Clinical Integration

What are the financial implications of physician/hospital integration?

With the growing trend towards clinical integration to accommodate the new payment programs under the value-based care we are seeing an increased number of physicians transitioning to hospital employment vs private practice. According to a study by the Physicians Advocacy Institute in 2016 there was a 63% increase to about 155,000 employed physicians as compared to 2012 with only 95,000 employed through a hospital. Value-based care is centered on quality and patient outcomes which is determined based on data that pulls from software; costly software and must be monitored. Most private physician’s do not have the financial resources to purchase and maintain so they stand the chance of losing money. Private physician’s view all of the changes with now having to report the information required to receive payments as having a negative impact on the actual time they are able to spend with their patients. As the number of employed hospital physicians rises so does the number of hospital outpatient department procedures and visits. The Physician Advisory study stated that “Medicare paid $2.7 billion more for services performed in hospital outpatient settings than if they were done in independent physician offices”. CMS is proposing to make payments for hospital outpatient services the same as a doctor’s office services. This would have a profound impact on large health systems since almost half of their revenue is generated from outpatient services and procedures.

Top 10 ways to improve Patient Engagement

In this new era of healthcare in which we are now moving towards a value-based care, making sure the patient understands what is happening with his/her care having a level of trust with the provider is of the utmost importance. Patient engagement is built on trust and confidence. Below are the TOP 10 ways for providers to improve their patient engagement:

  • Communication is key
  • Multi-Disciplinary Rounding – when providers work together in developing a cohesive treatment plan for their shared patient
  • In Laymen’s Terms – Explaining the situation and treatment options in a way that patients can understand
  • Accountability – The reality is people are human and make mistakes. When you are accountable it builds the trust between the provider and the patient
  • Education – Patients that know more about their health are more engaged
  • Transparency – Not withholding certain information in fear of scaring the patient
  • Follow-Up Appt – Having someone help patient schedule follow-up appt to ensure they return for follow-up care. They are more likely to keep if it is already scheduled
  • Online Resources – Almost everyone has a phone and will use it to access information if available
  • Encourage family participation
  • Remember to smile. Patients will be more engaged when they less scared. Smiling brings comfort to that fear

Is there a link between finance and analytics?

With robust software systems now available to obtain data from multiple interfaces you have the ability to bring it all together for data analysis. Predictive analytics is a powerful tool to analyze historical patient data for improving future patient outcomes. I am a certified Kaufmann Hall PEAK “train-the-trainer” for our performance management analytics program where we are able to identify areas of opportunity by determining benchmark measures. By increasing our quality outcomes we are able to increase our reinbursements.

Critical Analysis of Patient Experience and Financial Performance

If a patient and their family can leave the hospital feeling as though they received the best care and the ones treating them went out of their way to do everything they in their power to help, then it makes them feel comfortable coming back. It builds trust and trust creates relationships that forge loyalties. Repeat customers have the power to drive a company and is critical to their long-term success. According to a Press Ganey report through Health Leaders, “the patient experience is five times more likely to influence brand loyalty than conventional marketing tools such as billboards, television, print or radio ads.” And successful hospitals get that. I used to implement changes across modalities and throughout the hospital, based on the Press Ganey reports we would receive for Diagnostic & Interventional procedures. I felt very strongly that if we cared for them as we would our own loved one and not like they were just a number and could train our staff to do the same it would increase our Press Ganey scores. Positive patient outcomes are derived from shortened length of stay and coordination with care team reduces not only overutilization of tests and procedures but leads to higher patient satisfaction. Patients discharged from a hospital that are relaxed and comfortable are more likely to speak to others about their experience and with confidence take other members of their family to the same location when future events arise. In a highly competitive market your reputation in how you care for your patients AND how you deal with complaints from patients is what makes you stand out above others. Patient satisfaction has been on the forefront of many hospital organizations in the past several years and its measures are captured through Healthcare Providers and Systems (HCAHPS) scores. Deloitte Center for Health Solutions

Critical Analysis of bundled payments

Can alternate payment methods provide practical solutions to improving the quality of healthcare?
I would like to focus on one of the more accepted forms of the Alternate Payment Method, a bundled payment which is geared toward value-based care. The goal is to incentivize all providers participating in the patients care to coordinate the most effective and cost efficient course of treatment. With bundled payments, the total amount paid out for all related expenses to the episode of care are at a predetermined fixed, lump-sum payment and then divided among the participating providers. Additional costs above the fixed rate or potential savings is shared among the involved providers. For example, a patient with diabetes is admitted to the hospital for a cardiac cath procedure. The cardiologist would coordinate with the endocrinologist, the hospitalist, and wound care to ensure his diabetes is managed and his wound is properly healing thus preventing errors that could lead to complications or extend his length of stay. Both of which will increase the cost of this episode of care. Because the lump-sum payment must cover all related expenses to the episode of care it motivates the providers to coordinate the most efficient plan of care. Currently the fee-for-service model pays each provider individually for the same episode of care and promotes overutilization for unnecessary tests and procedures thereby leading to a fragmented treatment plan for the patient. Bundled payments should not be confused with global payments or “capitation” where the lump-sum payment is attributed to the patient not the specific episode..

Welcome to my blog

My name is Betty Rutherford. I am a Healthcare Professional studying for my MHA/MBA at The University of Houston – Clear Lake.

I am an analytical and results-focused professional with more than 20 years of experience driving results in complex and fast-paced healthcare environments. Reputation for establishing priorities, scheduling, and meeting deadlines through the skillful allocation of human and information technology resources.