Providers face an onslaught of daily practice management challenges. In this MGMA Body of Knowledge (BOK) brochure, uncover relevant and practical essentials to improve any medical practice. Explore areas such as operations and financial management, governance, patient care and adverse legal events. The MGMA Body of Knowledge helps you easily define improvement areas within your medical practice. It also assists all employees in building a sustainable business plan and optimizing daily operations for better performance.
Published By: MedAssets
Published Date: Nov 05, 2015
The shift to value-based care is one of the most significant financial, cultural and technological challenges ever faced by the U.S. healthcare system—and it will affect every stakeholder in the system. Healthcare providers can no longer focus solely on process-oriented measures and instead need metrics that gauge progress to deliver high-value care. This healthcare executive report provides three steps hospital executives can take now as they transition from volume to value and break down silos to create the infrastructure, processes and workflows required to succeed.
Published By: TruBridge
Published Date: Apr 01, 2015
Rolling Plains Memorial Hospital achieved a substantial $438,000 reimbursement improvement in just 3 months by taking advantage of TruBridge’s Clinical Documentation Improvement (CDI) Training. Rolling Plains Memorial Hospital is an 85 bed community hospital located in Sweetwater, TX with annual revenue of $42 million. As the executives at this facility noticed a discrepancy in patients’ charts and the level of care the patients received, they knew something needed to change. TruBridge was able to make a dramatic difference in clinical documentation and capture the earned reimbursements.
Published By: MedAssets
Published Date: Aug 01, 2014
While the challenges of implementing ICD-10 are well documented, the impact to the revenue cycle is not as well known. Revenue cycle leaders must model their payor contracts now to mitigate the risks that ICD-10 will bring.
Published By: McKesson
Published Date: Mar 09, 2016
The ripple effect of healthcare reform is beginning to impact care delivery strategies as care management now falls increasingly to providers.
According to a recent HealthLeaders Intelligence survey, hospital leaders are making progress with care management efforts, but more robust tools will be needed if hospitals want to scale up. The October 2014 survey polled 134 senior, clinical, operations, finance, marketing, and information leaders across the healthcare spectrum. The majority of respondents were from nonprofit organizations (63%), while the remainder (37%) came from for-profit settings.
The 20 leaders gathered at the 2015 HealthLeaders Media Revenue Cycle Exchange in Austin, TX, tackled the challenges of clinical documentation, which they identified as the biggest threat to their organizations' revenue cycle efforts.
The need for analytic tools to make sense of disparate data sources will certainly be expanding in the upcoming years. This report highlights what analytical data healthcare leaders are currently focusing on, as well as the challenges they expect to face when using analytics to support their organizations in the future.
This report reveals how a growing number of patient experience programs have moved beyond focusing primarily on training nurses to also include physicians and a host of nonclinical staff. Another sign of the degree to which organizations are embracing patient experience is the increasing number which feature a chief patient experience officer (or individual with similar responsibilities) on the senior leadership team. Complete this short form to download your FREE copy of PATIENT EXPERIENCE: Cultural Transformation to Move Beyond HCAHPS
Healthcare reforms have prompted hospitals across the country to improve cost efficiencies wherever they can. In response, the accounts payable department of Southern Louisiana’s Ochsner Health System discovered a solution that helped improve cash management while reducing costs.
Hospital communications used to be a lot simpler. If you needed to find a doctor, you could dial 0 and the operators would connect you or send a page on your behalf. People communicated through paper charts, wrote key phone numbers on grease boards, and kept on-call schedules in binders. Some of this still happens today, but communications across healthcare have become progressively more convoluted. The use of diverse mobile devices (smartphones, tablets, pagers, Wi-Fi phones, etc.), and the rise in care complexity necessitating care team coordination mean more sophisticated communication technology is required.
Healthcare reform regulations, increasing costs, and more competition are driving employers and their health plans to focus more than ever on opportunities to reduce cost trends. For example, the country experienced a 3.0% growth in per capita gross (allowed) medical and pharmacy costs from 2012 to 2013. Truven Health Analytics anticipates those costs in 2014 and 2015 will increase by 4% to 5% or more. By taking a data-driven approach, payers can manage costs and, ultimately, make their benefit programs sustainable in the context of healthcare reform. They can also maximize opportunities to improve population health and productivity and optimize the delivery of care.
