Fighting for volumes as new payment models raise questions
Competition for neuroscience volumes continues to intensify, particularly for lucrative neurosurgery cases. Yet, hospitals are encountering several barriers to growth, such as commercial insurers’ increasingly aggressive appropriateness review policies and competition with non-hospital providers for several outpatient product lines.
In this environment, neuroscience programs are both weighing the addition of new services to improve competitive position and tightening referral pipelines to prevent leakage. In planning their growth strategies, organizations also face questions regarding the value of care. The Patient Protection and Affordable Care Act of 2010 introduced a number of experiments with new payment models—including bundled payments, readmissions penalties, Value-Based Purchasing, and shared savings—that will be introduced as pilot projects and demonstrations by both Medicare and commercial payers across the next decade, tying payment incentives to the quality; cost; and, in some cases, the utilization of care.
Risk-based payment models will have the largest impact on stroke and spine programs, as providers across the country exhibit high degrees of variation in treatment decisions, quality outcomes, and adherence to guidelines.
Four imperatives for neuroscience programs
In light of moderate to low growth expectations, intense competition, and emerging risk-based payment models, neuroscience programs face four strategic imperatives for the near term.
1. Scope service line ambition—Hospitals considering pursuing more comprehensive offerings must weigh internal capabilities, as well as volume potential. Mid-sized programs can still strengthen service offerings through targeted investments, regional partnerships, and stronger physician engagements .
2. Strengthen referral relationships—Given moderate growth forecasts, neuroscience programs should reinvest in referral management strategies that improve access to specialists, refine tactics for physician outreach, and enhance communication with referring physicians.
3. Transform stroke management—Comprehensive stroke center status may not be feasible for some organizations. Risk-based payments will bring increased pressure to improve outcomes both within the acute care episode, as well as across the long term. Designing care processes to improve the medical management opportunity should be a priority for every stroke provider given the size of the affected patient population.
4. Develop comprehensive spine programs—Organizations must prepare not only for growth but also for increasing pressures on utilization appropriateness, including Medicare and commercial payer review of surgical necessity and concerns among primary care physicians regarding failure to consider more conservative therapies. New payment models will also require spine programs to expand offerings beyond the acute care episode to encompass the full continuum of back pain care.
Members, read on to learn more
Members of the Marketing and Planning Leadership Council have exclusive access to the full study. Read on to learn how to right-size neuroscience service line growth ambition, leverage referral relationships, optimize stroke care processes, and transform spine from an episodic to comprehensive service.
By reading this study, members will learn how to:
- Differentiate neuroscience services in their market through program development strategies
- Streamline referrals by building stronger relationships with area providers
- Heighten brand recognition and extend access through a regional model
- Enhance the patient experience and increase value through a multidisciplinary model
- Right-size program growth ambitions