Latest News in Healthcare

Three Environmental Factors Impacting the PPM Industry and Getting Deals Done

April 23, 2019

The PPM industry is by no means immune to the ebbs and flows of a traditional marketplace. Since the consolidation bubble burst in the 1990s, PPMs have gone from practically extinct to a once-again substantial component of the health care delivery system. But with greater influence comes more pressure to respond, and adapting to today’s complex operating environment requires those in the PPM industry to ensure they are building the foundational structure needed to help practices adapt to external factors and achieve long-term success.and achieve long-term success.

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Social determinants of health in an ACO for better population health

April 16, 2019

Valerie was a 31-year-old woman with uncontrolled diabetes, asthma, hypertension and was morbidly obese; she also had a history of trauma and depression. She increasingly was a no-show for appointments and would go to the emergency room instead of her primary care visits at Massachusetts General Hospital in Boston.

It wasn’t until Mass General implemented a social determinants of health (SDoH) survey that the providers learned that Valerie faced homelessness — until then, a P.O. box and a telephone number gave no indication of the larger issue in her life. They also learned that, despite being born and raised in Boston, Valerie could not read and write in English, her primary language.

Through SDoH work, Mass General staff were able to direct Valerie to emergency housing and ask what her goals were beyond health: Learning English, getting a job, securing an apartment and reuniting with her 3-year-old daughter, who was taken at birth due to Valerie being homeless.

As with most of us, social factors such as housing, education and a safe environment largely lead to better health outcomes.1 In Valerie’s case, her factors meant insufficient healthy food, lack of refrigeration for medication and issues with blood pressure heightened by living in a van and a lower sense of personal safety — all directly affecting the care providers working with Valerie.

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Practical approaches to medical technology capital planning

April 8, 2019

Medical technology in a healthcare organization often is viewed in the future tense: Something will do what we want it to do, sometime and somewhere down the road.

Consider Martec’s Law: Technology generally evolves faster than organizations,1 and there’s nothing medical groups can do to slow technological advances to allow them to catch up.

While it’s a constant challenge to keep up with these advances, there are capital strategies an organization’s C-suite can embrace to become more agile and hew closer to the leading edge, according to Ilir Kullolli, MS, director of clinical technology and biomedical engineering, Stanford Children’s Health, Palo Alto, Calif.; and Chris Gutmann, MS, information technology system director, Yale New Haven Health System, New Haven, Conn.

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Managing chronic care populations: Improve health & contain costs

April 2, 2019

Healthcare in the U.S. continues to move from volume-based care to value-based care. In the process, managing chronic disease has become both a universal imperative and a foundational element of a patient-focused population health program.

Leaders of many physician groups—including those partnered with multi-hospital systems—look for a solid, practical approach to chronic care management. Though difficult, practices are changing up their organizational structure to support alternative payment models that reward maintaining a healthy population.

This paper, a joint effort between Virence Health and Physicians Medical Center, PC, used a real-world example of how PMC introduced a successful population health program into its culture and, by doing so, made the shift to proactive, team-based care, allowing them to leverage their data and improve the lives of their patients.

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Spokane Digestive Disease Center uses price transparency to compete with larger health systems

March 26, 2019

RevCycle Intelligence  outlined how Spokane Digestive Disease Center used healthcare price transparency to gain a competitive edge over larger healthcare providers. In the new year, CMS created a mandate that required “all hospitals in the U.S. to publish a list of their standard charges online.”

Scott Glennie, CEO of Spokane Digestive Disease Center, saw this as an opportunity to “help his practice compete with local hospitals that had to comply.”

RevCycle Intelligence reported that outpatient services are more expensive at hospitals because they “get paid a higher rate for delivering the same services that could have been performed in a physician’s office.” Patients have been unaware of this and the fact that smaller health systems, like Spokane Digestive Disease Center, can “deliver the same services as hospital outpatient departments at must lower costs.”

Glennie decided to capitalize off the new mandate as well with the creation of Washington’s HealthCareCompare website that allows consumers to “research the prices of specific services in their area and compare prices.” These tools have empowered healthcare consumers to discover that they can find better prices for the same procedure.

Want to learn more about benchmarking and forecasting? Click on this MGMA Podcast.

Four top health systems taking strides towards improving patient engagement

March 18, 2019

The healthcare system is always looking to improve upon patient engagement with technology. Healthcare Finance described four new ways patient portals are improving “patient experience and health outcomes.”

Ochsner Health system used its patient portal to assist in treating hypertension. Healthcare Finance stated that Ochsner implemented “a new medicine program that combined patient-reported blood pressure data, clinical data and coaching.”