In response to concerns raised by healthcare leaders that the absence of adjustment for socioeconomic status (SES) and race characteristics in patient populations impedes the fair comparison of hospitals on risk-standardized 30-day unplanned readmission rates, Truven Health AnalyticsTM evaluated the extent to which risk-adjusted readmission rates for acute myocardial infarction, heart failure, and pneumonia are affected by adjustments for community-level SES factors through its Community Need Index (CNI) and patient race. The study shows there is, indeed, a statistically significant effect. For more, visit truvenhealth.com/wp/readmissionpenalties.
Spending on supplies and pharmaceutical services varies among U.S. hospitals. It is not uncommon for hospitals with similar types of patients, including case mix and severity, to have significant differences in purchasing intensity for certain clinical services. Even small changes in efficiency can make a difference for hospitals and health systems, because supply-chain spending typically accounts for hospitals’ biggest spend after labor costs. Costs totaled about $74 billion in 2012, according to the Healthcare Supply Chain Association.
The Agency for Healthcare Research and Quality’s Patient Safety Indicators (PSI) are a set of metrics that provide information on the potential for inpatient hospital complications and adverse events following surgeries, procedures, and childbirth. PSIs can be used to help hospitals identify potential adverse events that might need further evaluation, provide the opportunity to assess the incidence of adverse events and complications, and understand patient safety events on a broader level.
This Fact File examines trends in the detection and treatment of acute myocardial infarctions, or heart attacks, in two distinct groups:
STEMI—ST segment elevation myocardial infarction, with the ST segment referring to a specific part of an electrocardiogram tracing. In STEMI, the coronary artery is completely blocked and cardiac muscle dies.
NSTEMI—Non-ST segment elevation myocardial infarction. In NSTEMI, a coronary artery is partially blocked.
Truven Health Analytics™ evaluated the extent to which community need— a measure of the underlying economic and social factors that affect the overall health of a community, including income, cultural/language barriers, education, insurance and housing—is associated with elevated rates of preventable hospitalizations or an increased risk of hospitalization believed to be preventable with quality ambulatory care. The results of this investigation reveal a modest but statistically significant association between community need and an increased risk of hospitalizations that are believed to be preventable with good-quality ambulatory care.
The annual Truven Health AnalyticsTM 100 Top Hospitals® identifies U.S. hospitals with the best overall performance across multiple organizational metrics, including clinical, operational, and financial. The ability of some hospitals to adapt as the industry is changing demonstrates leadership as the winners set the standards their peers seek to achieve. The study revealed that the nation’s best hospitals had a lower mortality index, considering patient severity; had fewer patient complications; followed accepted care protocols; had lower 30-day mortality and 30-day readmission rates; sent patients home sooner; provided more timely emergency care; kept expenses low, both in-hospital and through the aftercare process; and scored better on patient surveys of hospital experience
The shift from inpatient to outpatient care is increasing as hospitals transition from volume to value. A specific shift is seen in interventional cardiology treatment (cardiac catheterization, intracoronary stents, and percutaneous transluminal coronary angioplasties [PTCA]), which is moving from an inpatient hospital to outpatient hospital setting. Preliminary data show that most interventional cardiology procedures will soon be performed in the hospital outpatient setting. It will be important for hospitals to consider future demand and volume for interventional cardiology services; capacity for an increase in hospital outpatient volume; and staffing and operational implications.
Healthcare organizations are allocating significant dollars, time and resources to the implementation of electronic health records (EHRs). While several studies have estimated the cost to purchase and install an EHR to be anywhere between $15,000 to $70,000 per provider1, real-world implementations have soared into the billions.
As the healthcare industry shifts focus from volume to value, standardization is needed to accurately benchmark labor resource utilization. This is the premise of a survey conducted by HealthLeaders Media and sponsored by Kronos.
What constitutes direct patient care? Hands-on patient assessment, administering medications, and performing procedures clearly top the list. But can other activities be considered direct care too—even those not conducted in a patient’s presence?
Download the free report to get statistics and analysis from the survey questions below and much more
- Which of the following actions are considered direct patient care in your organization?
- Which of the following actions are considered indirect patient care in your organization?
- Which of the following actions are considered neither direct nor indirect care but are categorized separately as non-patient care in your organization?
Partners HealthCare has implemented a program that helps surgeons and other clinicians easily apply best practice guidelines to a patient’s unique status. In this case study executives share the secret to boosting rates of appropriate use of high-cost procedures, and eliminating medical necessity reviews.
Denials are a pervasive and persistent problem. There is no single root cause for denials, and problems that lead to a denied claim occur throughout the revenue cycle. Read our whitepaper to discover how to analyze, prevent and manage denials.