Healthcare

For the C-Suite to become value added, the C-Suite level executives must become value added leaders within the organization. Senior leadership must learn how to recruit, train, nurture, maintain and retain these value added individuals.  For an organization to do more than just survive – to succeed, it must anticipate its customers’ needs and adjust its direction and momentum so that it is providing what the customer needs in a timelier fashion than its competition. Becoming an anticipatory organization guided by visionary leader is essential for growth. 

The 1989 movie Field of Dreams is one of my favorite baseball movies. In it, an Iowa farmer hears a mysterious voice tell him, “If you build it, he will come.” The voice is talking about building a baseball field in the middle of an Iowa cornfield to attract the ghosts of the Chicago White Sox players banned from baseball for throwing the 1919 World Series. The ghosts appear, including the farmer’s father, and so do thousands of spectators.

Futurists identify hard trends and build prognostications around what will take place. They also use the identification of hard trends to seize opportunities in order to transform businesses. 

CMS released a proposed rule on April 27^th which specifically addresses the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive as components under the Quality Payment Program. The Medicare Access and CHIP Reauthorization Act of 2015 repealed the Medicare sustainable growth rate over a year ago, but to date, the recently released proposed rule provides the most concrete guidance on the likely trajectory of physician payment under Medicare Part B for the next decade. While receiving such information is important and exciting for market participants, frankly CMS did not leave much time for physicians and health systems to consider this information, update strategic plans and execute accordingly. That’s because the first performance period begins in less than seven months on January 1, 2017.

The healthcare industry has been buzzing about payment reform and pay for performance for some time now, especially since the release of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the introduction of the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). The recent release of the MACRA Proposed Rule has further fueled the discussion and has those of us living in the healthcare industry focusing our sights on the items CMS says have value (or impact reimbursement).

The healthcare industry is in a state of constant change, and with change comes opportunity. With the passage of the ACA and MACRA, healthcare providers are, or will be, paid differently for their services. No longer can they rely upon the volume of services rendered to generate sustained income. With the transition from volume-based payments to value-based payments, many health systems are investing in data analytics platforms to help expose cost savings, as well as uncover hidden revenue. But is investing in data analytics worth the cost?

Here’s a potentially disturbing statement: “Rural healthcare needs healthcare – not buildings.”

I’ve been watching rural hospitals closely as they cope with the changing healthcare landscape, and I’ve come to believe this statement is true. You might find it disturbing because of its implications – if rural hospitals don’t need buildings, what happens to their staffs, their service, their presence in the community and their stakeholders? And most of all, without a physical presence in a community, what happens to urgent care and its lifesaving role in rural areas? 

Today, WRVUs are one of the most prevalent measures by which employers determine physician compensation.  WRVUs have the benefit of rewarding physicians for personally performed services based on relative values utilized by CMS without penalizing the physician for charity care provided on behalf of the hospital or for revenue cycle issues outside of the physician’s control. However, misconceptions still exist surrounding the selection of appropriate conversion rates for physician arrangements. Here are three common pitfalls to avoid when establishing a compensation-per-WRVU contract.

If anything has disrupted the business of healthcare delivery in recent years, the transformation of reimbursement from volume to value ranks highly. Whether and to what degree we accept this reality varies among providers and facility executives, but disruptive change is either coming or has arrived. Some markets may be less sophisticated than others, with some seemingly a few years to a decade behind, but if CMS has any input—which it does—market timing in value-based reimbursement will soon shrink dramatically.

I recently saw an excellent example of offering appropriate care in the appropriate setting when I reviewed my new HORNE healthcare plan. HORNE is offering a new program called “MD Live.” For the first time, our insurance will cover employees who consult a doctor remotely by using a phone, tablet or computer. The next time I feel a cold or the flu coming on, I can visit with a doctor and get the treatment I need without traveling to the doctor’s office. 

I was talking to a CEO of a healthcare organization recently, and I asked him what plans he had made for incorporating cost accounting into his financial processes. He admitted, a little reluctantly, that he wasn’t making plans at all. “How can I afford to go into that kind of detail?” he asked.

Although physicians around the country cheered the permanent repeal of the sustainable growth rate (SGR), the resulting reimbursement and payment model changes could significantly impact the fair market value of physician practices. The passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed the valuation environment significantly. The HORNE Healthcare team has been researching the changes, and here is what you need to know:

With the passage of MACRA in April 2015 we began to get some real clarity regarding Medicare’s plans for moving physician reimbursement from volume-based to value-based. With MACRA set to be implemented over the next few years, now is the time to begin addressing how changing reimbursement will impact physician compensation models. Because future reimbursement will be greatly impacted by physicians’ ability to deliver value and quality, hospitals will need to design compensation models that reward and encourage physician behaviors that support these goals.