COVID-19 is a tsunami for hospitals—the waters pulling back as beds are emptied, then an overwhelming and uncontrollable surge wave. Like an actual tsunami, this one may have multiple surges. But even with several waves, an actual tsunami is over quickly and recovery returns you to a former baseline. With COVID, it is likely that […]
The Blanket Waivers that CMS issued on sanctions under the physician self-referral law (Stark) do not halt application of the law during this emergency time period. Instead, they waive sanctions for certain circumstances that would otherwise violate the self-referral law. The 18 individual waivers address a variety of financial arrangements between physicians and designated health […]
Covid-19: A prediction challenge like no other Covid-19 will challenge hospital leaders in many ways. But no one expected that a key challenge would be in a basic skill every hospital administrator mastered early in their career – estimating volume. Hospital leaders are accustomed to estimating volume. They do it all the time – for […]
Ambulatory care has grown dramatically in recent years, and all signs point to continued growth. In 2017 (the most recent year for which data is available), net outpatient service revenue equaled 95% of net inpatient revenue, an increase from 83% in 2013.[1] Clearly every hospital and health system must have an effective ambulatory care strategy. […]
What is the Primary Care First Program (PCF)? PCF is a voluntary 5-year CMS Advanced Alternative Payment Model (APM) with two care models—one for “Advanced” primary care and one for high-need, seriously ill Medicare beneficiaries (Seriously Ill Population, or SIP). The latter is aimed primarily at providers who typically provide hospice or palliative services. Practices […]
Healthcare megamergers are picking up steam, with the merger of Aurora Health Care and Advocate Health Care completed in 2018 and the merger of Catholic Health Initiatives and Dignity Health (now CommonSpirit Health) finalized earlier this year. Optum also completed their acquisition of DaVita Medical Group in June of this year. It’s a trend that […]
Physicians who generate significant income from procedural or technical/ancillary components of their practice have understandable concerns that an employment relationship with a health system or hospital will not be financially attractive. They realize that employment could mean losing the income from their usually profitable procedures and technical components, and so are uninterested in having their […]
Many conversations we have with hospital and health system executives about market growth strategies eventually turns to the topic of micro-hospitals — and for good reason. These facilities typically include a small-scale emergency department (ED), low-acuity surgery, and are often comprised of eight to 10 inpatient beds as well as additional observation beds (notably, these […]
The move toward value-based contracts is happening “in small doses,” a 2018 MGMA survey found. While nearly three out of five hospitals participate in value-based contracts, just 34 percent of healthcare reimbursement is tied to value. This presents healthcare leaders with a dilemma: How can we engage physicians in value-based payment models when so little […]
The use of CPT code modifiers to adjust work relative value units (wRVUs) under physician compensation models has become a universal practice among hospitals and health systems that employ physicians—and with good reason. The risks of not applying CPT code modifiers—such as an inability to objectively measure performance—are significant. Why should healthcare organizations that employ […]