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At the Margins

Our latest insight into health care margin improvement efforts

Why you're not as ready for ICD-10 as you think

Ed Hock March 24, 2015

Until now, ICD-10 seemed like the boy who cried wolf.

But ready or not, it's looking more likely that the ICD-10 conversion is on its way.

With several years of preparations behind you, it's easy to get lulled into a false sense of readiness. Unfortunately, most executives I've recently spoken with have realized they're not as ready as they thought.

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Dual coding: What we learned from 8,000 claims

by Ellie Stoller March 19, 2015

We’ve seen how 5% revenue reduction risk under pay-for-performance has gotten the industry’s attention. Our own research has also shown that ICD-10 can affect 4.8% of reimbursement revenue—a risk that merits attention as well.

Due to the potential reimbursement impact, hospitals are beginning to dual code patient claims, allowing ICD-10 project leaders to compare DRG assignment of the same claim under ICD-9 and ICD-10 and prepare for the changes.

Barnes Health (pseudonym), a system in the Midwest, began dual coding a year and a half ago and shared its data with us.

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Business office centralization: When you should 'go virtual'

Robert Linnander March 17, 2015

With mergers and acquisitions increasingly making headlines, it is no surprise that health systems are called to streamline business office operations.

Integration has its challenges across the entire organization, and revenue cycle management is no exception. Finance leaders typically manage an assortment of technologies, a staff with diverse skill sets, as well as multiple contract arrangements with payers.

Here's how two members decided to take their business offices "virtual," and what it did for their respective organizations.

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Where are you on the population health capital planning continuum?

by Natalie McGarry March 9, 2015

Hospital and health systems demonstrate their priorities through the capital investments they make each year, which historically have centered on physical infrastructure and technology. As organizations increasingly enter into risk-based contracts, they need to reporioritize capital planning budgets to support their population health strategies.

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Think you're maximizing point-of-service collections? Think again.

Bethany Black March 5, 2015

Patients across the country are facing increasing deductibles as employers continue to modify their health benefits and use of health insurance exchanges grows.

While we used to classify deductibles above $1,000 as high, we're now seeing individuals with deductibles north of $5,000. The more patients owe, the less likely they are to ultimately pay part, or all, of their obligation.

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ICD-10: One step closer to prime time

Christopher Kerns March 3, 2015

A couple of weeks ago, I suggested that Congress had inched closer to accepting the October deadline for CMS's implementation of ICD-10.

One of the big unknowns was the end-to-end testing that CMS conducted with providers, payers and suppliers in late January and early February. My original hypothesis got a little more support with the recent release of results from that end-to-end testing of providers' ability to submit claims using ICD-10.

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Bundled services: Transitioning from cost savings to market share gains

by Natalie McGarry February 25, 2015

In April 2013, Medicare launched the Bundled Payment for Care Improvement (BPCI) Initiative to offer providers four voluntary bundled payment options. Now, more than 6,000 organizations are participating in the program.

Many participants also recognize consumers’ and employers’ interest in purchasing comprehensive and affordable episodes of care. And where there's demand, there's growth opportunity; an increasing number of providers are experimenting with private sector bundled payments as a tactic to grow market share.

Commercial Bundled Payment Tracker

Even Medicare is recognizing the power of including commercial payers in bundled arrangements by integrating private payer partnerships into the launch of the new bundled payment initiative, the Oncology Care Model. To appeal to purchasers, providers must create a bundled payment product that meets the needs and preferences of the market. Here are five key considerations to take into account before jumping in to your own bundled payment program.

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Will the ICD-10 deadline hold? Signs point to yes.

Christopher Kerns February 13, 2015

Whenever I speak with a CFO these days, there is a question that invariably—and I mean literally, without exception—comes up: Will CMS's October deadline for the transition to ICD-10 hold, or will it yet again get kicked down the road? If the recent congressional hearings are any indication, the odds of the deadline holding have improved markedly.

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