduction in the healthcare organization s overhead expenses Tasks to Improve Telecom Expense Management TEM In complex enterprises the process necessitates telecommunications specific efficiency improvements to the A P process for continual charge monitoring In an environment of increasing regulatory requirements escalating technology objectives and shifting payment guidelines reducing waste in the telecommunications infrastructure is a good value proposition for most healthcare providers To effectively realize this value proposition however an organization must apply with discipline and rigor the principles and processes of telecommunications expense management Whether the process is outsourced or performed in house healthcare finance leaders can play an important role in ensuring their organizations are taking the steps necessary to achieve the full potential for savings in this area Greg McIntyre is founder and president Tellennium Inc and a member of HFMA s Kentucky Chapter Footnote a Gartner Says Worldwide IT Spending to Decline 5 5 Percent in 2015 Gartner June 30 2015 Publication Date Monday February 01 2016 BACK TO PAGINATION New requirements resulting from healthcare reform bring hidden challenges in the area of IT By streamlining telecom systems equipment and practices hospitals and health systems can maximize efficiency and save money Recent shifts in healthcare policy and security requirements have challenged IT and operations management and margins in unprecedented ways There is an increased need of greater sophistication and functionality of data management and IT systems which has been driven by new payment rules quality initiatives electronic health record EHR deployments privacy and security requirements and increased insured populations under the Affordable Care Act ACA and Medicaid expansion Each of these factors has affected hospitals physician practices and virtually every other type of healthcare enterprise in the United States With such demands showing no sign of abating healthcare organizations face a challenge of growing technology systems while keeping operational expenses in line Hospitals and health systems pay hefty bills for telecommunications services and they often do so with very little insight or visibility into what they are paying for as items may be lumped into a monthly charge rather than being itemized This single category accounts for a whopping 43 percent of IT expense on average according to a June 2015 Gartner study a By applying principles of effective telecommunications expense management which focus on maximizing process improvement and eliminating waste an enterprise can recover significant funds and resources Such an undertaking frees up operational resources for management to focus on more mission driven services and tasks which ultimately may lead to better patient service and care The application of telecommunications expense management disciplines involves three broad steps Inventory of existing infrastructure Charge verification Optimization of rates and design for continual improvement Take Inventory of Existing Infrastructure The first step is to create an inventory audit of every line service circuit and device currently in place This effort includes identifying the purpose for each element and usage activity for at least the past 90 days The purpose for each component is especially important to ensure that service for critical but infrequently used lines such as fire alarms elevators and security connections is not inadvertently cut A process to record any changes also should be implemented Telecommunications includes all recurring expenses and associated devices such as the circuits to data centers individual lines circuits to each location every telephone or fax number feature mobile device including tablets and service plan Multiple locations amplify system complexity Because as mentioned above many telecommunications invoices lump multiple items into one monthly charge contact with the service provider will be required to obtain cost details for these items Once the inventory has been performed auditing usage will improve operational support and reveal hidden pockets of waste It is likely that unused circuits and services can be eliminated saving tens of thousands or even millions of dollars depending on the size of the organization Also keeping an accurate inventory dramatically reduces the support time for any changes or service required in the future Verify Billing Accuracy Frequently companies find telecom charges are incorrect and errors are almost always in the service provider s favor It is important to look for errors such as discrepancies in contracted rates compared with actual billed rates inappropriate charges and excessive tariff charges for noncontracted services It may take significant time to research and evaluate each item but finding the issues often is easier than resolving them with the service provider Any change made to contracts or services takes two to three billing cycles at a minimum for the providers to bill it accurately and continual monitoring and management of the changes is required long after changes are made Nonetheless such efforts are well worthwhile in that they can be an additional source of significant savings Optimize Rates and Streamline Design The final step in the process is to optimize rates and design a system for continual improvement Once all items are cleaned up a better telecommunications system design should be researched If the services haven t changed in the past three to five years there s likely a better design to get more performance for the same cost or less The organization should investigate whether a more cost effective efficient and resilient design is possible for the full range of wire line services including local long distance hosted solutions and the wide area network WAN The following are the key questions for this investigation Are the wireless devices being used the best