Healthcare

While attending the Healthcare Financial Management Association Region 9 Conference in New Orleans, we learned that bundled payments are near and healthcare facilities should start preparing now.   

Bundled payments consolidate reimbursement into a single payment for the care and services related to a specific procedure or episode along the continuum of care. These payments are designed to incentivize the coordination of care among various health care providers, such as physicians, hospitals and post-acute care facilities, as well as to emphasize accountability for the cost and quality of care provided to patients. The Centers for Medicare and Medicaid Services estimates that by 2016, 30 percent of Medicare payments will be value-based and will expand to nearly 50 percent by 2018.   

Healthcare reform has undoubtedly created more integrated delivery and payment models based on a culture of quality-focused and cost-efficient clinical management. In one example, many healthcare systems have begun implementing clinical co-management arrangements (“CCMAs”) to accomplish the physician alignment and integration required to achieve these goals. 

If I had to guess, I’d say you are reading this on your iPhone, iPad, Galaxy or some other mobile device. I’m not clairvoyant; research shows more than half of all emails are opened on mobile devices. It’s likely that if you use tablets or smart phones, you use them in almost every facet of your life from communicating with your friends, family members and work associates to helping with homework, paying bills and working from home. Fortunately, the security built into the systems is generally adequate for most of your personal needs. 

Recently, thousands of medical transcripts detailing the medical histories of children and adults, as well as notes made by doctors and psychiatrists, were publicly listed on an Internet search engine. Without proper encryption, confidential and extremely personal information was exposed to anyone who wanted to access it.

Have you taken a look lately at the statistics that tell the story of the future of health care in the U.S.? It’s sobering. The outdated payment model is just one part of the challenge. Between baby boomers retiring and overloading the system with aging patients that need more care, and the doctor pipeline dwindling, there is a fundamental need to change the delivery model before it crashes. 

The early experience with ACOs has not been very good. The cost of implementation has been higher than expected, and population health management has been difficult to achieve. Data released last October showed that out of 220 CMS ACOs, only 52 were able to share savings, and 115 ACOs had no cost savings. The CMS ACO spend was reduced by a paltry 1%.

So why were the results so underwhelming? It was harder to reduce costs than expected. Low hanging fruit did not exist. The outcomes could have been better if they had deployed these three important strategies.

All hospitals want to be quality leaders. They all want to have the best outcomes at the lowest cost. 

One of the biggest challenges in implementing a quality improvement strategy is figuring out where to begin. Most of the quality improvement efforts hospitals currently focus on are centered around mandatory monitoring regulations (CMS and otherwise). This tends to be effective for specific measures, but tackles only a small piece of the puzzle.  

On Day 2 at the AHLA Physicians and Hospital Law Institute, three themes ruled the day. Here’s a quick recap:

Telemedicine

A technology driven revolution is taking place in healthcare. The traditional patient/physician relationship is changing, and consumer demand will cause telehealth to become mainstream healthcare.  Remote access and patient monitoring will become more prevalent. Access to care will improve, as it will be available in locations where it is limited, or doesn’t exist, today.
 
The Federation of State Medical Boards (FSMB) has adopted the “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.” Leadership in your facilities should be familiar with FSMB policies.   

Act Now to Increase Your Odds of Success

Yesterday, the HORNE Healthcare team made notes of key points in sessions with over 400 of the nation’s leading healthcare attorneys. The presentations reinforced the idea that disruptive change is creating opportunities in the industry:

As the healthcare delivery system undergoes the transition from an environment where greater volume generally equates to higher revenues, to a world where utilization (i.e. volume) will no longer be a source of revenue but viewed as an expense, a question naturally arises - “How is one supposed to compensate physicians in a world turned upside down?” Here enters the vaunted term “value-based compensation” to answer the question – save that few people can then actually explain the intricacies involved to execute a “value-based compensation” arrangement. However, fear not, the basic composition of value-based compensation arrangements are what we will explore today.

The mindset of many hospitals over the last several decades has been to be everything to everyone. There was a desire to create a complex organization offering many different services. The challenge with this organizational philosophy is multi-fold, especially for rural hospitals that find themselves funding specialty services that are low in demand, sometimes at the expense of serving more pressing needs of their community.

Hospitals might want to take a page from the Proctor & Gamble playbook that changed from offering many different products in many different sectors to a simplified offering of their most profitable and targeted product lines. You can read more about it here in an interesting post on the story and its lessons for hospitals.

Nearly a year ago, we started our conversation on this blog about the big ideas and important news driving big changes in healthcare delivery. There are many challenges to face, but also many opportunities that can be mined. It’s an exciting and pivotal time for healthcare leaders and our goal remains the same as we approach 2015: to help our clients meet the future armed with the information that matters.

As you look toward leading your organization into the new year, here is a resource center of articles to help you move your workplace culture forward, note important regulatory deadlines and stay compliant, and secure patient health information (PHI). We look forward to continuing to bring you the resources you need to make informed decisions that protect and grow your organization. Happy New Year from our team to yours!

Have you taken a look lately at the statistics that tell the story of the future of health care in the U.S.? It’s sobering. The outdated payment model is just one part of the challenge. Between baby boomers retiring and overloading the system with aging patients that need more care, and the doctor pipeline dwindling, there is a fundamental need to change the delivery model before it crashes. 

A report released last summer from a private foundation that studies health care systems ranked the U.S. last overall among 11 of the wealthiest nations on the planet. Where do we rank first? Cost of care – ours is the most expensive health care system in the world. Unfortunately, a bigger spend does not produce better patient outcomes. The U.S. underperforms in many areas like access, choice, efficiency, and effective care. 

Take a look at the health care stats and trends in our infographic below that tell the story. What’s that great saying about the future? The only way to predict the future is to create it. Knowing the facts can help you prepare for the changes that are coming your way. Knowing the facts can start getting you out of survival mode and into a proactive approach that helps you and your patients thrive in a new and better model. There is no “riding out” the changes. Staying in status quo mode puts your health care facility at risk.