Revenue Cycle – A Path to Integration

Managing a revenue cycle has never been the most glamorous component of running a healthcare organization. Preregistering patients, collecting co-payments, submitting claims, and ultimately obtaining reimbursement for services is a costly and cumbersome process. It’s also an essential one, since this is how healthcare providers are paid for the work they do.

Revenue cycle management takes on added layers of difficulty – and importance – in a healthcare landscape characterized by increasing alignment between hospitals and physicians. As the industry responds to shrinking reimbursement and the pressure to operate in a value-based care environment, more and more physician groups are turning to hospital employment or affiliation as a means of ensuring financial stability. As a result, leaders are waking up to discover that their hospitals have become health systems seemingly overnight. Continue reading

CMS Targets New Payment Model for Oncology

On February 12, 2015, the CMS Innovation Center released details for a new payment and care delivery model designed to improve coordination for cancer care. The Oncology Care Model (OCM) is aimed at physician practices that administer chemotherapy and bill for services under the Medicare Physician Fee Schedule. Continue reading

HHS Promises Big Changes – And Raises More Questions

This post was written by Jim Donohue, Senior Manager, and Richard Trembowicz, Senior Manager.

Recently the U.S. Department of Health & Human Services (HHS) outlined ambitious goals to significantly increase the percentage of Medicare payments that are tied to quality and cost effectiveness over the next several years. The proposal, announced by HHS Secretary Sylvia M. Burwell at a press conference on January 26, 2015, would move Medicare away from the fee-for-service (FFS) system, calling for 30% of Medicare payments to be tied to quality-based alternative payment arrangements by the end of 2016 and 50% by the end of 2018. Continue reading

Collaboration in Pediatric Healthcare: Hospital and Health System Affiliation

The prospect of health reform once loomed like storm clouds on the horizon – dark, mammoth, and all but inevitable. Regardless, industry leaders uncertain about the scale of the impact sensed the changing climate and began preparing.  As a result, between 2009 and 2012, mergers and acquisitions doubled1 as hospital and health system leaders sought to offset challenges such as access to capital, low margins, and increased competition. It’s a trend that’s expected to continue as the ACA nears full implementation and reform mandates take hold, pushing the industry toward an environment based on population health management (PHM). Just this week, the U.S. Department of Health & Human Services announced plans to tie 30% of fee-for-service Medicare payments to care quality, through models such as accountable care organizations or bundled payment programs, by the end of 2016. Continue reading

Collaboration in Pediatric Healthcare: Aligning Children’s Hospitals and Physicians

Healthcare reform has triggered waves of change across the U.S. healthcare market, forcing systems and providers to reevaluate how, when, where, and whom they partner with to deliver care. Responding to these changes is particularly challenging for children’s hospitals and pediatric physicians.

Given their unique position in the healthcare system and lingering uncertainties about the impact of healthcare reform, successful pediatric organizations are taking steps to align with strategic partners to ensure that their mission of serving the nation’s child and adolescent population is sustained.

This post is the first in a four-part series that explores ways in which children’s hospitals are forming collaborative partnerships with physicians, health systems, academic affiliates, and research partners to thrive in a value-based healthcare environment. We begin by looking at strategic alignment between children’s hospitals and physicians. Continue reading