providers

Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to report on, and how to best use their EHRs to do so. This white paper provides you with the basic information you need to choose appropriate CQMs for your practice, and offers tips on how to use your EHR to store the data in a structured format.

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 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.

Healthcare providers should complete payer testing soon and use testing insights to focus ICD10 preparation efforts.

With technology on their side, patients now demand more transparency than every before, while payors want bank for their buck, proving that providers can no longer work alone.

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 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.

IT innovators set their sights on greater connectivity for patients, providers, and communities in 2016

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.

Workforce management and the pursuit of productivity have formed a consistent pain point for hospitals for several years. The Affordable Care Act has only exacerbated the problem, increasing the demand on providers as the number of insured grows and the bar continues to rise on quality of care. According to a recent HealthLeaders Media Council survey, workforce productivity and acuity-based staffing will continue to be top priorities this year. Karlene Kerfoot, PhD, chief clinical integration officer at API Healthcare, says the survey results indicate a shift taking place as workforce management initiatives are expected to deliver more than reduced labor costs.

Healthcare organizations with strong bond ratings are regarded favorably from a financial perspective, of course. In addition, research by the Truven Health AnalyticsTM ActionOI® program shows that such organizations tend to excel in other categories, such as average length of stay and results of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.

Healthcare providers can deliver much more effective care if they have an understanding of the characteristics, attitudes, and self-reported health status of a patient’s age group. By communicating effectively and delivering care in a manner that resonates with that particular group of patients, healthcare providers can strive to achieve better outcomes and higher patient satisfaction.

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.

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.

U.S. healthcare providers are venturing into the treacherous waters of value-based care, and many are starting their voyages in leaky boats, according to a recent survey of industry executives conducted by HealthLeaders Media and sponsored by RelayHealth.

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.

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. The best way to do that is to manage every aspect of their care. But the patients themselves will remain free to defect to another provider whenever they choose, either temporarily or permanently. Persuading them to centralize their care will rapidly become job 1. This report explores survey results about the primary forces enabling patient engagement and features a case study about the active care management program in development at Beaufort Memorial Hospital in South Carolina.

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.

Providers are increasingly making the leap and investing in their organizations in preparation for value-based care. However, while no one wants to be behind the competency curve when it arrives, it can be expensive to build competency for a new model before it is financially viable, causing providers to remain cautious.

Healthcare billing and claims handling has become increasingly complex. With the transition to Version 5010 of the HIPAA electronic transaction standards, the expansion of billing codes under ICD-10, and the ever-changing requirements of insurance companies and the Centers for Medicare and Medicaid Services (CMS), it can be nearly impossible for providers to keep up.

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.

How can providers and insurers reduce costs and increase patient satisfaction? In the evolving value-based care (VBC) model, better healthcare IT is a must have. L.E.K.'s Joseph Johnson and Harsha Madannavar identify key success strategies in our latest Executive Insights.