Resources
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Pittsburgh, PA 15222
[p] 412.281.2501
[f] 412.471.1996
Philadelphia, PA
1515 Market Street
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Philadelphia, PA 19102
[p] 267.639.4706
[f] 267.639.4792
West Palm Beach, FL
440 Columbia Drive
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[p] 561.689.7888
[f] 561.689.0478
Fort Lauderdale, FL
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[p] 954.731.5555
[f] 954.731.9552
Healthcare Management Advisor
Winter 2012 l Fall 2011 l Summer 2011 l Spring 2011 l Winter 2011 l Fall 2010 l Summer 2010
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While many proposed delivery system reforms encourage care coordination among primary care physicians (PCPs), specialty physicians and hospitals, little attention has been paid to the continuity of care for patients treated in hospital emergency departments (EDs). This article notes that there are significant barriers to such coordination — but also a number of benefits. A section offers four specific strategies to help improve EDP-PCP coordination. 
Harvard Business School professors Robert Kaplan and Michael Porter have proposed a radical new approach to measuring and thereby controlling healthcare costs. It makes patients and their conditions — rather than organizational units or diagnostic treatments — the fundamental unit of analysis for measuring costs and outcomes. This article discusses the data required and how to calculate it; the processes involved in the methodology; and the resulting benefits. 
Because physicians are key clinical decision makers, it’s critical that they be involved in hospital quality initiatives (QI). Unfortunately, hospital efforts to engage physicians come at a time when physicians are facing reimbursement and time pressures. This article offers six strategies to improve QI efforts. 
The volume and complexity of legal restrictions on the operations of governing boards continue to grow, making it critical that hospital directors be aware of their responsibility for ensuring compliance with the law. This article lists three points that board members should focus on, and shows how members can help ensure they’re fulfilling their compliance duties. 
Investment in one sector of the hospital industry has been picking up: capital infusions by private equity firms into not-for-profit hospitals and hospital systems. The common goal of these transactions is to earn above-average profits for the equity investors while maintaining the charitable missions and long-term survivability of the hospitals. But this article examines whether these are contradictory aims, and whether private equity firms can provide relief to financially stressed hospitals. A section provides a list of some of the more active hospital-focused firms, along with the entities that make the investments. 
It used to be called “pay-for-performance.” Now CMS describes it as “value-based purchasing” (VBP). Beginning in fiscal year 2013, per-discharge payments from base operating diagnosis-related groups (DRGs) to participating hospitals will be reduced. Hospitals then will have an opportunity to earn back those payment reductions — and more — through CMS’s VBP program. This article explains how the program represents the new paradigm for payment to hospitals initially, and for nearly all health care providers eventually. A sidebar shows how to prepare for current and future VBP criteria. 
When HMOs were morphing into MCOs more than 20 years ago, there was a strong movement to accept onto provider panels only physicians who could practice cost-efficient medicine. Such “economic credentialing” provoked vigorous debate. Now, the enactment of the Patient Protection and Affordable Care Act (PPACA) has brought economic credentialing back to the forefront. The PPACA’s Medicare Shared Savings Program will offer incentives to enhance care quality, improve clinical outcomes and increase the value of services delivered through the development of Accountable Care Organizations. This article shows where the issues stand now. 
The capital financing environment for hospitals has become quite volatile and unpredictable. Hospitals and health systems have had to contend with limited capital access, fewer options, higher costs, more restrictive terms and less flexibility than in previous years. Volatility and unexpected events are expected to continue for the foreseeable future. This article offers 10 strategies that can help keep a hospital afloat. 
Within the U.S. health care system, there’s a spotlight on compensated relationships hospitals have with their physicians, as the federal government cracks down on health care fraud and abuse. To preempt the substantial damages awards and settlements that can result from improper hospital-physician contracting arrangements, hospitals should develop compliance procedures for establishing new compensated physician relationships. This article shows how to establish such procedures, while a section warns against forgetting to examine existing arrangements. 
The sheer number of legal obligations that apply to hospital operations grows annually. And the consequences of violating or not complying with those obligations can result in large damages awards or settlements, government-imposed compliance programs, and exclusion from Medicare participation. But this article shows ways to reduce risk. It looks at the importance of employee education programs and discusses especially high-risk areas for noncompliance. 
The American Recovery and Reinvestment Act of 2009 enables health care providers, physicians and hospitals to qualify for incentive payments when they adopt and demonstrate “meaningful use” of health care information technologies, particularly electronic health records (EHR). Beginning this year, hospitals can receive the first group of incentive payments by satisfying 19 requirements described in Stage One of the meaningful-use rule. This article shows how to get started. 
It’s estimated that a large percentage of hospital readmissions of elderly patients are “potentially preventable.” As a result, CMS has launched initiatives to reduce readmission rates and the associated costs. This article discusses increased CMS authority to cut payments to hospitals that have high readmission rates for a variety of conditions. It describes two broad approaches for reducing the rates and lists strategies that have helped several hospitals. 
Poor employee health habits can negatively affect employers’ bottom lines through high absenteeism, poor quality output, low productivity and skyrocketing insurance premiums. But hospitals are likely to be well positioned to help local businesses institute health management programs. Well-established hospitals offer employers credibility, a track record of accomplishment, diversity and flexibility of services, and certified expertise. This article shows how to get started, while a sidebar discusses how to help an employer build the foundation for a workplace health improvement program. 
