Published By: MedAssets
Published Date: Aug 06, 2015
How can you prepare for regulatory reimbursement changes? Scenario planning is proving essential to cope with value-based reimbursement, shrinking networks and the Affordable Care Act. Strategize and plan for success by downloading this checklist.
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.
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.
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.
Today in healthcare the communication infrastructure is the backbone in IT. New reimbursement models are amplifying the need for care coordination, and communication between multiple departments, constituencies, and workflows is required. High-performing healthcare systems are adopting enterprise communication solutions to eliminate silos of information, improve patient care during critical situations, and make the most of their IT budget.
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.
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.
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.
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.
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.
Published By: Caradigm
Published Date: Feb 16, 2015
Many organizations joined the ACO program with the idea of using it as the first step in the transition to new reimbursement models. It’s a critical time for more ACOs to achieve the milestone of shared savings in order to demonstrate the ability to lower costs for an “at-risk” population. As best practices are emerging from early participants in the ACO program, ACOs have the opportunity to evolve their strategies in order to achieve more success.
Electronic health record (EHR) system implementation is one of the largest IT investments most healthcare systems have ever made but it’s success is largely dependent upon the data which feeds it. One the main data sources for the EHR is the item master, which drives not only supply chain processes but also a broad range of clinical and financial functions. Only with a clean, accurate and complete item master can a healthcare organization trust the outputs generated from its EHRs – from evaluating the clinical effectiveness of products to securing reimbursements. Learn how to execute a master data management strategy to derive the greatest value from your EHR investment.
Sharp is leading the way in the shift to shared risk. In this journey, they manage to the right financial metrics while still delivering appropriate care to their patient population. Watch the video to learn how GE Healthcare is helping Sharp make a difference.
The shift to value-based reimbursement (VBR) entails more financial risk for providers. Successful management of the transition to VBR can only be achieved when healthcare organizations are clinically and financially integrated to ensure tight care coordination and efficient resource utilization. That level of integration requires the aid of a robust IT infrastructure to support the enterprise. This whitepaper offers the opportunity to learn about new tools for healthcare providers to manage financial challenges associated with value-based reimbursement
Learn how to maximize efficiencies through greater system integration and automation, enable seamless interactions with providers, members and other constituents, and drive increased healthcare value with automated, value-based programs.
Published By: Allscripts
Published Date: Oct 14, 2015
Independent physician practices are weighing their options as fee-for-service reimbursement models shift to value-based-care models, such as Accountable Care Organizations (ACOs). Download this white paper to learn more about forming ACOs.
Rising costs, declining reimbursements and the mandate to improve quality: these are key challenges that surgery centers face every day. For years, costs have continued to climb, while reimbursements have declined or, at best, remained stable. To address these issues and succeed in the future, surgery centers need to develop comprehensive plans that leverage both supply chain and clinical expertise. For many facilities, the next step is to conduct a clinical assessment that identifies new ways to improve inventory management and clinical practices. The heart of this approach from Cardinal Health is a clinical team that leverages OR and supply chain expertise to understand, prioritize and pursue opportunities for improving the health of patient and your practice alike. To learn more, read this case study and find out how two surgery centers have used a clinical assessment from Cardinal Health to improve performance.
Published By: Cognizant
Published Date: Oct 23, 2018
Value-based care is the predominant model for enabling the healthcare industry to control costs and deliver better information to consumers. The basic idea is that reimbursements are based on the quality of the outcome of a procedure, episode of care, use of a device or therapy. Under this model, life sciences companies are rewarded for improving health outcomes and/or reducing the costs to achieve those outcomes. It requires life sciences companies to rethink many of their processes, from R&D through the commercial phase. Navigating those momentous shifts requires that life sciences companies embrace a range of digital technologies which will enable a holistic approach to value-based care. This white paper will examine the drive for value-based care, its impact on life sciences companies and how technology platforms can address the challenges the industry is facing.
Health care providers cope with an avalanche of complex rules, regulations, and administrative processes just to run their practices. At the same time, costs are increasing and reimbursement rates are declining. The only way for a practice to achieve financial health in this demanding environment is to learn how to operate at peak performance level.
Healthcare mergers and acquisitions and medical group growth have been strong industry trends for years. One reason is the desire for critical mass to gain leverage with payers as reimbursement declines and costs increase. Healthcare mergers and acquisitions may offer benefits for many medical groups; it is not without its challenges. Read this whitepaper to learn how to successfully manage growth of your medical group.