ones for the organization Are the rate plans the most efficient and cost effective Do policies need to be updated If significant design changes are necessary it is often best to undertake a request for proposal process with the service provider with detailed specifications even if the desire is to maintain services with the same provider Existing contracts also should be thoroughly reviewed to ensure the organization will not incur major penalties in the event it decides not to continue its contract with its existing service provider Typically this step yields about 25 percent of the total return of the process These savings are substantial but generally not as much as can be gleaned from the other two steps together as rates often are negotiated over time This step takes significant industry and marketplace acumen to achieve the greatest yield The entire process is shown in the exhibit below Telecom Audit and Optimization Process Keep It Clean and Optimal Although undertaking these steps may be viewed as a one time project for larger enterprises it should be a continual process to ensure maximum efficiency For smaller organizations the expense associated with a continual process and ongoing monitoring may be cost prohibitive making it more practical to go through the steps in separate projects performed within set time frames every few years Effective systems require expertise in telecommunications systems and billing Three basic elements are required whether the process is outsourced or managed in house Expert people who are well versed and experienced in telecom systems carriers equipment and contracts A process design that includes standard best practices and automations across the enterprise A systems database with accurate and extensive line item detail for all telecom equipment and contracted rates Dedicating the required experienced personnel resources to such an undertaking often is difficult but in house staffing may be the best option for organizations that do not have a complex IT enterprise Typically the latter means fewer than 10 locations and less than 40 000 per month in total telecommunications expense If an organization has only a few locations and 10 to 20 invoices it can use spreadsheets Microsoft Access database or SharePoint and work with accounts payable A P at a deeper level to track expenses and proactively keep them in line Among the committed resources the organization will require a knowledgeable IT telecom team member who can delve into the details of telecom bills Staff requirements also include a few hours per week to review detailed line item billing and handle dispute resolution These organizations may benefit from a one time telecommunications audit to help put them on the right track to managing it themselves For most medium size to large healthcare organizations managing telecommunications expense in house can be a complex undertaking require a significant investment of staff time and financial resources First and foremost it requires specific processes and knowledgeable dedicated staff An industry rule of thumb is at least one dedicated full time employee for every 400 000 per month of telecom expense Skills needed include IT knowledge of the enterprise system as well as expertise in telecom technology telecom charges and dispute resolution An in house solution also will require new business processes to be put into place as well as a centralized system for visibility of circuits devices management of changes and tracking of individual charges With an IT labor shortage facing the healthcare industry and spiraling technology requirements it makes sense to consider outsourcing of business processes for IT projects that are not specifically related to healthcare delivery The clear advantages are access to dedicated firms with subject matter experts experienced in identifying fraudulent and inaccurate billing resolving disputes deploying specialized knowledge of marketplace rates and analyzing customized carrier contracts Again whichever approach an organization chooses the critical components are committed highly experienced personnel an efficient process and a unique centralized database system to take on the continuous project of technology communications optimization Process Design An effective telecommunications expense management process follows a straightforward sequence involving three broad phases that are performed continually The exhibit below shows the essential tasks for each these three phases which set the stage for ongoing improvement and a potentially significant reduction in the healthcare organization s overhead expenses Tasks to Improve Telecom Expense Management TEM In complex enterprises the process necessitates telecommunications specific efficiency improvements to the A P process for continual charge monitoring In an environment of increasing regulatory requirements escalating technology objectives and shifting payment guidelines reducing waste in the telecommunications infrastructure is a good value proposition for most healthcare providers To effectively realize this value proposition however an organization must apply with discipline and rigor the principles and processes of telecommunications expense management Whether the process is outsourced or performed in house healthcare finance leaders can play an important role in ensuring their organizations are taking the steps necessary to achieve the full potential for savings in this area Greg McIntyre is founder and president Tellennium Inc and a member of HFMA s Kentucky Chapter Footnote a Gartner Says Worldwide IT Spending to Decline 5 5 Percent in 2015 Gartner June 30 2015 Publication Date Monday February 01 2016 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment

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  • EHRs: Long-Term Vision, Short-Term Change
