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Payers Feature Story

Leveling the Playing Field

How one health system competes with a national reference lab for outpatient lab services revenue.

For many hospitals, outpatient laboratory services are a profit center. This is the case for Buffalo, N.Y.-based Catholic Health Systems (CHS), which means that generating incremental growth in volume is a high priority for the organization. Also, like many hospitals, CHS faces strong competition from a national reference lab that has substantial cost advantages, including the efficiencies gained from centralized services at an out-of-state lab; minimal local staffing needs; and, outpatient-only services that eliminate costs associated with round-the-clock staffing, keeping stocks of blood and other critical supplies and maintaining multiple testing facilities

 

Keeping an Eye on the Prize

An automated posting and receivables management solution assists an optometric practice reduce A/R and maximize its human resources.

With a new chief executive officer at the helm and opportunities for growth on the horizon, one of North Carolina’s premier optometric practices saw an unprecedented opportunity to improve how it managed receivables and revenues. To that end, Horizon Eye Care focused on streamlining internal workflow to decrease days in accounts receivable and on identifying strategies to maintain current levels of staffing during this period of expansion. Among its top priorities was the adoption of claims management technology that would permit auto-posting to an existing practice management (PM)system with the goal of reducing delays and minimizing reliance on manual processes.

 

Path to Insight

Financial departments make or break organizations. Can BI improve healthcare CFO success?

Healthcare in the U.S. is on the cusp of monumental change. Already, the hospital and provider community is dealing with varying stages of consumer-directed healthcare and public access to quality and cost metrics; heightened focus on compliance with evidence-based care protocols; and, a staggering number of tier-network and reimbursement programs. Each of these fundamentally affects revenue streams, expense management and the ability to compete. Considered alongside the external economic forces impacting all industries, it is clear that healthcare industry executives must evaluate an increasing amount of information to best assess their organization’s health and future.

   

Part of the Equation

A sober assessment of the CMS PQRI initiative reveals a promising future for the program.

July 1, 2008 marked the first anniversary of the Physician Quality Reporting Initiative (PQRI), the pay-for-performance (P4P) program of the Centers for Medicare & Medicaid Services (CMS). Though some checks are probably still in the mail, CMS was expected to begin issuing bonus payments in July; it’s time for an assessment.

 

Consumerism in Healthcare

Studies show the consumer-driven approach provides mutual benefits to companies and workers.

According to the 13th Annual National Business Group on Health/Watson Wyatt Employer Survey on Purchasing Value in Health Care, a company’s average healthcare expenditure per employee was $7,211 in 2007 and expected to rise to $7,620 in 2008. In all, 453 large U.S. employers participated in the survey which also stated that in 2007, the average annual cost increase for healthcare was 6 percent, a reduction from the 8 percent increase in 2006. However, costs are predicted to again increase by 9 percent in 2008 and again (although at a slightly-lower rate) by 8 percent in 2009. With this double whammy of high healthcare costs and a slowing economy, healthcare stakeholders are examining the potential of consumer-directed healthcare plans (CDHP) to reduce their overall healthcare costs, given CDHP’s cost transparency and provider-related quality measurements.

   

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