Sutter Health has also been using patient portals to improve engagement in patients with diabetes. Patients can get online reminders of hemoglobin A1c ultimately improving “the rate of A1c test completion by 33.9 percent.”

Healthcare Finance reported Stanford Health Care’s improved patient portal allows patients with cancer to better manage their stress. Patients can be “surveyed before clinic visits to identify unaddressed symptoms.” This improvement “led to more than 6,000 referrals for psychotherapy, nutrition and other services.”

The UC San Diego Health opened Jacobs Medical Center that made a big jump forward in using technology to improve patient’s experience. This medical center has an Apple tablet in every patient’s room. The Apple tablet allows the patient to control small things like temperature or lighting as well as access to their “test results and schedules of medications of upcoming procedures.”

Want to learn more about patient engagement? Click on this MGMA Stat.

Physician practice losses: How much red ink can a health system afford?

March 11, 2019

Series: Examining Losses in Health System Physician Practices
Installment #10

As reimbursement pressures continue to mount, health systems are looking at every aspect of their operations and asking critical questions. These reviews frequently lead to the physician enterprise, when health systems lose money on their employed physicians.

Today, many health systems are starting to ask whether they can afford to underwrite their physician enterprise on an ongoing basis. Can the health system sustain current levels of red ink into the future? At what point can a hospital system no longer afford to subsidize physician employment on a large scale?

To such questions, many industry participants respond by saying practice losses are inevitable. They’re simply a cost of doing business. Some participants will also point out that many hospital departments lose money, and so, physician practices should be viewed no differently.
Others will venture to say that physician practices are “loss leaders” or that health systems ultimately make up the difference elsewhere in the overall enterprise. “At the end of the day, it’s all one pot of money,” they say.

Based on the last article in this series, however, it should be readily apparent that offsetting practice losses by inpatient and outpatient referral profits from employed physicians is a bad idea. Crunching the numbers for individual physicians or groups is a key allegation in certain high-profile and costly whistleblower cases. Losses should not be justified on this basis. A health system, therefore, needs to think about its physician enterprise apart from referrals.

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MGMA Announces Speakers for MGMA19 | The Financial Conference

March 8,2019

Leading finance and business experts to discuss best practices related to

financial management, business intelligence, contracting analysis, and revenue cycle management
Englewood, Colo. (Feb. 25, 2019) – Medical Group Management Association (MGMA) will host MGMA19 | The Financial Conference (#MGMA19FC), March 3-5, 2019, in Las Vegas.
This annual financial management conference is designed to provide healthcare professionals with the education and tools needed to run profitable and efficient medical practices. World-class speakers and conference sessions will offer insight into managing risk, operationalizing value-based contracts, and reducing care costs while maintaining high-quality outcomes.
Conference attendees have the opportunity to interact and share ideas and challenges with other medical practice executives, chief financial officers, and financial management and payer contracting professionals. The conference sessions focus on several content areas, including business intelligence, compensation and productivity, financial management, government affairs, and contract analysis and negotiation.

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  • 25 Feb 2019 9:40 AM | Cathy Herring (Administrator)

    Healthcare in the U.S. continues to move from volume-based care to value-based care. In the process, managing chronic disease has become both a universal imperative and a foundational element of a patient-focused population health program.

    Leaders of many physician groups—including those partnered with multi-hospital systems—look for a solid, practical approach to chronic care management. Though difficult, practices are changing up their organizational structure to support alternative payment models that reward maintaining a healthy population.

    This paper, a joint effort between Virence Health and Physicians Medical Center, PC, used a real-world example of how PMC introduced a successful population health program into its culture and, by doing so, made the shift to proactive, team-based care, allowing them to leverage their data and improve the lives of their patients.

    Click Here to Download the Paper

  • 19 Feb 2019 1:11 PM | Cathy Herring (Administrator)

    February 7, 2019 
    The Honorable Richard E. Neal
    Committee on Ways and Means
    1102 Longworth House Office Building
    Washington, DC  20515 

    The Honorable Kevin P. Brady
    Ranking Member
    Committee on Ways and Means
    1139E Longworth House Office Building
    Washington, DC  20515


    Dear Chairman Neal and Ranking Member Brady: 
    Patients, physicians, and policymakers are deeply concerned about the impact that unanticipated medical bills are having on patient out-of-pocket costs and the patient-physician relationship.  Health insurance plans are increasingly relying on narrow and often inadequate networks of contracted physicians, hospitals, pharmacies, and other providers as one mechanism for controlling costs.  As a result, even those patients who are diligent about seeking care from in-network physicians and hospitals may find themselves with unanticipated out-of-network bills from providers who are not in their insurance plan’s network, simply because they had no way of knowing and researching in advance all the individuals who are ultimately involved in their care.  Physicians and other providers are limited in their ability to help patients avoid these unanticipated costs because they, too, may not know in advance who will be involved in an episode of care, let alone other providers’ contract status with all the insurance plans in their communities. 
    As Congress develops potential legislation to provide relief to patients from health care costs that their insurance will not cover, we urge your consideration of the following policies. 

