Western Pennsylvania Healthcare News

Covering healthcare news in the Pittsburgh region and beyond.

Banner Ad

Finance Page Sponsored By:

How to Double or Triple the Size of Your Urgent Care Practice

by

By Luis de la Prida

You probably got into medicine because you wanted to make a difference in the world.  You recognized that urgent care fills a gap in the healthcare market.  You get to interact with a diverse range of patients, fulfilling your own vision of how healthcare should be done.

Now that you’ve been up and running for a while, the administrative burden is keeping you from what you love: practicing medicine.  It’s time to decide whether to hold and maintain or grow. How do you take your practice to the next level?

Growth takes risk and thinking strategically. If you find yourself at the point of wanting to grow, but not quite sure how to do it, then you’ll want to read further.

Current Landscape for Urgent Care Practices

Before figuring out how to create a growth plan or implementing an acquisition strategy, it is important to know the lay of the land.  Knowing who’s buying and why is an important step toward effective negotiating.  Knowing why practices are selling can position you to make an attractive offer that beats out your larger competitors. [Read more…]

Commercial Payers Embrace Bundled Pricing for Cost Containment, Better Outcomes

by

Shane Wolverto is Senior Vice President of Corporate Development for QuantrosBy Shane Wolverton

As commercial payers seek strategies to lower costs and improve care quality, they are paying closer attention to bundled payments.  While many payers express concerns about the impact of recent regulatory reversals that removed mandatory requirements for bundled payments, the benefits of bundled pricing still resonate strongly throughout the commercial marketplace. 

This is evidenced by a recent announcement from Humana, which expanded a bundled payment model into seven additional states that will cover hip and knee replacements within the Medicare Advantage beneficiary populations. This model is designed to improve outcomes and patient satisfaction during an entire episode of care while reducing their costs. More comprehensive data sharing with providers to evaluate and improve care across the continuum helps both Humana and providers meet quality and profit requirements. [Read more…]

How the Healthcare Industry is Benefiting in a Big Way from Fintech Start-Ups

by

The healthcare industry is one that has gone through all kinds of changes over the past decade thanks to innovation and technology. Now it seems the revolution taking place in the industry is being driven by those in the fintech, or financial technology industry. More and more fintech start-ups have their sights set on the healthcare industry with big plans on how they can make their mark.

Giving Patients Easier Ways to Pay

One of the biggest complaints from both patients and those on the administrative side of the healthcare industry is just how confusing and difficult the billing and paying system is. Change is not only welcome, it is needed at this point. Fintech start-ups are now looking at ways they can work to facilitate payments such as offering online billing and bill payments.

There is also the other side to bill payments and that has more to do with offering assistance when it comes to financial planning for patients. We all know that medical care isn’t cheap, and not everyone has insurance coverage. Fintech companies are now looking at products they can offer that help patients to better plan and budget their finances so that they can indeed pay for the medical services. [Read more…]

3 Ways Your Hospital is Leaving Money on the Table

by

seanaudleyphoto (2)Maximizing Revenue from Workers’ Compensation in Pennsylvania

By Sean P. Audley

Hospital administrators are always challenged to find ways to generate revenue from their hospital. Nearly every function in your facility can generate revenue, yet many are leaving money on the table, particularly when you’re dealing with workers’ compensation. Whether you outsource your workers’ compensation accounts to a vendor or handle them in house, it’s highly likely you are missing out on significant revenue from these accounts.

The payment of work-related medical bills is controlled by the Pennsylvania Workers’ Compensation Act and regulations are enacted under its authority. While most claims are not complicated to resolve, some pose roadblocks to payment. These outlier claims are often high dollar accounts and are often contested by employers. They can take months to resolve, tying up valuable staff time. Not understanding the intricacies of the law regulating these claims can result in missed deadlines or lost opportunities for payment.

As a result, your facility may be writing off accounts or settling for a reimbursement amount that is less than what you are entitled to receive. One way you can be more proactive in trying to maximize the revenue from these accounts is to partner with an experienced attorney well versed in workers’ compensation. This will not only increase your recoveries on these cases, but allow your staff to devote their time to less complicated claims, thereby increasing revenue on those as well. [Read more…]

Spending Your IT Budget More Wisely

by

Healthcare IT budget, healthcare finance, revenue cycle management

Stretching information technology (IT) budgets are an ongoing challenge for many medical offices today. In theory, your practice should first determine what IT you need to meet your business objectives, and then budget accordingly. However, because technology is constantly changing, many practices would like to stay ahead of the trends to improve their business operations. But there’s a way to stay current and relevant while stretching those precious IT dollars.

Understand your expenditures

Before you begin to slash away at your IT budget, Bob Merrill, IT strategy expert at PA Consulting Group, says to make sure that your practice understands what you are actually spending on IT. You can do that by simply listing each line item/category, and including IT-like expenditures, which may include items such as phone systems, mobile phones and associated services, voice and data networks, copiers, fax machines, printer/copier/fax supplies, maintenance agreements, as well as allocation of floor-space and associated rent for computer rooms. 

“Many of these expenditure categories are considered office expense, even though they duplicate capabilities available through IT technology,” he points out. “Sort the categories from highest annual expenditures to least, and focus on the costliest expenditures first when looking for opportunities for reduction.”

Donovan Niesen, co-founder of The Tech Outfit in Minneapolis, MN, says to begin with your biggest IT expenditures and work your way down.