    and billing functions are all mission critical The complexity of these processes for hospitals and health systems makes the IT challenges that much more difficult Maybe satirist Douglas Adams was right We are stuck with technology when what we really want is just stuff that works Publication Date Monday February 01 2016 BACK TO PAGINATION When it comes to the adoption and use of electronic health records EHRs the government s long term vision hasn t changed but the approach surely will In fact recent comments by Andy Slavitt acting administrator for the Centers for Medicare Medicaid Services CMS signal a possible end of the agency s Medicare and Medicaid EHR incentive program as we know it Since 2011 this program has doled out more than 31 billion to promote providers adoption and use of EHRs The meaningful use program as it has existed will now be effectively over and replaced with something better Slavitt said in mid January at J P Morgan s Annual Health Care Conference His remarks were posted recently on The CMS Blog Slavitt s comments follow related actions affecting the incentive program including the passage of the Patient Access and Medicare Protection Act which gives CMS additional authority to process hardship exemption applications for organizations unable to meet meaningful use Stage 2 rules Slavitt s message Reward providers for positive outcomes they achieve with patients Support physicians with technology don t distract them Require application program interfaces to allow apps analytic tools and other technologies to get data in and out of the EHR securely Achieve interoperability We are deadly serious about interoperability Slavitt said We will begin initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops and engaging a patient in their care And technology companies that look for ways to practice data blocking in opposition to new regulations will find that it won t be tolerated Interoperability or IT standards that allow health information systems to be compatible with diverse EHR systems is the central issue The concept of interoperability would allow the secure transfer of medical information to improve communication between clinical providers and patients reduce costly duplication improve safety reduce errors and improve outcomes As we all know technology and its implementation come with significant cost for hospitals and health systems This issue of hfm explores various issues related to technology implementation key considerations for independent hospitals and how mobile solutions can liberate data and reduce costs After nearly 10 years of a concerted push to digitize medical records designing a thoughtful well constructed approach to implementation can determine the success or failure of an implementation Workflows training clinician documentation integration with existing systems and the right interface with critical clinical and billing functions are all mission critical The complexity of these processes for hospitals and health systems makes the IT challenges that much more difficult Maybe satirist Douglas Adams was right We are stuck with technology when what we really want is just stuff that works Publication Date Monday February 01 2016 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY The Future of Online Patient Billing

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  • MACRA: The Evolution of the Medicare Physician Payment System Continues
    less of the performance threshold The adjustments will be applied on a budget neutral basis However CMS has discretion to apply a scaling factor to ensure that the increase in charges for eligible professionals who are above the threshold is equal to the decrease for those below APMs Through MACRA Congress offers two financial incentives for qualifying professionals to participate in APMs In addition to the 0 5 percent annual update differential that begins in 2026 qualifying providers participating in an eligible APM will receive a 5 percent annual bonus payment from 2019 through 2024 The bonus payment will be calculated based on the prior year s eligible billing Qualifying APMs are limited to models developed by the Center for Medicare and Medicaid Innovation CMMI the Medicare Shared Savings Program or other demonstrations Further qualifying models must Require the use of certified EHR technology Link payment to quality measures similar to those in the MIPS category Require participants in the APM to bear more than nominal financial risk if actual expenditures exceed expected expenditures or to be a medical home expanded under a CMMI program Beyond merely participating in an APM physicians must meet volume criteria to qualify for the financial incentives As shown in the exhibit below in 2019 and 2020 25 percent of a practice s Medicare physician fee schedule revenue must be attributed to services provided under an APM c After 2020 MACRA will allow total patient revenue to be included in the calculation thereby helping practices meet the legislation s aggressive goal for transitioning payments from fee for service to APMs Alternative Payment Model Qualifying Payment Volume Criteria MACRA s incorporation of revenue from Medicaid and commercial health plans to determine eligibility for APM participation incentives aligns with the January 2015 announcement by the U S Department of Health and Human Services that it plans to collaborate with other healthcare purchasers in the development of APMs d The legislation specifically directs CMMI to consider models that are aligned with private payers Medicaid and other state based initiatives Also in recognition that many of the current qualifying APMs may not be a good fit for all specialties or allow participation by smaller groups 15 professionals or less MACRA encourages development of models targeted to these groups To better solicit ideas for APMs from stakeholders the legislation creates an 11 member technical advisory committee to review proposals for new physician focused models As a result providers can anticipate a proliferation of models similar to the Oncology Care Model which