Practice Management Alert

Which old-school FFS moves still boost practice revenue—and which ones you must ditch now.

Your practice’s strategy for success in the value-based reimbursement era must hold on to some old techniques, ditch others, and adapt completely patient and financial management moves. Don’t know where to start? We’ve got a plan.

At MGMA’s 2017 Financial Management and Payer Contracting conference, Navicure vice president of Strategic Planning and Regulatory Compliance Ken Bradley outlined a process that practices can follow to achieve success (i.e. get paid more in value-based payment contexts).

Bradley’s process begins by requiring practice staff to shift their thinking about what’s happening in healthcare today. In today’s market, the patient is at the center of all approaches to delivering care. Patients are concerned with the following questions:

• Did you cure me?
• How long will it take me to recover?
• When can I return to work?
• How do I maintain my health?
• Is this problem going to come back?

Follow Bradley’s Guide to Value-Based Care and Reimbursement in 10 Steps:

1. Take advantage of the technology that has been created to help you thrive. Adopt good technology that measures and assesses internal financial and operational metrics and capabilities. For example, tune up your revenue cycle by outsourcing it to a third party. Then, for the long term, consider technology that assists in moving clinical data to the appropriate places as the patient moves through the care continuum and that makes data accessible to other providers at the time of care.

2. Measure and assess the current financial and operational performance of your payers. This step requires you to get clear on your gross and net collection numbers, clean claim rates, denial rates, and A/R days. In value-based payment models, payers want to keep costs down, so it’s important to optimize your care delivery and administration costs.

3. Assess your patient population and what services you’re providing. Query your EHR database to get clear on the following questions:

• What’s our demographic makeup?
• What types of conditions are we treating?
• Who are our high utilizers?
• Which of our patients have chronic conditions and co-morbidities?
• What are the top services we are providing?

Gather a group of your staff to help you collect all this data. Pull in clinicians to unpack what the collected data means and develop appropriate actions.

4. As accurately as possible, determine your cost to provide the services that make up most of your revenue. Look at your internal costs first, and then consider what kind of services your patients need before and after seeing you. Answering this question can help you add more services to your practice, link up with pre- or post-treatment doctors, and provide end-to-end treatment for patients. Bonus: This exercise gives you an internal benchmark to think about during negotiations with payers.

5. Assess value propositions and find the services you provide better than anyone else. Get together with your staff and answer the following questions:

• What do we do better and/or differently than everyone else?
• What do we do a lot of that has room for improvement?
• Are we making decisions based on data?
• Are we coding for all services provided, all conditions, and all complications?

6. Assess your external environment and payers. This step asks you to research your competition. Ask yourself:

• What payers are in your market?
• Who are your competitors, and what are their quality and cost numbers?
• Do you know anyone who is a patient of a competing provider who can show you their EOB?
• Who are your referral partners, and what are their quality and cost numbers?

7. Look for ways to cut administrative and clinical costs. Ask the following questions to cut down on spending:

• Can we automate something that we’re doing manually?
• Can we reuse a clinical test that was done outside our office to avoid unnecessary or duplicate costs?
• Can we try telehealth treatments?
• How can we reduce hospitalization and/or Emergency Department usage?
• Are we capturing data associated with each event of our care delivery?

8. Learn about MIPS, APMs and private payer options, and decide which programs are best for your short- and long-term participation. Educate yourself and your practice on what each program requires. Pick your pace with MIPS. Consider the ROI of these choices, i.e. the 4% bonus or penalty. “The delivery of care is not just going to be a practice; it’s going to be a team of people who are linked,” says Bradley. “They have to learn how to be affiliated with a facility to be part of the future.”

9. Turn up the value. Keep the patient and patient care at the center of your thinking. What treatments are necessary to treat the patient end-to-end? What services does your practice provide, and what other providers would you need to partner with to provide end-to-end treatment?

Think about where the patient has been before you and where they’ll go after you. How can you price an end-to-end service that involves working with other care providers for each of your top revenue-generating services? Consider negotiating with payers to keep both your costs and patients’ costs low.

10. Continually measure and monitor performance. Look for ways to improve. Engage your entire practice in looking for ways to improve your delivery of care and reduce costs for your practice and patients. Establish an infrastructure with clearinghouses and IT so that you capture the clinical and administrative data you need to make informed decisions.