Healthcare

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!

Whether you are a healthcare provider or a patient, it can be challenging to be away from family and friends at such a celebratory time of the year. But the lengths that hospitals and other healthcare facilities will go to spread holiday cheer for patients and staff is truly inspiring. We reached out to some area hospitals and asked them to share their stories.
 

With most hospitals paying for emergency department on-call coverage, it is important to understand the factors that influence the value of these arrangements. Following these simple ABCs make understanding and documenting fair market value a lot less complicated.

As health care evolves from fee-for-service to shared-savings model, accountable care organizations are a key component in driving this evolution. ACOs can be broadly defined as: "a group of health care providers who accept shared accountability for the cost and quality of care delivered to a population of patients." This concept places the financial risk of each patient's care on the group of providers.

There have been many obstacles blocking the success of implementing the ACO model nationwide. At a recent summit, I attended a session about why ACOs have not been successful, and many challenges were discussed, such as:

In earlier days of hospital-based physician coverage, specialties were mostly limited to radiology, pathology, anesthesiology, and emergency medicine. As the hospitalist specialty developed, more hospitals began contracting for inpatient coverage to provide a broader continuum of care. Later, additional specialties, including pediatric hospitalists, intensivists, nocturnists, laborists, surgicalists, and neonatologists, grew in popularity.

Coverage by hospital-based physicians can be based on shifts or hourly or daily coverage, and can extend to multiple facilities and hospital departments. Coverage can include restricted and unrestricted on-call coverage as part of the arrangement. In addition, administrative responsibilities, quality improvement, and program development are often required.

Non-profit hospitals should take notice of changes the IRS has made in its Draft 2014 Form 990 Schedule H. The IRS is trying to make its Schedule H more closely mirror requirements in the Affordable Care Act, section 501(r). In particular, the updated draft form requires more commentary so that the IRS can get quicker visibility into whether hospitals are living up to the true purpose of the Community Health Needs Assessment (CHNA) regulations. Here are some key points to note in the updated form:
 
More specificity in check-the-box questions
 
501(r) details that a hospital must adopt an implementation strategy to meet the needs identified in the CHNA by the end of the same taxable year in which the CHNA was conducted. The Draft Schedule H now asks for the tax year in which the CHNA was adopted and either a link to or a copy of the implementation strategy. This updated draft also provides clarity to the IRS about allowable exceptions that might be missed in a simple review of previous forms.

Join our own Thomas Prewitt, M.D., director of the HORNE Healthcare Delivery Institute, for plain talk about how we’ve reached critical mass in health care by buying into unnecessary care. Dr. Prewitt walks us through memorable examples of how unnecessary tests and procedures put patients at risk and drive up costs.

• The challenges physicians face to stop “over-treating” patients
• What we as patients need to do to take ownership of our personal health care
• How our healthcare focus needs to shift from rescue-care to overall patient health

To see Dr. Prewitt’s TEDx event talk, click here:

Getting your patients actively involved in their health care keeps them healthy. Simple. This very important learning comes from a recent Robert Wood Johnson Foundation's Quality Field Notes brief about patient engagement¹.

And, according to other research², in order for changes to the healthcare system to be successful in reducing expenses and improving quality, the patient must be consistently "engaged" for everything to work.

The concept of patient engagement has been in existence for more than a decade. But, what is patient engagement?

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. 

In the continuing evolution of hospital/physician relations, new and more complicated pay arrangements find their way into the market each year. However, overpayment of physicians can run afoul of regulatory requirements for fair market value and commercial reasonableness. Having more than one paid service or compensation arrangement between parties increases the risk that aggregate compensation is more than FMV. While the compensation terms outlined in each agreement may represent FMV, when taken together, total compensation in some cases can exceed FMV. The following scenarios show some of the ways that pay arrangements can be “stacked,” placing the parties at higher risk:

A major change to pension plan reporting takes place in fiscal year 2015 that could become a significant headache for governmental hospitals if they don’t get started now preparing for it. The ramifications of GASB 68 are substantial enough without the stress of waiting too long to prepare. Here’s why: 

While non-physician providers already play a large role in providing health care in the U.S., it is expected that in the near future NPPs will begin to take on a larger role because more individuals will have access to health insurance and there is an existing shortage of physicians. Most state laws require some level of physician supervision over the services of NPPs—specifically physician assistants and nurse practitioners which are the two types of NPPs that are commonly employed in the physician practice setting and are more generally associated with broad patient care services.

Compensating physicians for supervising NPPs normally involves two types of supervision and two compensation structures, however each case must be analyzed as the amount of supervision varies and the resulting compensation must conform to the fair market value of the services performed.