will start in 2016 e MACRA Implications CMS has made it clear it would like to aggressively move more providers into payment models bearing downside risk in the future MACRA provides the legislative framework to do just that The phrase the Secretary shall appears more than 100 times in MACRA leaving providers with a number of uncertainties and affording the agency significant discretion in how the law is implemented In this environment providers should take the following steps Monitor the regulatory process related to MACRA closely It will be important to follow CMMI s development of qualifying APMs closely to understand how such models will shift risk to physicians and attempt to align with other payers This information can inform a practice s development of similar models with Medicaid and private payers so it can have sufficient revenue flowing through an APM to qualify for the incentives should it elect to pursue that option Beyond the design of various models some basic questions need to be clarified For example where the MACRA legislation states such payments are made under arrangements in which the eligible professional participates in an entity that bears more than nominal risk the way CMS defines participates could affect alignment opportunities for physicians and health systems Regardless of how this question is resolved health systems will need to continue to assess options for improving physician engagement and alignment Develop a strategic and financial framework for evaluating whether to default to the MIPS program or immediately seek to participate in an eligible APM Although CMMI doesn t have a long track record of offering APMs experience to date has shown that the decision making window afforded providers is relatively narrow That may be acceptable for models that involve a relatively small portion of a provider s overall revenue However pursuing the APM incentives likely commits physicians to exposing a material percentage of their revenue to downside risk in a matter of years As part of this work physicians will need to understand the gaps in their longitudinal care management capabilities and the up front and ongoing costs related to filling those gaps the potential impact on revenue from all payers and the longitudinal cost of providing care for episodes or populations for which they will likely take risk With those key pieces of information available management teams will be better able to quickly assess whether participating in a proposed APM model fits with the practice s strategic plan and capabilities and meets financial targets Begin or continue experimenting with payments that transfer some degree of risk to providers If a physician practice opts to pursue the APM incentives the experience gained managing risk will help identify missing capabilities It will provide invaluable experience with modeling and managing the financial results Should the practice decide not to pursue the APM incentives partially qualifying for an APM is scored favorably under the Clinical Practice Improvement component of the MIPS program under MACRA Chad Mulvany FHFMA is technical director reimbursement and regulatory issues in HFMA s Washington D C office and a member of HFMA s Virginia Washington D C Chapter Footnotes a Hereafter physicians includes all other eligible professionals unless otherwise noted b Physician extenders include physician assistants nurse practitioners clinical nurse specialists and certified nurse anesthetists CMS may expand the MIPS to other professionals in 2021 c CMS allows for an alternative calculation that is based on the volume of patients and requires providers to meet the same thresholds d HHS Better Smarter Healthier In historic announcement HHS Sets Clear Goals and Timeline for Shifting Medicare Reimbursements from Volume to Value News release Jan 26 2015 e See Mulvany C CMMI s Oncology Care Model New Model New Twist Eye on Washington hfm June 2015 Publication Date Monday February 01 2016 BACK TO PAGINATION Legislation repealing the sustainable growth rate SGR consolidates physician quality reporting programs and increases incentives for physician group practices to participate in what the Centers for Medicare Medicaid Services CMS refers to as alternative payment models APMs On April 16 2015 President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 MACRA into law Beyond creating some predictability in payment updates for the physician fee schedule MACRA attempts to consolidate the myriad physician incentive programs into one pay for performance program It also encourages physicians and other eligible professionals to participate in APMs that would hold these participants accountable for cost and the quality of care a The incentives to participate in APMs could be transformational but CMS has yet to resolve a number of questions that will determine the extent to which physicians will be willing to engage in these models Physicians will need to follow the regulatory process closely As new APMs are developed organizations should quickly evaluate whether participating in them would be in keeping with their capabilities and strategic and financial interests Stable Payments MACRA should bring some predictability to physician fee schedule updates for the foreseeable future It repealed the SGR with its ritual patching thereby preventing significant cuts to Medicare physician payments Instead physicians will receive annual updates of 0 5 percent from 2016 through 2019 with no update from 2020 through 2025 After 2025 a physician s payment updates will be determined by the payment model the physician chooses Physicians who choose the pay for performance Merit Based Incentive Payment System MIPS will receive updates of 0 25 percent in 2026 and thereafter while those who choose a qualifying APM will receive updates of 0 75 percent MIPS participation Starting in 2019 the MIPS program will consolidate the current patchwork of physician pay for reporting and pay for