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At the Margins

Our latest insight into health care margin improvement efforts

Get the most bang for your CDI buck

Christopher Kerns December 18, 2014

Clinical documentation improvement is a marathon, not a sprint.

Getting a CDI program up and running requires significant time and resources. But that’s not the end of it. We’ve found that top-performing CDI programs continually improve and re-evaluate their efforts, in order to sustain the gains they’ve made.

I sat down with Morgan Haines, a partner in our Consulting and Management Services division, to find out how the best-of-the-best programs are maintaining momentum.

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Overcoming the patient pay problem requires patient engagement

by Marcus Hincks December 16, 2014

Health insurance coverage alone is not indicative of patients’ ability to pay their medical bills. As consumers increasingly gravitate towards high-deductible health plans (HDHPs) because of the low premiums, many still cannot afford the high deductibles, thus creating greater amounts of bad debt.

The average American has $1,766 in overdue medical debt

Providers are revisiting collection efforts, hoping to engage patients and alleviate bad debt. We spoke with leaders from Novant Health to discuss a tactic they’ve taken—partnering with interest-free loan providers to help patients with their financial obligations.

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An ounce of prevention pays off: 90% of denials are preventable

Morgan Haines December 11, 2014

Denials management is a perennial topic. Most hospitals have ongoing efforts in this area—but very few can say definitively, “We’ve cracked the code on denials.”

Part of the challenge is that denials management is not just a do-one-thing-and-do-it-well issue. You have to master three core skills—recovery, prevention, and contract negotiation—to truly stomp out denials. But other initiatives have a way of taking priority, causing teams to default to focusing their efforts on revenue recovery.

As you make your list of goals for the coming year, I challenge you to consider this: Preventing denials is always better for your bottom line than recovering them. Only about two-thirds of denials are recoverable, but almost all (90%) of them are preventable. Though prevention is not easy, fixing the root cause of denials has a much larger financial impact than overturning them.

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Leading by teaching: A CFO's perspective on managing a system's finance team

Robin Brand December 9, 2014

Ann Pumpian is the CFO of Sharp HealthCare in San Diego, Calif. This is the second part of our two-part interview with her about her system's decision to leave the Pioneer ACO and how she mentors and educates her team to understand the implications of SharpHealthcare's financial strategy.

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The ACA from the inside: A system CFO’s perspective

Robin Brand November 20, 2014

Ann Pumpian is the CFO of Sharp HealthCare in San Diego, Calif. Read the first part of our two-part interview on her experience leading Sharp through the roll-out of the Affordable Care Act and how the health system has adapted to market changes.

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Year 2 of the exchanges begins tomorrow. Here's what we learned from Year 1.

Dan Diamond November 14, 2014

There are lots of questions surrounding what’s going to happen with the Affordable Care Act’s insurance exchanges. Will the Supreme Court upend insurance subsidies? Will CMS hit its sign-up projections?

And most relevantly, what will happen when the exchanges open for business on Saturday?

Those are all things we’re watching closely on the Daily Briefing, the Advisory Board’s flagship newsletter. (I’m the executive editor.) They're also major issues being tracked in the Health Care Advisory Board's ongoing meeting series, which I recently attended.

As we prepare for the ACA marketplaces’ second enrollment period, here are some lessons from the first.

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Will bundled payment cost you a bundle? Not if you do it right.

Harry Kirschner November 13, 2014

Bundled payment finally appears to be coming into its own. Between the rapidly expanding Medicare Bundled Payments for Care Improvement (BPCI) initiative and analogous private-payer efforts, it looks like as much as two-thirds of payment will be delivered through bundled contracts by 2020.

But not all providers are biting. Of the hospitals given the green light for participation in the early rounds of the recent BPCI expansion, more than a quarter decided to pass.

Why the cold feet?

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Restrictions on tax-exempt bonds complicate soft capital investments

by Corbin Santo November 4, 2014

We’ve spoken with health system finance leaders from across the country about how their organization’s capital strategy is shifting as the industry transitions from volume to value. One thing we’ve learned is that more nonprofit organizations are exploring alternatives to tax-exempt bond financing. In many ways, this trend is simply a result of the shift in underlying assets being emphasized in capital plans. But other forces in the bond market are also at play.

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