3 Ways to Use Hospital Price Transparency Data for Competitive Advantage

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by John Harris, Director
and Clare O'Mara, Senior Associate

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Shifting a $1 trillion dollar industry from confidential contracts to publicly published pricing is a massive transformation. In the middle of recovering from the COVID-19 crisis, hospitals are responding to this transformation. Background: The hospital price transparency rules require consumer-friendly tools to help individuals shop for hospital services based on price. They also require hospitals […]

Posted in Strategy & Planning

3 Key Factors to Analyze as Cardiac Procedures Move to Outpatient

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by Mark J. Dubow, Director
and Ross Shuster, Manager

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By recategorizing procedures previously designated inpatient only, CMS is actively redirecting a significant number of cases to Hospital Outpatient Department (“HOPD”) and community-based ambulatory surgery center (“ASC”) settings. We have discussed the impact this will have on outpatient surgery, and strategies to prepare. This outpatient shift will also affect cardiac services, creating both risks and […]

Posted in Strategy & Planning

Continuing to Navigate the Changes in the Medicare Physician Fee Schedule

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by Karin Chernoff Kaplan, Director

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The changes in Work RVU (WRVU) values contained in the 2021 Medicare Physician Fee Schedule have the potential for wholesale disruption to productivity-based physician compensation models. To date, the response has varied among health systems, but for the most part, due to pandemic distractions and the sheer complexity of the impact, organizations have kicked the […]

Posted in Provider Compensation

Launching a Community Oncology Center: 5 Key Considerations

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by Meredith Inniger, Manager

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Rapid evolution in diagnostics and treatment for cancer care, innovation through genomics and predictive analytics, the continuing shift toward value-based care are hastening the migration of oncology from hospital settings to community-based centers.  This raises the question: Is now the right time to invest in a community oncology center? The experiences of multiple health systems […]

Posted in Strategy & Planning

Anatomy of a Deal Series No. 3:
The Art of Negotiating a Deal in Healthcare M&A

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by Daniel M. Grauman, Managing Director & CEO
and Scott Stuecher, Manager

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So you’ve made it through the request for proposals (RFP) process, an ordeal that can amount to a great deal of (usually digital) paperwork and a series of check-the-box demands, with little, if any, one-to-one discussion with the issuer. Now comes the interesting part: discussions between the healthcare organization that is seeking a partner, and […]

Posted in Partnerships, M&A, and Finance

The Surgery Shift from Inpatient – Assessing the Financial Impact

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by Mark J. Dubow, Director
and Meredith Inniger, Manager

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Surgery has long been a key driver of hospital profitability. Effectively handling the new Medicare outpatient surgery rule[1] and subsequent care shift to outpatient settings is critical to long term financial success. This rule includes several important policy changes, most notably the elimination of the Inpatient Only List on a phased schedule through CY2024 when […]

Posted in Strategy & Planning

Hospital M&A: 3 Key Considerations to Reach a Fair Deal

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by Daniel M. Grauman, Managing Director & CEO
and Kevin Cope, Manager

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Board members of not-for-profit community hospitals face enormous pressure to protect their community’s access to care. Even when the economic reasons for hospital mergers and acquisitions (M&A) are compelling, the decision to cede control to another system cannot be made based on purchase price alone. It’s just one reason why not-for-profit board members must understand […]

Posted in Partnerships, M&A, and Finance

Compensation to Employed Physicians for Providing On-Call Coverage

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by Karin Chernoff Kaplan, Director

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Hospitals are increasingly challenged to meet their Emergency Department (ED) and trauma center coverage requirements. This challenge has been enhanced by the shortage of specialty physicians in certain markets, and the increasing number of physicians unwilling to provide the coverage, due to quality-of-life issues, reimbursement pressures, and increased malpractice liability related to emergency care. Therefore, […]

Posted in Provider Compensation

Anatomy of a Deal Series No. 2:
Thinking Strategically About the RFP Response

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by Daniel M. Grauman, Managing Director & CEO
and Scott Stuecher, Manager

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The search for a partner typically begins with a request for proposals (RFP). It’s a process designed to solicit interest from other organizations and narrow the field to two to three candidates that could prove to be a good fit. For health systems that respond to an RFP from an independent hospital, the goal is […]

Posted in Partnerships, M&A, and Finance

Interactions of Medicare Alternative Payment Models

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by John Harris, Director
and Amanda Brown, Manager

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CMS continues to authorize voluntary and mandatory alternative payment models (APMs) to shift risk to providers. Beyond choosing which models offer the best opportunity, providers must evaluate the impact of participating in multiple APMs simultaneously. Overlapping APMs can be synergistic or self-defeating. Where simultaneous participation is an option, overlapping incentives are complicated and may not […]

Posted in Strategy & Planning