performance programs i e the electronic health record EHR meaningful use penalty the Physician Quality Reporting System and the Value Based Payment Modifier into one composite system Merit Based Incentive Payment System Components The MIPS program initially will apply to the payments of all physicians and physician extenders who are not full participants in a qualifying APM b Payment adjustments under the program are on a sliding scale based on a physician practice s performance relative to its peers across four categories described in the exhibit above As shown in the exhibit below the maximum amount of Medicare physician payment that depends on outcomes in the MIPS program grows over time Although only 4 percent of a physician s Medicare revenue is exposed in 2019 in 2022 and subsequent years that figure grows to 9 percent Physician Value Based Payment Implementation Timeline Unlike the approach it uses under the current value modifier program CMS will communicate the MIPS target thresholds in advance Practices that are at or above the threshold will receive no payment adjustment or an increase those below the performance threshold will receive a negative payment adjustment with the maximum negative adjustment imposed on practices for which the score is 25 percent or less of the performance threshold The adjustments will be applied on a budget neutral basis However CMS has discretion to apply a scaling factor to ensure that the increase in charges for eligible professionals who are above the threshold is equal to the decrease for those below APMs Through MACRA Congress offers two financial incentives for qualifying professionals to participate in APMs In addition to the 0 5 percent annual update differential that begins in 2026 qualifying providers participating in an eligible APM will receive a 5 percent annual bonus payment from 2019 through 2024 The bonus payment will be calculated based on the prior year s eligible billing Qualifying APMs are limited to models developed by the Center for Medicare and Medicaid Innovation CMMI the Medicare Shared Savings Program or other demonstrations Further qualifying models must Require the use of certified EHR technology Link payment to quality measures similar to those in the MIPS category Require participants in the APM to bear more than nominal financial risk if actual expenditures exceed expected expenditures or to be a medical home expanded under a CMMI program Beyond merely participating in an APM physicians must meet volume criteria to qualify for the financial incentives As shown in the exhibit below in 2019 and 2020 25 percent of a practice s Medicare physician fee schedule revenue must be attributed to services provided under an APM c After 2020 MACRA will allow total patient revenue to be included in the calculation thereby helping practices meet the legislation s aggressive goal for transitioning payments from fee for service to APMs Alternative Payment Model Qualifying Payment Volume Criteria MACRA s incorporation of revenue from Medicaid and commercial health plans to determine eligibility for APM participation incentives aligns with the January 2015 announcement by the U S Department of Health and Human Services that it plans to collaborate with other healthcare purchasers in the development of APMs d The legislation specifically directs CMMI to consider models that are aligned with private payers Medicaid and other state based initiatives Also in recognition that many of the current qualifying APMs may not be a good fit for all specialties or allow participation by smaller groups 15 professionals or less MACRA encourages development of models targeted to these groups To better solicit ideas for APMs from stakeholders the legislation creates an 11 member technical advisory committee to review proposals for new physician focused models As a result providers can anticipate a proliferation of models similar to the Oncology Care Model which will start in 2016 e MACRA Implications CMS has made it clear it would like to aggressively move more providers into payment models bearing downside risk in the future MACRA provides the legislative framework to do just that The phrase the Secretary shall appears more than 100 times in MACRA leaving providers with a number of uncertainties and affording the agency significant discretion in how the law is implemented In this environment providers should take the following steps Monitor the regulatory process related to MACRA closely It will be important to follow CMMI s development of qualifying APMs closely to understand how such models will shift risk to physicians and attempt to align with other payers This information can inform a practice s development of similar models with Medicaid and private payers so it can have sufficient revenue flowing through an APM to qualify for the incentives should it elect to pursue that option Beyond the design of various models some basic questions need to be clarified For example where the MACRA legislation states such payments are made under arrangements in which the eligible professional participates in an entity that bears more than nominal risk the way CMS defines participates could affect alignment opportunities for physicians and health systems Regardless of how this question is resolved health systems will need to continue to assess options for improving physician engagement and alignment Develop a strategic and financial framework for evaluating whether to default to the MIPS program or immediately seek to participate in an eligible APM Although CMMI doesn t have a long track record of offering APMs experience to date has shown that the decision making window afforded providers is relatively narrow That may be acceptable for models that involve a relatively small portion of a provider s overall revenue However pursuing the APM incentives likely commits physicians to exposing a material percentage of their revenue to downside risk in a matter of years As part of this