Healthcare Issues & Trends

Advice & Insights for healthcare's Leaders & HR Professionals


Leading Living: Presenting at 2014 Iowa Hospital Association's Annual Meeting

Posted on October 13, 2014 by Bill Jessee

On October 7, I attended the annual meeting of the Iowa Hospital Association in Des Moines, Iowa, and made two presentations as part of their Physician Alignment track at the meeting. The attendance was a surprise to me--about 1,500 total registrants, and 275 or so for each of my two sessions.

The first session was titled "Where Is Health Care Going? And How Will We get There?” It focused on the rapid pace of change in the delivery system, in particular the transition from volume-driven to value-driven payments for health services. After overviewing some of the major drivers of changes we are seeing (rising costs, spotty quality, etc.), we explored the industry’s response to those forces. Among the major trends were consolidation of both insurers and providers, blurring lines between the two, the huge transition in physician practices from free-standing entities to parts of hospitals and health systems, and the universal demands for increased accountability for safety, quality, efficiency, and satisfaction. 

While the first session was very content focused, the second titled, "Navigating Troubled Waters: Leading the Process of Change," was aimed much more at the critical role of leaders in driving the process of change, and the skills needed for effective healthcare leadership. We explored the personal characteristics of effective leaders, with “trust” being a theme that repeatedly surfaced. Strategies for building trust were explored, as were actions that diminish trust. Several specific leadership tools were also explored to help the attendees maximize their leadership skills. 

Both sessions were well-received. Click here to download handouts from other presentations at the three-day meeting.

Benchmarking Without Benchmarks?

Posted on July 28, 2014 by Brad Lenertz

“We are unique, so finding a benchmark for us is impossible!” If you’ve heard this once, you probably have heard it a thousand times! Even worse, if you’ve said this once, it was probably one too many times!

In the healthcare industry, the concept of individualized patient care is natural. But that doesn’t mean we don’t do diagnostic tests and compare the results to what is considered “normal” ranges for similar patients? Healthcare providers benchmark patient care all of the time – yet still create an individualized care plan for each patient’s specific needs. Why would we approach the health of the practice any differently?

It isn’t uncommon that we encounter a client program where benchmark data truly doesn’t exist. In these cases we don’t stop trying to help the client improve. After all, we know what “better” looks like without a benchmark. So, driving improvements in the absence of benchmark data, starts with an assessment of the “current state” of the program with common metrics. The next step is to envision what the “future state” will look like, quantified in terms of those metrics and allowing for the gaps to be identified. Then, through rapid cycle improvements targeted at those gaps, we make changes and re-measure to determine impact.

The concept isn’t new. It is the scientific method, the same methodology that drives medical advancements.

We have often seen a practice with performance that benchmarks well ahead of its peers, sustain a false sense of accomplishment, resulting in performance below potential. Conversely, we have seen practices with performance well below benchmark, lose enthusiasm for improvement because they see how far they are behind, how far they have to go. So even when benchmark data is available, measuring impact of change relative to previous performance will never lead you astray in your quest for optimizing your practice’s potential.

Benchmarking with out benchmarks? Sure! You should do it all the time!

Work RVU Production below the 25th Percentile – Work Harder!?

Posted on June 30, 2014 by Brad Lenertz

The internal medicine department of a hospital-owned multi-specialty group was due to have their contracts renewed. In keeping with their corporate physician compensation plan, the Physician Practice Executive Council commissioned a Fair Market Value analysis, which included a review of historical compensation and production. As a group, the five internists’ compensation and production levels hover at the median, per FTE. However, individual review shows there to be a significant deviation among the providers. At the low end, Dr. Lowe’s compensation and production levels fell below the 25th percentile.

An E&M coding analysis for Dr. Lowe led to the discovery that her coding practices varied greatly from the national coding practices of her peers. Theoretically, Dr. Lowe would not have to increase patient volumes in order to be more productive. If her work effort is documented to support the coding pattern of her peers, by accurately coding her work she would experience a 57% increase in productivity!

The same analysis was completed for the other internists. Only one of the physicians was found to have a coding pattern that resembled that of the national benchmark. The other three also showed potential for increased productivity between 18%-23%. For this small group of five internists, the total revenue opportunity that was identified exceeded $250,000.

