Boards have a duty to see that hospitals and health systems comply with all state and federal laws and regulations, but they generally delegate responsibility for establishing, managing, and monitoring compliance programs to management. They also have a fiduciary responsibility to see that charitable assets are used appropriately.
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.
Creating a successful patient experience strategy is a long-term investment in planning, surveying, training, and technology. Healthcare organizations hope these efforts will pay off at the very least with a growing base of loyal patients, better care quality, and stable reimbursement. And then there are those organizations that are turning patient experience into a movement. What’s their endgame? They intend to build state-of-the-art service-oriented cultures that rival other industries, and they are doing it through data analytics, unique communication programs, radical cultural shifts, and consumer-centric technologies.
The Centers for Medicare & Medicaid Services, the nation’s largest payer, has set a clear direction with its publication of targets: By 2018, 50% of fee-for-service payments will be through alternative payment models, such as ACOs and bundled payments, and 90% of FFS payments will be tied to quality or value. And CMS has begun to introduce mandatory bundles. This suggests that all providers will
need to develop population health competencies, including the ability to manage risk for both cost and quality.
This report outlines the top challenges providers are facing in the transition to value-based care. The results this year reinforce both the magnitude of the task and leaders’ reluctance to make a full commitment while details of emerging but still largely unknown payment models are unresolved.
Most providers are involved in at-risk payment models of one kind or another. Their experience now should help them develop expertise that will be vital when value-based payments are the norm. Among the lessons to learn today is how to benefit from closer working relationships with payers in the future. In this latest report, peer leaders examine ways to benefit from closer working relationships with payers.
Nearly six years after passage of the Patient Protection and Affordable Care Act, the healthcare industry is in the midst of a massive retooling that is dramatically altering the way we think about cost management, strategic partnerships, and customer service.
Fee-for-service reimbursement is giving way to new models of care delivery and payment to support a system based on pay-for-value. With financial risk or payments tied to value measures (such as patient satisfaction, clinical performance, and population health), compensation and reimbursement will increasingly be tied to value-based incentives.
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.
With the inception of Value-Based Purchasing, the measurement of successful patient care delivery has been redefined. The move from fee-for-service to pay-for-performance means that reimbursements are tied to the quality of care that is delivered.
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.
The tax on high-cost health plans, which are often referred to as Cadillac plans, is expected to impact a considerable share of the plans provided by healthcare organizations for their own employees, as much as 39% by 2020. The implications are significant because the excess-benefits tax requires the employer to pay 40% on the value of the portion of the plan that exceeds thresholds set by the Patient Protection and Affordable Care Act. Employers also need to consider that the tax is measured as a direct function of plan cost, and not actuarial plan value, and that a number of factors can drive excise-tax exposure.
ICD-10 has presented monumental preparation challenges to U.S. healthcare providers, who have had to overhaul their billing departments and systems and retrain their staffs. And many may now think the heavy lifting is done, according to a recent survey of industry executives conducted by HealthLeaders Media and The SSI Group, Inc. But while providers may successfully get a bill out the door with a valid ICD-10 code, they may not be prepared for a payment delay or an actual drop in revenue when the payer sends it back for more details.
Download the free, on-demand version of this webcast that took place on December 8, 2015.
Leaders from Beaufort Memorial Hospital and Influence Health discuss the challenges providers face and the skills they must acquire to increase patient engagement. In the coming era of accountable care, providers will finally have something to gain by actively engaging patients in taking care of their health—and a lot to lose by not doing so. Increasingly, providers will receive a fixed sum to care for each patient attributed to them by payers, and they will be able to make an overall profit only by keeping those patients as healthy as possible.
Registered nurses, with targeted training, are the secret weapon in the race for comprehensive care coordination.
Accountable care organizations. Patient-centered medical homes. Value-based reimbursements. Bundled payments. Healthcare is experiencing a revolution brought on by the Patient Protection and Affordable Care Act that aims to put patients squarely in the middle of all their clinical and financial decisions. Payers, including government agencies and insurers, are tying the quality and safety of patient care to reimbursements, making patient-centered care a necessity in all settings.
In many aspects of healthcare, we see indications of change, with movement toward new payment models and investments in infrastructure to support the delivery of value-based care. Cost control remains a top financial lever, but the discipline is becoming more complex. From a brute-force perspective, controlling cost has a direct effect on operating margin, which provides the classic move of cost control through cost cutting. Now, though, organizations need new command over cost factors themselves.
HealthLeaders' survey on workforce management queried leaders from a cross-section of U.S. healthcare organizations, including hospitals, health systems, physician organizations, and long-term care/skilled nursing facilities. The 150 respondents represent executives across all disciplines — administration, clinical, operations, finance, marketing, and information. In the next three to five years, hospitals, health systems, and other patient service providers expect to augment their time-and-attendance and payroll systems with integrated applications that enable more sophisticated data crunching around labor analytics, acuity management, and staffing assignments. The goal? To convert the workforce from overhead to asset — a flexible, agile asset that will help organizations succeed in an increasingly demanding regulatory and competitive environment.
Download this whitepaper to learn the following:
1. Background and basis of decreasing payments and increasing risks
2. Challenges and opportunities associated with the trend
3. How to thrive versus simply survive in this new healthcare environment
Today, healthcare providers need payment clarity – visibility into when and how much they will be paid, by whom, and the ability to better navigate the many obstacles to payment. To learn more, Download the new whitepaper from RelayHealth Financial.
Investing in healthcare benefits education and outreach for consumers can pay big dividends in the form of financial patient satisfaction and loyalty when those consumers become patients. Read this article to learn more.
In today’s interconnected world you need to future-proof the integrity and reputation of your business. Your company’s network remains the Achilles heel of the whole enterprise because once compromised, your company’s reputation is compromised as well. Banks, credit card brands, payment processors, and e-commerce companies regularly launch new products and services that have new, unforeseen fraud risk factors.
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