work physicians will need to understand the gaps in their longitudinal care management capabilities and the up front and ongoing costs related to filling those gaps the potential impact on revenue from all payers and the longitudinal cost of providing care for episodes or populations for which they will likely take risk With those key pieces of information available management teams will be better able to quickly assess whether participating in a proposed APM model fits with the practice s strategic plan and capabilities and meets financial targets Begin or continue experimenting with payments that transfer some degree of risk to providers If a physician practice opts to pursue the APM incentives the experience gained managing risk will help identify missing capabilities It will provide invaluable experience with modeling and managing the financial results Should the practice decide not to pursue the APM incentives partially qualifying for an APM is scored favorably under the Clinical Practice Improvement component of the MIPS program under MACRA Chad Mulvany FHFMA is technical director reimbursement and regulatory issues in HFMA s Washington D C office and a member of HFMA s Virginia Washington D C Chapter Footnotes a Hereafter physicians includes all other eligible professionals unless otherwise noted b Physician extenders include physician assistants nurse practitioners clinical nurse specialists and certified nurse anesthetists CMS may expand the MIPS to other professionals in 2021 c CMS allows for an alternative calculation that is based on the volume of patients and requires providers to meet the same thresholds d HHS Better Smarter Healthier In historic announcement HHS Sets Clear Goals and Timeline for Shifting Medicare Reimbursements from Volume to Value News release Jan 26 2015 e See Mulvany C CMMI s Oncology Care Model New Model New Twist Eye on Washington hfm June 2015 Publication Date Monday February 01 2016 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically

    Original URL path: http://www.hfma.org/Content.aspx?id=45997 (2016-02-10)
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  • A Progress Check on 7 Aspects of CINs
    CIN share sufficiently similar overall goals and cultural attributes and can work together effectively The leadership and culture of CINs usually evolve over time Many questions CIN leaders are asking today are strikingly similar to those that aligned integrated systems such as Geisinger Health System Kaiser Permanente and the Marshfield Clinic asked 25 years ago Examples include the following familiar leadership focused questions How do we communicate effectively across the different elements of the system What roles do physician leaders play Should we try a dyad approach to leadership How do we develop the next generation of leaders Is our leadership approach helped or impeded by bringing in leaders from other systems How do we structurally link our goals culture and incentives CINs also have unique leadership issues that can prove challenging for example knowing what to do if leadership styles and personalities clash within the CIN This challenge is relatively easy to deal with if most or all of the CIN is within the same health system because health system leadership can help lead shape and or referee the development of the CIN However CINs often cross health system boundaries with the result that several strong leaders are involved In these instances the CIN culture and leadership must evolve with a leadership setting process that is similar to what takes place in a merger The leadership style that often results from this process is predictable Follow the money i e those leaders who bring more dollars usually have the greatest influence on leadership Differences in Perspectives Among Health Systems Physicians and Payers Based on the depiction of a CIN shown in the exhibit the following questions represent key management and leadership issues One Perspective of a Clinically Integrated Network How do we optimize relationships within the health systems circle For example a CIN should benefit health systems as a group enhance health system health system linkages and avoid seriously damaging specific health systems How do we optimize payer relationships for the CIN as a whole For example leadership may decide to start with one payer and with one payer segment e g Medicare Advantage One question is how much risk the CIN should assume Another key question focuses on how the CIN should deliver optimum service to meet differing needs of employers and individuals where one employer wants a wellness emphasis and another employer wants a hands off approach with individuals meanwhile making their own care choices How do we navigate the financial flows within the physician circle A decision is required regarding the funds flow to primary care and how it should be determined Some CINs have stumbled on this issue right out of the box What roles will physician leaders play in the CIN over time Some say Physicians must lead the networks Others say This is a remarkably tough leadership job that only a few can manage so limiting the role to physicians is shortsighted Many CIN leaders do not view the payer circle or the overlaps among health systems physicians and payers as being within their purview However physician leaders who can influence all three circles are accomplishing more faster As shown in the exhibit on page 79 the CIN is essentially the overlap among the three circles All three circles and the overlap shift over time in response to market conditions policies including regulations and laws and especially the needs of and demands on patients who are the ultimate customers Cost Reduction Most CIN leaders recognize that to be successful the network must reduce costs Most believe that costs have to be attacked at several points simultaneously Care transition points Areas of focus include not only reducing readmissions but also increasing handoffs between