Revenue Cycle Management
Experts say that cash-only practices are a workable business model when done the right way, but it may be disruptive to others in the market.
Many small, rural hospitals have struggled financially in recent years. But one critical access facility in Nebraska has discovered a means to financial stability and beyond.
A quarter of the nation's hospitals, those with the worst rates of hospital-acquired conditions, will lose 1 percent of every Medicare payment for a year starting in October. The sanctions, estimated to total $330 million over a year, kick in at a time when most infections measured in hospitals are on the decline, but still too common.
While the revenue cycle management system has been focused on clinicals, chief financial officers are saying their hospitals' financial infrastructure needs are more important.
How do hospitals survive if they keep patients healthy and at home? For New Hampshire’s New London Hospital, the answer is to partner with the largest hospital in the state to keep costs low and possibly boost patient volume.
As health systems and hospitals straddle the two worlds of volume and value, it's tough to know what to do about upgrading revenue cycle management systems. Upgrade? Or get by on what's already there?
Simply put, most current revenue cycle management systems are not well positioned for a future in which healthcare is rewarded for quality not for volume -- but change is coming.
"Clinical integration" and "organizing for value" are two key themes at the HFMA 2014 ANI conference. Both are crucial in preparation for the transition from a fee-for-service reimbursement system. Here's an example of how one health system is preparing, by teaming with a health plan on a new care management venture.
Of the states that built their own health insurance exchanges that are now operational, Washington, Kentucky and Minnesota enjoyed some successes that might be replicated.
Medicare's ACOs have had mixed early outcomes, but some commercial accountable care ventures, including PPO plans, are showing promise.