    Click here to read the full letter. 

  • 19 Feb 2019 9:05 AM | Cathy Herring (Administrator)

    Date: February 19, 2019

    The healthcare industry is constantly growing and introducing new ideas. MedCity News reported how “innovation in healthcare delivery, the use of data analytics to unlock new clinical insight, disruption of the existing pharma business model and the continued shift to value-based care” are the reasons why investors are putting more money in the healthcare industry than ever before.

    Healthcare has seen high investments across all sectors. Specifically, MedCity News stated that “one of the biggest magnets for investment in New York has been insuretech start up Oscar Health.” However, there wasn’t as much growth within digital startups. MedCity News blamed this on “volatility in the public markets.”

    MedCity News elaborated on a few more drivers contributing to the growth in investment. The direct-to-consumer health companies that provide “streamlined and personalized consumer experience” are large influencers. San Francisco-based One Medical is also furthering innovation by providing “telehealth to in-home visits to concierge medicine, and often all in one package.”

    MedCity News described these companies as creating a shift towards better patient engagement and care navigation, and for good reason, according to Cedar CEO Florian Otto. 

    “Health insurance is an area that can be much more patient friendly.” Otto was quoted in MedCity News. “Understanding patient benefits should be easier and insurers could be a more active partner in how patients consume healthcare.”

  • 13 Feb 2019 12:01 PM | Cathy Herring (Administrator)

    Date: February 8, 2019

    The healthcare industry is constantly on the lookout for new and exciting ideas. Caitlin Cronk, the associate director of digital planning and strategy at NYU Langone, is always driving towards the next technological innovation. MobiHealthNews reports how Cronk and her colleague, Nader Mherabi, find the next new thing.  

    The two started by gathering “a lot of different ideas from industries that are consumer and customer focused.” While researching, Cronk would learn from “what worked and what didn’t across an array of fields.” Some of the industries they investigated ranged from the travel industry to the consumer products industry.

    MobiHealthNews outlines how Cronk and Mherabi used a few different techniques when learning about patient engagement behavior. The two colleagues felt that “it’s always important to get the end user’s voice into the innovation process.” Cronk stated that “we have different forums that our patient experience team get us connected with” and they “have also done some market research and leveraged some market surveys.”

    MobiHealthNews reports that the focus of this system right now is “patient access and telemedicine, as well as experiences across radiology, obstetrics and the post-procedural space.”

  • 05 Feb 2019 10:02 AM | Cathy Herring (Administrator)

    Date: February 5, 2019

    Recent events at Chicago Mercy Hospital have brought attention to the threat of violence at the workplace, specifically healthcare. Medical Economics outlines this threat and how to combat this issue.

    Compared to other industries “U.S. healthcare workers are three to four times as likely to experience workplace violence,” according to the article. However, after the Emergency Preparedness Final Rule in 2016 was passed “it dramatically upped the regulatory ante and spurred additional progress in medical facilities.”

    Medical Economics describes the five elements that OSHA guidelines states are necessary for a violence prevention program and then outlines the steps for implementing this program. The first step is to define and assess risks and how these risks may be different for facilities of different sizes, locations, etc. It’s also important that all interested parties are involved in program design to ensure that “all needs are met.” Once the program is designed there needs to be a “strategic, thoughtful, connected, and comprehensive” process of implementation. Finally, “decision-makers should reassess and potentially update mitigation strategies on an ongoing basis.”

    Medical Economics states that if healthcare facilities continue to develop these programs they will “deliver on this promise of providing high-quality care in a comfortable, safe, and secure environment.”

    What to learn more about risk management? Click on this MGMA Insight Article.

  • 29 Jan 2019 8:11 AM | Cathy Herring (Administrator)

    Date: January 29, 2019

    This installment of the article series runs counter to popular trends when it comes to setting physician compensation for physicians in health system practices. Many health systems pay their physicians solely based on data from physician compensation survey data or on valuations prepared using such data. Sole use of survey data in setting physician compensation levels, however, can lead to practice losses. Health systems that fail to consider the full range of physician practice economic factors are at-risk for never-ending red ink from their physician enterprise.