inpatient and outpatient care primary and specialty care surgical and rehabilitative care and home and office care Staffing and process redesign The cost reduction focus here is on areas such as the redesign of primary care processes and non care staffing and on developing and promoting the option of virtual office visits Further economies of scale Examples include development of IT and telemedicine service centers Over time a CIN must reduce costs not only within the physician circle but among all three circles for example through increased information sharing and reduced duplication between payers and physicians Incentives Alignment As a CIN evolves the incentives within the network often require some degree of adjustment As the CEO of a regional health system recently told us I have to change my hospital CEO s incentive packages every three years First I weight overall system performance higher Then over time the hospital CEOs start to ignore aspects of their own hospitals So I weight that aspect of performance higher Then pretty soon I have to go back to group performance This way over time I can maintain the emphasis on both the group and the individual business unit It seems likely that CINs do require continuing adjustments for example between the payer and the CIN between the CIN and its business units and between a physician group and its physicians In addition to the shared perspectives of CEOs such as the one quoted above we have seen other signs that CIN leaders recognize the need to make ongoing changes to incentives As a CIN moves from one emphasis to another for example from executing a land grab to attracting patients to reducing costs to fine tuning the delivery system to redesigning next generation processes to fine tuning care for different population segments changes in incentives can be expected Change Management Ultimately success for a CIN will come down to effective change management Is it more difficult to manage change in a CIN than in a health system or a physician group or with a payer We believe the answer is yes Will CINs tend to organize more around patient customer segments rather than around payers Again we believe the answer is yes We see early signs in this direction Will CINs develop a common culture common incentives and a common leadership style The jury is still out We need to check in later to find out Keith D Moore is CEO McManis Consulting Denver and a member of HFMA s Colorado Chapter Dean C Coddington is a senior consultant McManis Consulting Denver Publication Date Monday February 01 2016 BACK TO PAGINATION Today s clinically integrated networks CINs vary greatly and at this stage managing them may be more art than science Many healthcare organizations are early in their journey to form and use CINs Others regard the networks simply as useful and flexible tools For still others CINs are the building blocks of the future Here we check on the progress of seven aspects of a CIN Goals and priorities Effective network formation Culture incentives and communications Differences in perspectives among health systems physicians and payers Cost reduction Incentives alignment Change management Goals and Priorities Much of the variation among today s CINs is tied to differences in the overall strategies of health systems that formed them For example some health system leaders describe their markets as being in the land grab stage One of these leaders recently told us We are developing the tools for population health management but our primary goal is to ensure our group of hospitals physicians and other players is more attractive to the marketplace than are those of our competitors For these organizations a CIN is a flexible tool for developing a broader range of close relationships representing less than a merger but far more than a loose alliance Many CINs are in the tool development phase where the focus is on four key questions Which tools are best for us Which vendors should we work with What do we achieve with a partner versus with a vendor What elements of infrastructure should or should not be the same across the network A few CINs are going deeper asking questions such as How do we lower our per member per month costs and how do we keep and distribute a significant share of the cost difference Effective Network Formation CIN leaders are beginning to recognize that their networks require ongoing fine tuning Among more mature CINs large scale thinking regarding strategies such as land grabs have led to new more intricate questions regarding considerations such as the network s attractiveness and how effectively it meets the needs of key population segments The following typical questions reflect this focus Do we have the right partners to meet the needs of children across our service area Do we have the right partners and relationships for meeting the needs of chronically ill patients Of patients with multiple diagnoses What arrangements have we made for quaternary care Is our primary care network right sized for our specialty care Do we have the full complement of services for example rehab home health and behavioral health for our populations Are we attractive to our target demographic groups Are we attractive to leading employers and employer groups Some CINs form ministrategies and action plans over time around patient segments Culture Leadership and Communication Another area of questioning that shapes networks revolves around whether the diverse participants in a CIN share sufficiently similar overall goals and cultural attributes and can work together effectively The leadership and culture of CINs usually evolve over time Many questions CIN leaders are asking today are strikingly similar to those that aligned integrated systems such as Geisinger Health System Kaiser Permanente and the Marshfield Clinic asked 25 years ago Examples include the following familiar leadership focused questions How do we communicate effectively across the different elements