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Top Areas of Opportunity for Hospitals and Health Systems Today

Despite the unknowns systems employ physician Healthcare provider leaders should make sure they are operating at best
of the current healthcare practices, which can be examine all aspects of their organiza- practice levels. And if CDI is solely
environment, big changes extremely expensive and tion’s pharmacy operations to drive focused on Medicare DRG payers, there
are certainly on the hori- hurt the bottom line if they peak efficiency and revenues. Providers is significant opportunity to improve
zon that will significantly are not managed appropri- can optimize pharmacy performance by hospital and physician quality profiles
affect hospitals and ately. There are two pri- maximizing 340B programs, improving by expanding to all DRG payers and,
health systems across the mary areas of opportunity clinical programs to best in class per- taking it even further, to all payers.
country. Reimbursement to improve physician prac- formance levels, leveraging pharmacy
is expected to continue tice performance. First, it is automation, operating a profitable retail Employee Health Plans
declining, while the pres- critical for organizations to pharmacy, and capturing and filling more Hospitals and health systems have a
sures to improve quality deploy the appropriate prescriptions from the owned physician unique role as both employers and
and reduce costs will skill mix within practices practices and employees. providers of care. Employee health
intensify. Where should to liberate physicians from plans that provide resources and incen-
hospital and health sys- BY RAMONA LACY, unnecessary work and Clinical Documentation tives for staff to proactively manage
tem leaders focus their FACHE allow them to focus on Improvement (CDI) their wellness represent opportunities
efforts over the next 12 care delivery. With most health systems now owning for hospitals to pilot population health
months to help their organizations not This means ensuring that advanced physician practices and clinics, a strong initiatives within their organization,
just weather the storm, but thrive, regard- practice providers and other clinicians outpatient clinical documentation pro- improve workforce performance and
less of changes to healthcare policy? Here operate at the top of their licenses, such gram is critical for both revenue and increase employee satisfaction.
are four top areas of opportunity that as using nurse practitioners and physi- compliance. Providers should review out- Management of chronic diseases like
providers can tackle today to generate cian assistants to deliver more common patient coding and documentation diabetes and asthma and addressing
lasting results. medical care and having nurses work in processes to ensure the goals of the out- unhealthy behaviors like obesity and
areas like infusion therapy and patient patient CDI program mirror those of the smoking can be implemented and yield
Patient Access and Physician triage. Scheduling represents another inpatient program: complete, accurate powerful results. In addition, we recom-
Practice Operations opportunity and goes hand in hand and compliant clinical documentation, mend hospital health plans direct
Improving patient access will be criti- with patient access. Providers should coding and billing that 1) accurately employees to the organization’s physi-
cal to a hospital’s financial performance evaluate current scheduling practices to reflect patient severity, Risk Adjustment cians, specialty care providers and phar-
and patient satisfaction ratings. In our ensure clear and concise templates, Factor (RAF) scores, the level of service macy, which generates additional rev-
work with hospitals and health systems processes, technology and scheduling provided and quality of care rendered, enues.
across the country, we typically see a wait instructions are in place along with and 2) deliver maximum compliant While often necessary, change is not
of 30-60 days for patients to see a physi- metrics to track progress and promote reimbursement. easy. The areas above represent oppor-
cian. We recommend the goal should be sustained efficiency. Providers must also account for key tunities for hospital and health system
3-5 days for a visit, particularly now that differences in the outpatient setting, leaders to seize today to position their
numerous options are available for imme- Pharmacy including significantly higher volumes, organizations for success, boost the bot-
diate care, such as urgent care centers, At clients across the country, we see shorter timeframes or episodes of care, tom line and improve patient experi-
retail clinics, and telehealth. In an envi- tremendous opportunity in the pharma- and multiple code sets, guidelines, ence, regardless of the looming transfor-
ronment of declining reimbursement, cy department. The United States claims forms and payment methodolo- mation of the healthcare industry.
hospitals need to provide better patient spends close to $500 billion on pharma- gies.
access to be competitive and financially cy costs annually, exceeding over 10% Opportunities also abound in inpa- Ramona Lacy is Managing Partner at
successful. of overall healthcare spending, and tient CDI. Hospitals and health systems Prism Healthcare Partners. For more infor-
The majority of hospitals and health these numbers increase every year. should assess their CDI programs to mation, visit www.prismhealthcare.com.

