11 Opportunities to Improve Your Heart Program In 2017

Thursday, January 5, 2017 | Larry Sobal

 

Yes, 2017 is shaping up to be a very interesting year for health care, and cardiovascular programs are right in the mix. As I’ve blogged about in recent weeks, uncertainty around the new President and his administration add a level of intrigue that we have not been seen in some time. I continue to stress that this uncertainty does not mean you should take a “wait and see” approach. My experience in traveling to heart programs across the country shows there are many opportunities for improvement right now; I want to help you focus on what’s most important for you.

Hope is not a plan.

With that in mind, here is my Top 11 list for 2017. (Most people come out with their Top Ten lists this time of year—I wanted to be a little different.) My list is not presented in a particular order of importance as I believe each item warrants your consideration. Also, these suggestions apply to heart programs as well as individual cardiology and/or cardiothoracic surgery practices, which may be independent or embedded into a Cardiovascular Service Line (CVSL) through some form of contractual alignment or employment.

1. Strategy – I have found almost all organizations are challenged with too many competing priorities. There will always be more good ideas than there is the capacity to execute. It boils down to the reality that in order to achieve something you have never achieved before, you must do things you have never done before (like actually prioritize and say “no” to some things). That requires a combination of disciplined focus, behavioral change and utilizing different leadership, strategic planning and plan execution approaches.
   
   
2. Financial – Margins are getting squeezed in almost every organization, and 2017 is the year to put yourself in a position for sustainable financial success. The easiest way to do this is to conduct a thorough assessment of your Revenue Cycle and make sure you are getting paid accurately and appropriately for the work you are already doing. There are many programs leaving hundreds of thousands of dollars on the table because of poor documentation, charge capture (ex: inpatient consults), coding and billing processes.
   
   
3. Compensation – I’m always surprised when organizations tell me “our market hasn’t shifted to any at-risk reimbursement yet, so we want to keep our physicians focused 100% on wRVUs.” When I probe further, they point out tens/hundreds of millions of dollars of charity care, self-funded health insurance coverage and inpatient fixed DRG payments that are essentially “at risk” reimbursement. Whether or not you are in one of the new CMS-announced, Episodic Payment Models or not, it’s likely your physician compensation plan could be improved to more closely align to organizational realities.
   
   
4. Legislation – MACRA has started, cardiac bundles are here, Appropriate Use mandates are around the corner, and there are myriad other legislative initiatives underway that will impact you, or will be changed by the new administration. If you can’t keep up with these on your own, I strongly suggest you join the Cardiology Advocacy Alliance to stay informed!  www.cardiologycaa.com
   
   
5. Workforce Planning – Does any of the following keep you up at night? Aging physicians, underutilized Advanced Practitioners, difficulty in recruiting, or a growing apprehension that the clinical workforce you will need in five years, and where you will need them, is different from what you have today. Then you need to formal workforce plan!
   
   
6. Access – Aside from heroic “shoe-horning” in patients, or just plain begging, can you consistently get new patients into your schedule this week? Are your return visits backlogged so that annual visits become 14-month appointments? Has your daily clinic volume declined since you adopted your EMR? Now is the time to reengineer your scheduling policies, practices, and clinic work flows, and set some minimum patient volume standards. If you have not investigated the multiple benefits of using scribes, you may be missing a huge win-win-win-win for your access and physician, staff and patient satisfaction.
   
   
7. Clinical Improvement – If the last substantive clinical improvement you can point to is reducing your STEMI times, I guarantee that somewhere in your market is a competitor who has developed a real competency for driving clinical change, reducing unnecessary variation and is leaving you in the dust on cost and quality. CMS and commercial payers are already rewarding winners and penalizing losers. Get better or get left behind. Pick a patient population (CHF, AMI, CABG or A-Fib) and develop a clinical pathway or guideline that fits your community approach to care.
   
   
8. Think “Systemically” – Whether you are a practice where all 15 physicians do things differently or a regional system with 15 locations, 2017 might be the year where “best practice” moves from fantasy to reality. Hidden (or obvious) variation is a barrier to scientifically (and systematically) finding your ideal state of performance. Once you have relatively stable performance, you can then apply improvement methodologies and reliable measurement to gauge what really works.
   
   
9. Think “Episodically” – Heart disease and heart disease patients, touch many parts of the continuum of care, not just in your CV practice or hospital CV program. Understanding the current state of your episodes of care will help you identify where: care hand-offs break down, costs are out of line, and outcomes suffer. You should not wait to be paid in a bundle to motivate you to understand your CV population and the data that lead you to cost or quality improvement opportunities.
   
   
10. Multidisciplinary Connectivity – Heart disease is a team sport. Are you engaging cardiologists, primary care physicians, hospitalists, ER, CV Surgeons, Vascular surgeons, post-acute providers and others to collectively discuss what is working well and what isn’t? You’ll find that these collective perspectives open up a number of ways to break down some traditional barriers and drive improvements.
    
    
11. Leadership Development – Successfully navigating through the uncertain and rapidly changing health care landscape will require strong leadership. What are you doing to foster and leverage the dyad leadership for physicians and administration to work more effectively together? Where and who are your future leaders, and are you investing in their development now so they are ready to step in when needed? 

In addition to Top Ten lists, this time of year brings a lot of advice and well wishes. Here’s mine: Hope is not a plan. Want to have a Happy New Year? Make sure your heart program is better at something by the end of the year than it was at the beginning.

 

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

 

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