There’s been a growing consensus in the medical community that teamwork is critical to patient care. This article describes the benefits, the training involved, and the qualities of the physicians who participate. However, this approach is so new to the health care industry that it requires outside input for its implementation. The article looks at the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) program and the three phases a hospital should observe in rolling it out. 
For two decades, there’s been a contentious debate between teaching hospitals and the Social Security Administration over whether residents should be treated as employees or students. If students are considered to be employees, both they and their hospital-employers must pay FICA taxes to cover Social Security and Medicare. Hospitals have relied on a FICA exemption to define residents working more than 40 hours a week as students, but a Supreme Court decision in January upheld a Treasury regulation making such residents ineligible for the exemption. As this article explains, hospitals must immediately begin paying payroll taxes for these residents. 
The health care industry is experiencing a convergence of three technology-based initiatives: 1) the transition from ICD-9 to ICD-10 in coding and adjudicating health care claims, 2) the introduction of the 5010 standard for electronic transactions between providers and payors, and 3) the HITECH incentive program for implementing certified “meaningful use” EHR systems. Deadlines for these initiatives are fast approaching, and many hospitals are already falling behind in preparing for them. This article describes the steps they need to take. 
Lean management is all about removing waste and improving workflow. Due to its success in other economic sectors, it’s being adopted rapidly in health care. This article shows how hospitals can use lean processes to distinguish value-adding process steps from non-value-adding steps, allowing them to cut out the wasteful steps. 
Although initially geared more toward individual use, social media is being used increasingly by a variety of businesses to gather information, communicate with stakeholders and facilitate collaboration among interested parties. These benefits are particularly appealing to health care organizations. This article shows why, and includes a section offering examples of leading hospitals that already have an established social media presence. 
After seven years of debate, the Joint Commission has made significant changes to medical staff standard MS.01.01.01. As a result, hospital governing body and medical staff may need to make appropriate adjustments to meet the March 31, 2011, compliance date. This article discusses the changes, which are concerned primarily with the provisions that must appear in the medical staff bylaws (rather than rules or policies). 
The way that a hospital manages its revenue cycle can mean the difference between a positive or negative bottom line. Some of the leading reasons for lost revenue are insurance denials and self-pay failures. Other causes include lost charges, delayed payments, underpayments and the costs of rework. This article lists seven measures a hospital can implement to improve its revenue cycle. 
The forces pushing hospitals and physicians to work together more closely are almost overwhelming. Decreasing reimbursements, increasing costs and growing administrative headaches are leading more physicians to actively seek affiliation with hospitals — from casual physician concerns with hospital strategy and operations to full commingling of interests and activities. There are a number of prominent strategies available, including three joint venture models. These offer tremendous benefits, but many business and legal questions need first be considered. 
Many factors have converged recently that place quality of care and patient safety at the top of the agenda for hospital governing boards. For example, the health care industry is dealing with the patient safety movement, pay-for-performance plans and stricter government regulations. But what should a board’s role be? The Institute for Healthcare Improvement has created more detailed recommendations for the minimum quality-related activities of governing boards of health care organizations. A section in this article discusses fiduciary duty and quality of care. 
True or not, over the last several years, a perception has developed that not-for-profit hospitals and health systems provide no more charity care than their for-profit counterparts. Such thinking has led to increased scrutiny of tax-exempt health care entities and whether they deserve that status. And the recently enacted health care reform along with an Illinois Supreme Court decision in March may make it harder to qualify for tax-exempt status. 
The Patient Protection and Affordable Care Act of 2010 will create reforms that indirectly influence every provider and payor entity in the health care system. This short article looks at three of the many ways that hospitals will be affected. 
If a death or serious disability results from a preventable medical error, the potential legal and financial consequences are huge. This article examines the recent history of attempts to identify and prevent “adverse events,” and lists five recommended responses to them. It also discusses the findings of an Office of Inspector General (OIG) study of this issue. 
Healthcare reform will significantly expand patient access, yet major problems remain with the U.S. health care system. Overall costs are unsustainable, and several health-outcome measures lag behind other industrialized countries. The Patient Protection and Affordable Care Act (PPACA) includes provisions to address these issues through aggressive promotion of accountable care organizations (ACOs). This article explains what an ACO does, and discusses three PPACA programs that directly affect ACOs. It also suggests how to form an ACO and offers special tips for hospitals. A section looks at legal impediments to forming an ACO. 
Many hospitals don’t have a complete understanding of the impact their facilities have on the environment, including the presence of toxins, the dollars spent on harmful products and processes, the health effects on patients and employees, the energy efficiency of hospital activities, and the volumes of waste that they disgorge. This article looks at some of the situations that may be present in a hospital and how to address them. These involve a hospital’s supply chains, waste disposal system, facility design and operations, and food service. A section lists three online sources that can help hospitals improve their “environmental health.” 
Nearly every hospital uses a group purchasing organization (GPO) for at least some of its purchasing needs. In the 1980s and 1990s, the industry consolidated into seven large GPOs to provide national group purchasing services. Now it looks like the industry is changing again as interest in regional and local GPOs grows. This brief article discusses hospitals’ increasingly assertive relationships with GPOs, and federal scrutiny among concerns about whether GPOs produce genuine purchasing savings for their members.