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.
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.
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.
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.
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.”
March 11, 2019
Series: Examining Losses in Health System Physician Practices
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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