As a financial executive for a hospital or health system or their employed practice, you know medical billing denials as constant headaches that negatively affect your organization’s revenue, cash flow and operational efficiency.
Numbers tell the story. The industry benchmark for medical billing denials is 2% for hospitals.
It’s no secret that the way healthcare providers are paid is changing. Today, payment is mostly driven by the volume of services delivered, but the alternative payment models (APMs) that came out of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) are gaining speed.
In today’s changing healthcare environment, having the right health IT systems and tools at your disposal is not only key to ensuring quality and improving outcomes, but also operational efficiency and effective business management.
Surviving and thriving in today’s evolving healthcare world means focusing on improving quality, access and outcomes — and doing so in a way that bolsters your organization’s bottom line and grows margins.
The need for a connected healthcare system and the reality of healthcare reform has fueled our progression toward a more interoperable existence. Many other industries have also experienced a technological “disruption,” but the overall complexity of healthcare, combined with a lack of widely-adopted standards, has made our journey a bit more arduous.
This week celebrates National Health Information Technology (HIT) Week, and it’s prompted me to take stock of how far our industry has come. Just two years ago, industry experts were unclear how quickly and extensively providers and health plans were adopting value-based approaches. A 2014 national study on value-based reimbursement conducted by ORC International and commissioned by McKesson first revealed that 90% of payers and 81% of providers already had some value-based contracts in place.
“No margin, no mission.” It’s long been the rallying cry of healthcare leaders who understand that they cannot serve the needs of their communities and patients without at the same time ensuring that their organizations are financially sound. However, a recent study published in Health Affairs found that 55% of for-profit and not-for-profit acute-care hospitals were not profitable.
Hospitals and post-acute care providers such as home health and hospice organizations are working more closely together than ever before. Each year, 10 million Medicare beneficiaries are discharged from hospitals into various post-acute care settings. Two-thirds of these people have two or more chronic conditions, with 14% having six or more.
Healthcare is well down the road towards full value-based reimbursement and it is important for providers – especially practitioners – to understand they can achieve success with payment being tied to value by focusing in three areas:
On the journey to improved clinical and financial health, hospitals are all looking for a silver bullet that simply isn’t there. Value-based care comes in many forms that will be used simultaneously to bridge from health care’s current fee-for-service (FFS) to global capitation. The job of health care leaders is to figure out how to navigate the complexity associated with managing the many payment and delivery models. That means not only understanding the administrative, payment and delivery impacts of the models being deployed but also knowing how to measure performance across each of the models.