The total Work RVU Production of a provider or group of providers is an indicator of their operational effectiveness. Groups of providers averaged together may hide the lower performance of individual providers, so it is important to fully understand the data on an individual provider basis. When normalized for a 1.0 FTE effort, individual providers whose performance is below the 25th percentile should have a clear understanding of what is impacting this performance. A review of the provider’s E&M Coding pattern as compared to CMS benchmark data may reveal helpful insight.

If your practice struggles with physician productivity below the 25th percentile, the answer may not be to get them to work HARDER, they may need to work SMARTER. INTEGRATED Healthcare Strategies not only has the expertise to help identify if working SMARTER is the right strategy, we offer solutions to help build systems and processes that educate and support them working smarter.

You've Noticed a Downward Trend in Work RVU Production- Now What?

Posted on May 23, 2014 by Gallagher Integrated

Dr. Bob, Internal Medicine Department Chair, joined his Practice Council’s Strategic Planning Meeting just as the practice administrator, Mike McMager, provided a recap of the follow-up required to keep the practice on an aggressive planning schedule. Mike concluded the meeting with a round-table call for any other business. Dr. Bob quickly announced, “I’m concerned that our staff have fallen behind with charges again. My quarterly production report shows a decline and neither my nurse, Lisa, or I can explain why this would be. Our schedule hasn’t changed and we certainly haven’t been seeing fewer patients. The only explanation is that our staff is behind. After all, this isn’t the first time this has been a problem and we can’t afford to delay claims!”

The room begins to buzz with chatter from the other physicians. Not all of them have experienced the same downward trend, but they all seem to be in agreement that their production is lower than expected and are convinced that the staff has fallen behind. They demand answers and action, without sacrificing the important progress they need with their planning schedule.

After a lengthy review of the charge entry staff, assessing their outstanding work, Mike determined this was not the cause; all of the charge entry work was current. He considered several other causes, unable to identify the root cause of the decline.

With great pressure from the physicians to identify the cause but stay on track with the planning schedule, Mike engaged INTEGRATED Healthcare Strategies’ Physician Practice Operations team to identify the cause. INTEGRATED consultants were swift to schedule a focused practice assessment that included an on-site review. Mike’s team provided INTEGRATED with a detailed download of all charge data for the previous 36 months. The consulting and data analyst team was able to identify a subset of CPT codes that were being billed inconsistently.

INTEGRATED consultants had also identified, during their on-site interviews, a staffing change in the business office that occurred six months previously. The inconsistent billing data corresponded with the timing of the staffing change. They discovered that the training plan for the new hire did not include a critical process flow for what the practice defined as “add-on” procedures. The new staff person did not know when and where these procedure charges were routed, and thus the charges went unbilled.

INTEGRATED was able to identify and recommend the resubmission of claims data for the previous six months. The recaptured revenue from this component alone, was three times the cost of the practice assessment conducted by INTEGRATED. Several other revenue enhancements and cost reduction opportunities were also identified by INTEGRATED’s assessment. And, Mike McMager was able to focus his energies on the strategic planning follow-up, keeping the planning cycle on schedule.

If you notice a downward trend in production without a change in provider FTE, you need to understand what is impacting this production.

At INTEGRATED Healthcare Strategies, we have a team dedicated to Physician Practice Operations. Our entire focus is on measuring, benchmarking and improving operational performance. We can help your practice identify the root cause of a downward production trend.

Leading Successful Health System Integration

Posted on June 4, 2013 by Gallagher Integrated

Authored by Debbie Weber, as appeared in the Summer 2013 issue of HR Pulse, a publication of ASHHRA


We’ve all recently read a lot about hospital mergers and acquisitions, and the integration of medical group practices into health systems. Much of that has focused on physician engagement, economies and efficiencies of operational centralization, and creating the new enterprise-wide culture.

But few resources are available to health care human resource (HR) leaders regarding the unique business and cultural differences between the HR needs of an acute care hospital and those of a medical group practice. HR leaders who are keenly aware of these differences are heavily involved in the redesign and restructuring of their HR departments to create an infrastructure that supports their organization’s new and rapidly expanding business model.

While medical group practices certainly share a similar genetic makeup with other health care business lines, there are subtle and not so subtle differences HR leaders need to clearly understand.  View full article

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