Physicians and advanced practice providers are crucial to every performance, quality, safety, care utilization and patient satisfaction goals. These factors significantly affect an organization's financial viability, which is why providers' compensation must be aligned with them.
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.
The HealthLeaders Media Council is a group of 8,600+ senior healthcare executives from the nation’s leading healthcare provider organizations. They offer insights on the shifting healthcare climate so as to inform their peers and the industry-at-large of operative strategies and existing challenges.
Intelligence Reports are the result of these insights. These reports can be used to benchmark an organization's performance and progress compared to peer organizations, as well as gather insights and advice from industry experts and leaders on a variety of critical topics.
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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.
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.
Some factors commonly used to explain poor operating performance do not prevent many hospitals from being highly profitable. For example, Truven Health AnalyticsTM has found that rates of uncompensated care, drug expense, and other factors do not seem to differ between unprofitable and very profitable hospitals. But factors such as Medicaid utilization rates and poor reimbursement rates do appear to impact the least profitable hospitals. One controllable factor that appears to be significant is labor productivity, with the most profitable hospitals posting the lowest labor expense per patient.
The annual Truven Health 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. Study projections indicate that if the new national benchmarks of high performance were achieved by all hospitals in the United States, nearly 126,500 additional lives could be saved, almost 109,000 additional patients could be complication-free, and $1.8 billion in inpatient costs could be saved.
The Truven Health 15 Top Health Systems® in the United States outperform their peers by demonstrating balanced excellence—operating effectively across all functional areas of their organizations. Investigating the winner and nonwinner data from this study is a useful way to see how the nation’s health and the industry’s bottom lines could be improved. For apples-to-apples comparisons, the 15 Top Health Systems were placed into size categories by total operating expense: large (>$1.5 billion), medium ($750 million–$1.5 billion), and small (<$750 million).
The median fiscal and operational performance of U.S. hospitals over the past year remained relatively flat, despite expectations to the contrary. The data spans a four-year period from 2009Q4 to 2013Q4. Overall, hospitals saw flat or no growth in utilization, but major teaching hospitals saw steady utilization growth.
The Truven Health 15 Top Health Systems study annually identifies those health system leadership teams that have most effectively aligned outstanding performance across their organizations, and achieved more reliable outcomes in every member hospital. Truven Health Analytics measures U.S. health systems based on a balanced scorecard across a range of performance factors: care quality, patient safety, use of evidence-based medicine, operational efficiency, and customer perception of care.
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 Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies hospitals that achieve the best performance on a scorecard of performance measures. This year, based on comparisons between the winners and a peer group of similar high-volume hospitals that were not winners, the study found that if all cardiovascular providers performed at the level of this year’s winners, approximately 9,500 additional patients could survive, more than $1 billion could be saved, and almost 3,000 additional bypass and angioplasty patients could be complication-free. This is based on an analysis of Medicare patients; if the same standards were applied to all inpatients, the impact would be even greater.
The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies U.S. hospitals that have achieved the best performance on a balanced scorecard of performance measures. Based on comparisons between study winners and a peer group of similar hospitals that were not winners, winners are achieving better outcomes while operating more efficiently and at a lower cost. If all cardiovascular providers performed at the same level of this year’s winners, almost 8,000 additional lives could be saved; nearly 3,500 heart patients could be complication free; and more than $1.3 billion could be saved.
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 changing healthcare environment has put pressure on healthcare organizations to deliver top-quality care while keeping costs under control. Superior operational and financial performance can be measured by high margins and low costs. But there are significant operational indicators that differ between high- and low-performing hospitals, depending on whether performance is defined by expense or by margin. Often, hospitals with the lowest costs are considered the most successful. But low-cost hospitals do not necessarily behave the same way as hospitals with healthy margins. Low-cost hospitals can include both efficient hospitals and hospitals that are in dire financial circumstances that have forced them to even eliminate expenses necessary for their long-term fiscal health.
Published By: Parallon
Published Date: Sep 16, 2015
A recent HealthLeaders Media Intelligence survey asked respondents to rank their top challenges impacting financial performance and to identify specific areas of concern within each of those issues. Their top three issues were system implementation and interoperability, recruiting and retaining talent, and reengineering the revenue cycle. On the surface, it’s tempting to think these findings aren’t surprising. Yet emerging external factors, including the cumulative effects of the HITECH Act (meaningful use), the Affordable Care Act, and an aging U.S. population, are creating new frameworks in which to view and solve these traditional problems.
Published By: Parallon
Published Date: Dec 18, 2015
Download the free, on-demand version of this webcast that took place on December 16, 2015.
Change is commonplace within the healthcare industry. Executives are faced with many of the traditional challenges of operating hospitals. Now emerging external factors like the HITECH Act (meaningful use), the Affordable Care Act and an aging U.S. population are pushing providers to change the frameworks in how they view and solve these traditional problems.
Creating a state-of-the-art clinical documentation improvement (CDI) program isn’t just about boosting coding accuracy. It’s a key strategy in managing the transition from volume-based to value-based care, say healthcare leaders. That transition is a risky endeavor that is putting hospital and physician financial performance to the test. As hospitals participate in new care and business models aimed at improving value, leaders must ensure that their organizations are able to maintain reimbursement levels, effectively treat the chronically ill—especially in outpatient settings—and gather accurate data that will allow them to assess performance and segment their varying populations. While some organizations often believe they are leaving revenue on the table because of documentation and coding issues, CDI offers numerous opportunities for improving financial performance, finds a recent HealthLeaders Media survey of 149 healthcare executives at provider organizations.
Driving financial performance in the outpatient setting is a top-of-mind priority among senior health system leaders. But managing the differing clinical documentation methodologies and risk assessment strategies present the greatest challenges to optimizing this important source of revenue, according to a recent HealthLeaders Intelligence survey. Provider organizations are finding the ambulatory setting is still a ‘Wild, Wild West’ in terms of assessing risk, clinical documentation, coding billing and medical record keeping practices. Download this report to discover key targets to improve ambulatory revenue.
Provider organizations can realize tremendous gains in financial performance by integrating electronic health record (EHR) and revenue cycle management (RCM) systems. Especially in the face of the transition to ICD-10, results include optimizing revenue streams directly at the point of care, maximizing and speeding reimbursement, minimizing denials and streamlining the collection process.
Healthcare organizations are facing uncertain times, which is putting strains on their revenue cycle management. Automation can help lower staff costs, enhance clean claims rates, cut denial rates, improve patient collections and reduce bad debt.
Healthcare organizations are facing uncertain times, which is putting enormous strains on their RCM. This white paper will show how you can lower your staff costs, enhance clean claims rates, cut denial rates, improve patient collections and reduce bad debt.