of the system What roles do physician leaders play Should we try a dyad approach to leadership How do we develop the next generation of leaders Is our leadership approach helped or impeded by bringing in leaders from other systems How do we structurally link our goals culture and incentives CINs also have unique leadership issues that can prove challenging for example knowing what to do if leadership styles and personalities clash within the CIN This challenge is relatively easy to deal with if most or all of the CIN is within the same health system because health system leadership can help lead shape and or referee the development of the CIN However CINs often cross health system boundaries with the result that several strong leaders are involved In these instances the CIN culture and leadership must evolve with a leadership setting process that is similar to what takes place in a merger The leadership style that often results from this process is predictable Follow the money i e those leaders who bring more dollars usually have the greatest influence on leadership Differences in Perspectives Among Health Systems Physicians and Payers Based on the depiction of a CIN shown in the exhibit the following questions represent key management and leadership issues One Perspective of a Clinically Integrated Network How do we optimize relationships within the health systems circle For example a CIN should benefit health systems as a group enhance health system health system linkages and avoid seriously damaging specific health systems How do we optimize payer relationships for the CIN as a whole For example leadership may decide to start with one payer and with one payer segment e g Medicare Advantage One question is how much risk the CIN should assume Another key question focuses on how the CIN should deliver optimum service to meet differing needs of employers and individuals where one employer wants a wellness emphasis and another employer wants a hands off approach with individuals meanwhile making their own care choices How do we navigate the financial flows within the physician circle A decision is required regarding the funds flow to primary care and how it should be determined Some CINs have stumbled on this issue right out of the box What roles will physician leaders play in the CIN over time Some say Physicians must lead the networks Others say This is a remarkably tough leadership job that only a few can manage so limiting the role to physicians is shortsighted Many CIN leaders do not view the payer circle or the overlaps among health systems physicians and payers as being within their purview However physician leaders who can influence all three circles are accomplishing more faster As shown in the exhibit on page 79 the CIN is essentially the overlap among the three circles All three circles and the overlap shift over time in response to market conditions policies including regulations and laws and especially the needs of and demands on patients who are the ultimate customers Cost Reduction Most CIN leaders recognize that to be successful the network must reduce costs Most believe that costs have to be attacked at several points simultaneously Care transition points Areas of focus include not only reducing readmissions but also increasing handoffs between inpatient and outpatient care primary and specialty care surgical and rehabilitative care and home and office care Staffing and process redesign The cost reduction focus here is on areas such as the redesign of primary care processes and non care staffing and on developing and promoting the option of virtual office visits Further economies of scale Examples include development of IT and telemedicine service centers Over time a CIN must reduce costs not only within the physician circle but among all three circles for example through increased information sharing and reduced duplication between payers and physicians Incentives Alignment As a CIN evolves the incentives within the network often require some degree of adjustment As the CEO of a regional health system recently told us I have to change my hospital CEO s incentive packages every three years First I weight overall system performance higher Then over time the hospital CEOs start to ignore aspects of their own hospitals So I weight that aspect of performance higher Then pretty soon I have to go back to group performance This way over time I can maintain the emphasis on both the group and the individual business unit It seems likely that CINs do require continuing adjustments for example between the payer and the CIN between the CIN and its business units and between a physician group and its physicians In addition to the shared perspectives of CEOs such as the one quoted above we have seen other signs that CIN leaders recognize the need to make ongoing changes to incentives As a CIN moves from one emphasis to another for example from executing a land grab to attracting patients to reducing costs to fine tuning the delivery system to redesigning next generation processes to fine tuning care for different population segments changes in incentives can be expected Change Management Ultimately success for a CIN will come down to effective change management Is it more difficult to manage change in a CIN than in a health system or a physician group or with a payer We believe the answer is yes Will CINs tend to organize more around patient customer segments rather than around payers Again we believe the answer is yes We see early signs in this direction Will CINs develop a common culture common incentives and a common leadership style The jury is still out We need to check in later to find out Keith D Moore is CEO McManis Consulting Denver and a member of HFMA s Colorado Chapter Dean C Coddington is a senior consultant McManis Consulting Denver Publication Date Monday February 01 2016 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize

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  •