    We should first note that practice losses resulting from survey usage is not the fault of the survey data. It’s a user problem! Survey data are designed to provide information in statistical format (also known as descriptive statistics) about respondents to the survey. As such, surveys are highly useful for general benchmarking, providing a range of data for comparison purposes relative to the survey cohort.

    The problem arises, however, in the ways survey data are used in physician compensation-setting for health system practices. Two broad approaches for using survey data are observed in today’s marketplace.

    In the simplest approach, a specific percentile for compensation is selected as the appropriate level to pay a physician. Typically, the median or 75th percentile is selected for total compensation or the compensation per wRVU ratio. In practice, these rates may be blanketly used for all physicians with no consideration of the facts and circumstances for the physician’s practice. Such blanket use of this or that percentile is usually supported by claims about market conditions, regulatory guidance, or appeals to common practice (e.g., “this is how everybody does it”).

    The second approach attempts to match compensation with a physician’s production, typically based on wRVUs. A highly common form of matching involves paying a physician at the total compensation percentile that corresponds with the physician’s benchmark level of wRVU production. For example, a physician whose wRVUs benchmark at the 65th percentile for wRVUs is paid at the 65th percentile for total compensation.

    Another form matches the compensation per wRVU ratio to the benchmark level of wRVUs. Under this variation, the physician’s whose wRVUs benchmark at the 75th percentile is paid at the 75th percentile compensation per wRVU ratio. Yet another form uses the median compensation ratio for the quartile of production level for the physician as the blanket rate for paying a physician.

    This second approach is based on the belief that production is the only critical driver of compensation levels in the marketplace. No other economic factors impact market compensation for physicians. So, if you can track or benchmark a physician’s wRVU production, you can predict the market compensation for that physician.

    This view, however, doesn’t square with the reality of the data. Below is a scatter-plot diagram taken from MGMA’s pay-to-production plotter report from the 2016 Provider Compensation report for non-invasive cardiology.

  • 23 Jan 2019 8:14 AM | Cathy Herring (Administrator)

    Date: January 23, 2019 

    For more than a decade, MGMA has hosted the Financial Conference. It’s a chance for practice leaders to get together to solve the financial issues their practices are facing.

    In this episode of the Industry Insights podcast, we focus on those most pressing financial issues and learn strategies on how to address and solve those problems. As part of the lineup, MGMA Sr. Editor Craig Wiberg discusses The Financial Conference. Also, we hear from industry experts including Steve Dickens, Sanjay Seth, and Jim Malloy.

    Additionally, Erica Betz, project analyst for MGMA stat discusses how good data can improve a medical practice and Jaci Johnson gives the 411 on CPT coding changes for 2019.

    To listen to the podcast, click here

  • 15 Jan 2019 9:51 AM | Cathy Herring (Administrator)

    Date: January 15, 2019 

    Succession planning is a critical aspect of healthcare management. For long-term practice success, there needs to be a good plan for senior leaders, both clinical and non-clinical, who will someday leave the practice.

    Succession planning takes time and effort from the administrator and the practice shareholders. Being proactive with succession planning will help ease the burden on the practice when leaders depart.

    At times, administrators may feel as though they are reactive to problems, but when looking at the strategic plan of the organization, they must be proactive in succession planning. There is a significant cost associated with hiring and training new staff members. The cost of recruiting and training a new employee is double the salary of the person being replaced.1 As the baby boomers near retirement, it is crucial for healthcare leaders to determine the next leaders within their respective organizations. Succession planning allows the administrator to have a plan when a key member leaves or retires.

    For more material access, click here

  • 16 Jul 2018 8:43 AM | Cathy Herring (Administrator)

    Date: July 16, 2018

    MGMA Connection Magazine will be undergoing a transformation beginning January 2019 aimed at better serving all audiences that comprise MGMA's membership. 

    To read more and submit an article, visit MGMA's Website.

  • 11 Jul 2018 8:35 AM | Cathy Herring (Administrator)

    Date: July 11, 2018

    Currently, physician practices participating in value-based arrangements with Medicare Advantage (MA) plans may be required to simultaneously comply with MIPS in order to avoid a penalty on their Medicare Part B reimbursement. In response to MGMA advocacy urging reduced provider burden and recognition of practice participation in innovative MA alternative payment models (APMs), CMS is developing a demonstration to exempt qualifying practices from MIPS. CMS is also considering counting participation in risk-bearing MA APMs toward the Advanced APM pathway under MACRA beginning in 2018. MGMA will submit feedback in response to CMS’ planned demonstration. 

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