Where your heart program is leaving big money on the table, and how to get it

Thursday, January 12, 2017 | Larry Sobal

 

After my blog last week, 11 Opportunities to Improve Your Heart Program In 2017, I received a lot of inquiries about how much money heart programs are leaving on the table. So I thought this week I would focus on five specific areas where there are often significant financial opportunities. In addition to pointing out the opportunities, I am providing you with the names and contact information for the MedAxiom consultants who can help you in each area.

Cath Lab Optimization

MedAxiom has engaged the collective efforts of members, our data team and industry partners to understand the changing cath lab landscape. The output has been to create a solution we characterize as the "cath lab care pathway." The pathway is defined by best practices that lead with quality while reducing costs and enhancing revenue. Whether you were selected for the AMI bundle or not, the financial benefits related to cath lab optimization occur in multiple ways:

• Increased patient access and throughput through redesigned scheduling templates/capacity model
• Reduced costs by increasing same day discharges to keep outpatients out of your inpatient space
• Redesigned staff roles and responsibilities
• Leveraged office and hospital staff and technology efforts
• Reengineered processes void of waste and reduced departmental expenses

What does this mean for your invasive program? Our optimization projects have yielded direct financial benefits ranging from $750,000 to $2.4 million. Contact Anne Beekman if you have questions or need some help here.

CHF Center of Excellence

Under the Hospital Readmissions Reduction Program (HRRP), CMS will be withholding up to 3% of regular reimbursements for over 2,500 hospitals in 2017 if they have a higher than expected number of readmissions within 30 days of discharge for six conditions, including heart failure.

In our work to guide programs to create a systemic CHF Center of Excellence, the financial benefits related to CHF improvement include:

• Elimination/reduction of readmission penalties associated with CHF
• Variable cost avoidance/reduction for Medicare CHF inpatients, including reduced length of stay
• Readmission reductions, usually 20-40%
• Volume related revenue growth through referral channel management

Remember, it’s not just the Medicare population you need to focus on. Many of your commercial contracts are designed so that better coordination and management of CHF also reaps positive financial impact. What does that mean for a heart program?  In some cases, the collective impact has exceeded $1 million annually. Contact Ginger Biesbrock to find out how.

Revenue Cycle Optimization

Ten years ago (i.e. the old days), most cardiology groups were independent, still using paper medical records, with certified professional coders right down the hall, and the process of documenting, coding, billing and collecting was much simpler.

Today you’d be unique if you could tell me your charge lag time, total days in A/R, net collection ratio, or your denial rate. Not knowing, and not having a finger on the pulse of your revenue cycle processes, is akin to burning money. Do any of these apply to you:

• Your documentation and code selection for office visits do not accurately reflect the level of service provided.
• You are not capturing all the possible reimbursement from cath and EP lab procedures, both on the professional and technical side.
• You’re still doing work without adequate pre-authorization and not getting paid.
• You’re still collecting inpatient charges on pieces of paper that your physicians (hopefully) turn in.

I know, the concept of improved documentation resulting in higher reimbursement just never seems to make it to the top of your (or anyone else’s) strategic priority list. Why change? We often find uncaptured revenue in multiple millions of dollars. Not getting paid for the work you are already doing is the most painful cost of all. Contact Nicole Knight if you need some help here.

Not getting paid for the work you are already doing is the most painful cost of all.

Access and Clinic Throughput Optimization

The top performing MedAxiom members routinely see 25+ patients per physician per day, have same day access for urgent patients, and get new non-urgent patients into the office the same week. Imagine taking your ambulatory clinic to that level of performance. The financial benefits related to access and clinic optimization occur include:

• 20-30% increase in office visits. This increases new patient access and works down the backlog of the hundreds/thousands of follow-up patients who are waiting to be scheduled.
• Patients seen in the office, especially new patients, generate (appropriately) lots of downstream services including diagnostic testing, labs, procedures, etc.
• A poorly functioning clinic has many abstract costs, such as higher employee turnover, harder recruiting, emotional stress, etc. This dysfunction is eating dollars.

So what is the bottom line? Depending on the size of your program, the amount can be substantial—in some cases representing millions of dollars. Contact Denise Brown to learn more.

Advanced Practice Provider (APP) Optimization

We see quite a bit of variation in how APPs are utilized. It is not uncommon to find an APP program has a negative entry on a delivery system’s finance ledger. This scenario is unfortunate and unnecessary, and we have examples where APPs represent a very sound investment, with charges 2.5 to 4 times their salary and collection rates of up to 57%. The financial benefits related to APP optimization occur in multiple ways:

• Programs utilizing APPs at the top of their license, where the majority of their work is reimbursable through expanded use of APPs in clinic and improved efficiency of APPs in the hospital
• Programs billing under the APP NPI number
• Using APPs (instead of physicians) for work such as early discharge facilitation, assurance of core measure fulfillment and appropriate documentation to capture acuity

What does this mean for a heart program?  We have seen programs create over $2 million in new revenue. Contact Ginger Biesbrock — she can help.

If you would like to meet these MedAxiom experts in person, or learn how to optimize your MACRA bonuses and other ways to improve your heart program, come to the MedAxiom CV Transforum Spring’17 conference. Details on the CV Transforum, being held April 18-20, can be found here:  http://cvtransforum.com.

The registration price increases on January 24^th, so register soon to avoid that extra cost.

 

 

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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