A recent study showed that for the 10th year in a row, financial challenges are #1 on hospital CEO's list of concerns. More than healthcare reform, government mandates, and patient safety, the constant battle to be financially stable is the what keeps the healthcare C-suite up at night. So what factors are contributing the the financial worries? Let's take a look.
When we look at healthcare payment reform, and our move away from fee-for-service models of payment, the focal alternative this year has been bundled payments. In this scenario, physicians are paid a set amount for treating a certain type of patient, and assumptions are made by the payer about what services or treatments a patient like that would need. They compensate according to that average. Under the fee-for-service model, when they were paid for whatever tests they ordered or treatments they rendered, they certainly had more freedom of choice.
Whether or not it’s our collective focus, we would be remiss to ignore the fact that when it comes to the financial bottom line, healthcare is a business. In other industries there are financial benchmarks, or key performance indicators, that help businesses stay on the right track. All businesses should make use of some type of financial performance measures, from the companies dominating their industry and pulling in billions of dollars to the kid on your street selling lemonade. Understanding your organization’s profitability, debt and economic patterns of performance is key to ensuring that you can sustain that performance - and see revenue increase- for years to come.
If you need a quick refresher, Value-Based Purchasing is the incentive program that came along with the Affordable Care Act, which is hoping to help providers adjust to the move from fee-for-service models of pay to pay that is linked to quality rather than quantity of services. Under the VBP model providers and the organizations that they work for will be either docked Medicare payments for poor outcomes or awarded bonuses for striking a balance between high quality care and low cost. The hope is that VBP will inspire providers to become not just thriftier, but more innovative when it comes to providing care.
2014 was another year big year for healthcare. As we continue to move toward a more patient-centered and transparent healthcare system, so too continue the changes to our payment models, insurance coverage and commitment to patient outcome measures. While there were many changes to keep track of, three things seem to have defined the progress made in the scope of revenue cycle improvement.
Managed care has been around for almost one hundred years, at least in theory. When placed up against fee-for-service payment models, however, it was a hard sell. Traditionally, the way that physicians were compensated for their services was a fairly straight-forward invoicing process: they would bill the patient (or later, the payer) for everything they did in terms of diagnosing or treating the patient. Everything.
As 2014 draws to a close, many of us in the healthcare industry are looking back at the year we’ve had and reflect on what worked, what needs to change and what we can expect for 2015. As an industry, healthcare saw a continued move towards accountable care, shared decision making, value-based purchasing and patient satisfaction measures. Buzzwords abound, there was a lot for everyone - providers, patients and payers - to juggle this year. And it looks like the trend is apt to continue into 2015.
We hear a lot about bi-partisanship in politics - but what about healthcare? Sometimes it seems like the payers and the providers, the administrative and the clinical, are across the aisle from one another in more ways than one, and it brings to mind the challenges faced by politicians who just can’t see from the other side’s perspective. While politics shoulders many competing agendas, when it comes to healthcare the bottom line is the same no matter where you are: good health for the best price. This is even true of the patient’s themselves, who are becoming more and more concerned with the cost of the services they receive - and using the internet to find out if there’s a better “bargain” on care somewhere else.
You might be thinking - “Just five challenges?!” and it’s true that the healthcare industry is facing many challenges at the moment. Five of them, however, are most specific to hospitals. We often think of hospitals as the “front lines” of healthcare, and while it may be true that the majority of practicing physicians, nurses and allied health professionals find employment there, new data shows that one vital piece of the hospital picture might be missing: patients.
There are few aspects of healthcare that are more controversial, confounding and frustrating than payment reform. It’s hard to imagine that there was ever a time when patients just paid the doctor for their services. Since that payment method created economic disparities in access among the rich and the poor, several reforms later we find ourselves somewhat on the opposite end of the spectrum: more patients than ever can have access to care, but the process for compensating physicians hasn’t been able to keep up. Doctors are rendering services without receiving payment - and their practices can’t sustain on that type of arrangement!