In a Nov. 14 session at the Becker's Hospital Review 6th Annual CEO + CFO Roundtable, Nov. 13 to Nov. 15 in Chicago, a panel of healthcare finance leaders gathered to discuss the changing reimbursement landscape as well as ways to thrive in it.
The panel included:
• John Kurvink, vice president of corporate affairs and CFO, Brant Community Healthcare System in Ontario, Canada
• Jill Batty, senior vice president and CFO, Cambridge (Mass.) Health Alliance
• Robert Mittendorff, MD, partner, Northwest Venture Partners in Palo Alto, Calif., and San Francisco
Gretchen Townsend, partner at Chicago-based McGuireWoods, moderated the panel.
Dr. Mittendorff noted high-deductible health plans are a major trend in the reimbursement landscape, which is changing the payer mix at healthcare organizations.
"High-deductible health plans are leading to rise of the new payer, the consumer. When I hear a CFO speak about the large payers, it is usually in terms of not really understanding where they are going. There is more confusion now than a year and a half ago and CFOs are grappling how to set their payer mix," said Dr. Mittendorff.
Ms. Batty noted that engaging physicians is key in the evolving reimbursement arena.
"We have a clinical staff that is 100 percent employed, but that doesn't mean we don't have to engage them," she said. "Our primary focus is trying to create an environment where the payment line is consistent. This is a lot trickier than it sounds, getting all the payers to agree to the contract [and] quality metrics. It needs to make sense and needs to be as consistent as possible. This is challenging in a multipayer environment. We are asking also asking our practices to focus on inreach so that when the patients arrive, we can really reliably perform the services we said we can perform. We are trying to smooth that [payment line] for our providers, otherwise the burnout rate is [exacerbated]."
Mr. Kurvink weighed in with regard to the importance of engaging patients, particularly in a single-payer system.
"Our patients that come through the door don't have a co-payment," he said. "Employers bear the burden and if the patient is not employed, the government pays. So we are focused on trying to identify the high users of the system and wrap community services over them so they don't overuse our services, such as the emergency room. We are trying to make sure the service [that is needed] is out there in the community and trying to triage patients so they don’t take up an acute care bed."
The panelists also said that they see changes as well as opportunities ahead for health systems in the reimbursement landscape.
"You're going to see more risk-taking and management of risk via bundled payment and value-based care programs," said Dr. Mittendorff. "Also, more cost will be shifted to the consumer and there will be more clearly defined care pathways... I am sympathetic to U.S. healthcare providers. My advice for them is to experiment, fail fast. There is a lot of innovation out there, whether its payment analytics or care management."
"Data analytics is really important and automation is exciting," said Mr. Kurvink. "We spend so much time collecting data. If we could have a single source of truth and have it be automated, we could spend more time analyzing it and using it… We spend a lot of time getting data, but not looking at it."'