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At the Margins

Our latest insight into health care margin improvement efforts

Three assumptions that blind you to savings opportunities in clinical supply spend

Harry Kirschner April 22, 2014

Even if you excel at cost management, there’s still room for improvement. Hospitals getting top-quartile pricing can find additional savings of 12-22%—but they must do so without hurting clinical quality, physician satisfaction, or long-term savings potential.

Only physicians and suppliers know how to make just the right changes, but are you asking them to help you find the biggest opportunities or just assuming?

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No, you can't skip ahead to ICD-11—and other answers on the ICD-10 delay

Robin Brand April 15, 2014

By now you know all about H.R. 4302: the "doc fix" that has delayed ICD-10 code set adoption until, at earliest, Oct. 1, 2015. And chances are, you have more than a few questions about the implications of Congress's surprising decision.

To get some answers, the Daily Briefing's Dan Diamond spoke with the Advisory Board's ICD-10 expert, Ed Hock, about the implications of the delay. Read on to learn about reactions from across the industry, what it all means for providers, and what Ed is telling executives (no, you can't just skip ahead to ICD-11).

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The 5 market factors that will dictate your population health contracts

April 11, 2014

Sarah Gabriel

Local market dynamics have major implications for determining the population health contracts and terms available to a provider.

No surprise, right? It makes sense that market dynamics impact the options available to providers for negotiating certain terms of population health contracts with purchasers, whether the arrangement is capitation, shared savings, or pay-for-performance bonuses.

Market dynamics will also impact whether and how quickly providers and purchasers in the market are likely to move toward population health contracting, how much financial risk providers are willing and able to take on, and what types of contracts are available to providers.

Over the past month, we’ve spoken with hospitals and health systems across the country at various stages of contracting for population health, and through these conversations, we’ve been able to identify the characteristics that measure the readiness of a market for these types of arrangements. 

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Wondering how to improve documentation? Start with a look in the mirror.

Ed Hock April 8, 2014

I meet with a lot of CFOs in my job, and whenever I bring up clinical documentation improvement, I’ve noticed I get a similar reaction: "If we could just get our physicians to pay more attention,” they say, “our documentation problems would be solved."

It’s natural to want to pass the blame, but it’s far more effective to share responsibility.

I’m not saying these CFOs aren’t right. Documentation improvement should largely focus on physicians. But hospital administrators also play a critical role. Could you unknowingly be a roadblock to your physicians' success?

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ICD-10 delay makes it through the Senate

Robin Brand April 1, 2014  | Comments (2)

Following the direction of the House of Representatives last week, the Senate passed legislation that would postpone the mandated conversion to ICD-10 for one year, setting the compliance date to no sooner than Oct. 1, 2015.

The delay is part of a much larger bill (the "doc fix") that centers on a 12-month temporary patch to the sustainable growth rate, preventing a 24% cut to physician Medicare reimbursement.

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Breaking: Another ICD-10 delay?

Christopher Kerns March 26, 2014

Although CMS administrator Marilyn Tavenner has repeatedly said that no more ICD-10 delays were in the works, it seems as though Congress may have other plans.

Slipped in to the legislation on the Sustainable Growth Rate patch (aka the "doc fix") is a provision that may elicit sighs of relief or howls of frustration—depending on one’s point of view.

The bill includes a one-year delay of CMS’s adoption of ICD-10 codes for Medicare reimbursement.

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Survey: 95% of organizations are at or below budget on ICD-10 transition

March 25, 2014

David Lumbert

Early results from our ICD-10 Readiness Survey show that nearly 95% of organizations reported expenses at or below budget, with the variance between budget and actual expenditures ranging from 5 to 15%. But we also learned that there are still many tests—and challenges—to face before Oct. 1.

For starters, providers lack consensus on the percentage of charts to dual code, the prevalence of renegotiated commercial contracts, and whether to model the financial impact of delayed reimbursement stemming from the transition.

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Operational oversights could be costing you millions

John Johnston March 20, 2014

What do you do when a quarter of the inpatient care you provide is avoidable?

I regularly talk to health system executives who say that the percentage of their inpatient care that's avoidable is between 20 and 30% (one prominent health system's COO even said at least 30%). And they're looking for solutions.

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