Staffing Model Innovation in the NICU

Like all healthcare organizations, children’s hospitals face mounting pressure to reduce costs. Hospital leaders face the challenge of hitting ambitious new financial targets without compromising the quality of care. This is an especially delicate balancing act in the neonatal intensive care unit (NICU), where many of their sickest and most vulnerable patients are located.

In their article Needing More From Your NICU, ECG consultants Shelby Jergens and Clark Bosslet urge NICU leaders to turn a critical eye to their unit processes. They identify three areas that present the greatest opportunity for impactful change—staffing models, compensation methodology, and care coordination—and offer actionable plans based on what they’ve seen work with their clients. Here, Shelby and Clark talk about the work they’ve done with pediatric organizations around staffing model innovation in particular. Continue reading

Pursuing Success in a Value-Based World

The Affordable Care Act has fended off multiple legal challenges. CMS has already implemented one mandatory bundled payment initiative and is eyeing more. MACRA looms on the horizon.

It’s an understatement to say the healthcare industry is in a period of dramatic change, and the continuing shift to value-based care will require radical thinking on the part of health system executives. But for those leaders willing to embrace change, the evolving landscape offers tremendous opportunity to remake their organizations and achieve new levels of success.

In this brief video, ECG Principal Jim Lord talks about the transition to value-based care and how forward-thinking health organizations can position themselves to thrive.

CMS’s Mandatory AMI Bundle Is Cause for Chest Pain

This week the Centers for Medicare & Medicaid Services (CMS) announced a new mandatory bundled payment program for cardiac care. The proposed 5-year demonstration would go into effect on July 1, 2017, in 98 to-be-identified markets. The model would make hospitals financially accountable for the cost and quality of care for acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) during inpatient stays and for 90 days following discharge. Continue reading

The Shift From Grouper to APC Reimbursement: Advice for ASCs and HOPDs

In 2008, when the Centers for Medicare & Medicaid Services (CMS) shifted its payment approach in the outpatient surgery industry from the nine-grouper methodology to APC-based reimbursement, many assumed that commercial payors would follow suit. But the majority of insurers continued to base reimbursement to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs) on grouper-based methodologies. Their models remained enhanced or modified versions of the historical CMS ASC model, with a few differences such as mapping of CPT codes and additional groupers. The resistance to adopting an APC-based model was largely due to the high system and operational costs associated with making the switch. Continue reading

CMS’s Proposed OPPS Rules Generate Confusion and Anxiety

CMS’s new proposed rules related to the Bipartisan Budget Act of 2015 would severely inhibit hospitals’ ability to expand and modify outpatient service offerings around the country. Issued on July 6, the regulations have yet to be finalized and comments are being requested; however, hospital planning executives are understandably fuming about the restrictive and complicated rules, which would compromise their ability to conduct provider-based billing at outpatient sites located more than 250 yards beyond the hospital walls. Of particular interest is the direct comment by CMS that Section 603 was designed to curb hospital acquisition of physician practices and the current practice of providing the same services under a higher-cost model of OPPS. Continue reading