With all eyes focused on efforts to repeal and replace the Affordable Care Act, it’s tempting to forget that, at the end of December, Congress passed a huge healthcare bill that still has a long way to go before it’s fully implemented.
One in five claims are delayed or denied, creating 3% loss of net revenue. Not only do these denials erode the provider organization’s bottom line, they require an inordinate amount of administrative work for both payers and providers. But they don’t need to. Technology now exists to stop the denials, improve the process and allow organizations to make more investments in the front end of the revenue cycle.
As healthcare organizations face increasingly complex reimbursement in the move from fee-for-service to value-based reimbursement, maintaining financial viability really is job one. The refrain in our industry is all-too-common: “No margins, no mission.” In other words, if you can’t make your numbers, you can’t keep your doors open.
Can you really make the switch from reactive to proactive in daily operational functions? Health systems implementing an integrated capacity management strategy can do just that because this approach aligns your organization to focus on contemporary problems such as correlating outcomes and cost.
Value-based care will lead to lower costs, higher efficiency, and better patient outcomes. But sometimes, focus on the day-to- day logistics of your transition can cause you to lose sight of the larger goal. If you find enthusiasm for your value-based care initiatives waning — whether you’re halfway there, haven’t yet started, or are in the final sprint to the finish – consider these three ideas.
With the recent passage of the “21 st Century Cures” initiative and focus on the ONC oversight rule, it is clear that the federal government wants to continue to promote and push interoperability as do we in the healthcare industry. Interoperability is essential for value-based care because having a complete patient record and just-in- time information provides an opportunity for more informed decision-making, a reduction in costs and higher-quality outcomes.
Whether your organization is an employed physician group, hospital or health system, optimizing your revenue cycle provides an excellent opportunity for margin improvement. Denial management and cost to collect, in particular, are key areas where you can reduce costs.
Healthcare organizations are facing tighter-than-ever margins as they work to grow their businesses and keep pace with the shift toward value-based care models. As a result, organizations are looking for financial management solutions that will secure their bottom line, improve margins and help them deliver the best possible care.
Shifting to value-based reimbursement (VBR) is a challenging journey, and trying to proactively manage risk at the same time only makes things more complicated. However, there are simple ways a provider organization can more proactively position their organization for a shift to VBR.
Relying on intuition, some healthcare leaders think there is an inverse relationship between positive patient outcomes and healthy labor costs. When labor costs improve, they assume staff is reduced and patient outcomes suffer. And when labor costs worsen, leadership believes it’s easier to meet quality goals and control length of stay. But it doesn’t have to be that way.