It's easy for hospitals and healthcare organizations to get bogged down by the enormity of everything that has to be accomplished this year, or to develop tunnel vision by focusing on one idea at the expense of many others.
And while only healthcare leaders can prioritize the needs of their respective organizations, there are six key priorities that can help hospitals and healthcare organizations achieve an advantage in 2016:
1. Value-based care initiatives.
Go from discussion to doing. Regardless of how you do it, this is the year to go from thinking about value-based care to making it happen. But it's such a big topic that it demands significant changes in perspective and implementation of multiple initiatives. Where should you begin? If you have a significant Medicare patient population, look closely at chronic care management and transitional care management services. These services can support your efforts to improve patient care, quality, outcomes and revenues. And, with the right resources, you can deliver them with little impact to your existing workload.
2. Patient Access
Make it easier. HCAHPS scores measure general patient satisfaction, but they won't show which specific improvements will make a difference. For instance, how simple (or difficult) is it for patients to make appointments, get directions, referrals, and financial obligation information—or reach a live person? These activities are essential to patient satisfaction. The right patient access solution – including both people and technology – can optimize processes and improve efficiency. Other industries have long used these solutions to improve loyalty, retention and perceptions of value. Healthcare can, and should, do so, too.
3. Coding
Dominate denials management. With ICD-10 coding firmly in place, the industry is experiencing some troubling payment trends:
• Payer system "glitches" from unspecified codes and other non-standard submissions
• Increases in medical necessity denials
• Slower payments
• Underpayments
The solution is to review, monitor and track each claim, identifying disconnects and bringing errors to the payers' attention. Denials management isn't glamorous work, but it must be done every day to identify all errors and also to address and remedy them in a timely manner.
4. Charge Capture
Stay dedicated to clinical documentation.
The best technological systems in the world won't ensure optimal revenues if the right information doesn't go in. Make sure physicians and staff truly understand how specific codes in multiple combinations can yield accurate charge captures — or serious errors. Again, coding and compliance is not glamorous work; clinical documentation improvements don't always generate immediate, dramatic revenue improvements. However, it is absolutely essential, both to achieve optimal revenues and compliance.
5. Patient Self-Pay Collections
Raise your communications standards. With more people than ever participating in high-deductible health plans, patient self-pay will be on the rise. But that need not yield a future of lower collections and higher bad debt. The secret to success is more and better communications. Yes, you must advise patients of their responsibilities, request payment at point-of-service and pursue collections. You also must be clear without being cold, friendly while still being firm and flexible while still managing revenue objectives.
6. Analytics
Scrutinize everything. If you aren't already using analytics, you should be. Analytics offer insights into every area of your health system or hospital, informing decisions and guiding initiatives — when considered in the right context. It's tempting (and misleading) to skew results according to stated expectations.
So, this year, eliminate bias by scrutinizing your data and approach. Remember that correlation isn't causation, and examine everything inside and outside of your organization that might affect data trends. Ask, "How can we continue to improve?" rather than, "Are we achieving what we want?"
Then, you can turn your data into meaningful, sustainable results.
Each of these focus areas could be handled in-house with well-trained people to implement them, technology to support them, and creative approaches to make them effective for your patients and business alike. However, an experienced partner can often provide the bandwith, capabilities and advice you need to overcome obstacles and achieve results when in-house resources are stretched to their limits and cannot take your organization where it needs to go this year.
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Pat Leonard is president of McKesson Business Performance Services in Alpharetta, Georgia. He can be reached at performanceinfo@mckesson.com.
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