Why Choose a Dedicated Healthcare Group?

When I first came up • Doctor and nurse medical career models. “Throughout human history, revolu-
with the idea of creating a burn-out rates are high. • Knowledge and understanding of tions have resulted in economic shifts,
dedicated healthcare group, • More doctors work fiduciary planning. major changes in culture and the
the response was why? for healthcare care organ- • Knowledge and understanding of upheaval of established institutions. We
When I continued to pur- izations than ever before. medical and non-medical liability issues. are living in a revolutionary time. When
sue that idea, the response • Tort reform has • Knowledge and understanding of tax the revolution begins, there’s a lot of fear
was why? It was a valid changed, creating more laws and strategies based on age and and chaos. The institutions are under
question to ask because at potential liability for income. attack and out of all that dynamic activi-
the time, financial service malpractice claims. • Knowledge and understanding of ty, new ideas, new leaders, new philoso-
organizations did not have • Overhead for inde- how to integrate these into realistic phies, visions, collaborations and part-
dedicated groups for pendent practitioners is attainable advice. nerships emerge.”
lawyers, engineers, nurses at all-time highs. What are a few examples of questions Brad Wilson, President and CEO of Blue Cross
or doctors. • New doctors are opt- that doctors should be asking? Blue Shield of North Carolina, as paraphrased
When I started asking BY HOWARD ing for employment • What financial products do I own from the printed article written by Judy Miller in
the question why not, the WOLKOWITZ models that offer salaries now? Managed Healthcare Executive, July 1, 2012.
answer tended to be, “It’s and work/life balance. • What financial resources should I
just another group of high income pro- • Independent doctors are competing have now? THAT’S WHY!
fessionals—nothing unique or special against the employed doctors of the hos- •How do each of the above fit into my
about them.” I expressed that the health- pitals they refer patients to. overall planning strategy? For more information contact Howard
care industry was changing and the plan- Do I still need to answer the question, •Under current state law, where are my Wolkowitz, Financial Advisor, at
ning industry needed to change with WHY? financial exposures? HWolkowitz@FinancialGuide.com
them in response. The answer was Financial planning and financial man- • Under current tax law, how much or (954) 625-1517.
always the same: “They need invest- agement are lifetime endeavors. In fact, it money am I “leaving on the table?”
ments and insurance like everybody else, involves short-term, intermediate-term • What is my current employment sta- The opinions above belong to Howard
just go out there and sell it to them.” and long-term decisions. Decisions that tus and what benefits am I entitled to Wolkowitz and the information contained here-
Although this may be true, it doesn’t impact the protection of you, your family receive? in does not necessarily represent the opinions of
touch upon the real issue or the answer and the people who depend on you. • If I can be hired, then I can be fired. MassMutual or its affiliated broker-dealer MML
Investors Services, LLC.
to the question, why? Insurance and When I needed a surgery, I already had a How do I protect myself? MassMutual Financial Group is a marketing
investments have always centered doctor who could perform the surgery Financial planning and asset manage- name for Massachusetts Mutual Life Insurance
around products with features and bene- and knew plenty of doctors I could tap ment begins with understanding a physi- Company (MassMutual) and its affiliated com-
fits. Healthcare professionals require a into. I wasn’t looking for buddies and cian’s career model: independent con- panies and sales representatives. Securities,
dedicated healthcare group because friends, I was looking for the surgeon tractor, employee, or entrepreneur. A investment advisory and financial planning
services offered through qualified registered rep-
healthcare is unique, different, and has who had the most successful track planner can provide advice based on the resentatives of MML Investors Services, LLC.
changed for all healthcare providers. record. physician’s employment model. This will Member SIPC. [www.SIPC.org] OSJ: 2400 E
Whether it’s about health care reform, What goes into being a successful dictate how advice is provided for bene- Commercial Blvd., 11th Floor, Ft. Lauderdale,
managed care or healthcare transforma- financial “surgeon” for doctors today? fits, tax-planning, and asset protection FL 33308 (954)331-5100. CRN201906-213613
tion; Let’s face the facts: • Knowledge and understanding of planning.

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