“When evaluating ways to reduce your IT spending, it is absolutely critical to do a proper risk assessment to understand any pitfalls that can arise from changes made,” he cautions. [Read more…]

Improve Clinical Communication to Reduce ED Overuse and Control Costs

by

Brad Brooks is Co-Founder & Chief Executive Officer of TigerTextBy Brad Brooks

Much has been written recently about the opioid epidemic running rampantly through American cities and towns. The crisis impacts everyone, including hospitals that are being inundated by patients with opioid-related emergencies, often including overdoses of potentially lethal combinations of prescription medications and illegal drugs. 

Concurrently, healthcare organizations are seeing an increase in patients visiting emergency departments (EDs) complaining of pain in order to obtain opioid prescriptions. Drug-seeking patients typically return to the ED several times a year, or visit multiple hospitals in surrounding communities in search of having a prescription filled.

ED overuse, however, is not exclusive to drug addicted patients. It also includes patients with mental illness; with multiple, uncontrolled chronic diseases; or those who believe the ED is their only access to care.

The financial consequences of unnecessary ED utilization are very real. One study estimates that $38 billion in spending each year could be eliminated by diverting care from the ED to a more appropriate setting. Streamlined clinical communication can help hospitals and health systems to reduce some of this overuse, improve patient care through more appropriate actions, and augment reimbursement under value-based payment models through better efficacy.

By aligning communications across multi-disciplinary care teams—not just physicians and nurses—but also social workers and rehabilitation facilities, patients can get the effective, appropriate help they need and organizations can reduce wasteful care spending. [Read more…]

Value-based Purchasing and Reimbursement: The Business Case for Improving Quality and Patient Safety

by

By Andy Weissberg

In the increasingly competitive, transparent and value-based healthcare economy, hospitals and health systems in Western PA and throughout the nation are facing increasing financial pressure from healthcare purchasers and payers to improve patient care outcomes. At the center of value-based purchasing and reimbursement, performance against numerous measures of quality and patient safety performance also heighten hospital concerns for reputation and market share. 

Although patient safety and quality have traditionally been regarded as disparate domains of performance measurement in traditional fee-for-service (FFS) models, they are increasingly interconnected in performance-driven, value-based purchasing, payments and reimbursement from both public and private payers, underpinning the business case to improve the quality and safety of health care.

The top and bottom line: only high-performing hospitals that deliver higher quality, safer and more efficient care with measurable and improved clinical outcomes will thrive and financially survive, improving a health system’s reputation and ability to increase market share and encourage patients to use in-network services. [Read more…]

Three Ways Medical Practices Can Budget Smart

by

By Nick Hernandez

It is once again the time of year when medical practices should be working to finalize their operating budget for the next calendar year.  Unfortunately, too few practices actually take the time to create a meaningful budget, instead seeing the endeavor as a complex, time-consuming process that likely will not be used.  Creating and following a budget involves self-discipline and sacrifice, but will help you develop wise spending habits to better manage your practice’s finances now and into the future.

If you’re continually seeing failure at budgeting, the best place to look is usually at the fundamentals.  It only takes a fundamental misstep or two to transform a well-planned and well-formed budget into a complete disaster.  Budgets should be realistic, flexible, and consistent with practice goals and objectives. 

Here are three keys to consider that will point you on the right track toward success as you build your budget:

1. Know why you are budgeting.  If you’re developing a budget just because someone says it’s a good idea, it probably won’t help very much.  Similarly, if you’re just following the steps in a practice finance workbook because it suggests this is a great way to move towards financial success, budgeting won’t help much at all.  The reason for budgeting is to help you spend less than you earn.  It shows you where your spending weaknesses are and provides the structure for you to get stronger in those areas.  If you’re in the dark about how much your practice spends and where you spend it, changing habits will be difficult.  And even if you’re financially comfortable, a budget can help you identify unnecessary expenditures and deduce ways to redirect funds towards your priorities. [Read more…]

Pensiamo Helps Lower Healthcare Operating Costs

by

Healthcare Supply Chain Company Provides Solutions to Most-Challenging Needs

“Regardless of what was going to happen with the ACA, we, as a country, are spending too much on healthcare,” says Pensiamo CEO, Jim Szilagy in a recent video interview, “What we can do as Pensiamo, through our supply chain solutions, we can lower the operating costs for healthcare providers.” 

According to a recent leadership survey by national healthcare advisory firm BDC Advisors, results indicate that most healthcare leaders will continue value-based care strategies despite political uncertainty. 

Pensiamo agrees and is positioned as solution to healthcare providers’ most challenging needs. Big shifts are underway since the ACA was introduced, with increased cost pressure through bundled payments, the rise of consumerism in healthcare, the shift from inpatient to outpatient care, and the growth of population health management, providers are facing increased revenue compression. Cost reduction is no longer an initiative; it is an imperative. 

The BDC survey results report cost reduction and asset redeployment remaining on the top of the healthcare executives’ priority lists. Institutions unable to adapt to the shift are facing bankruptcy, with 10 reported closures in 2016 and five more already in 2017, according to healthcare trade journals.

Supply chain is a critical enabler of healthcare transformation; supply costs are usually the second largest expense in a hospital after labor costs.  Pensiamo, the healthcare supply chain company is an independent, for-profit enterprise, with UPMC as its founding client. Pensiamo has delivered millions of dollars in annual value to its client, UPMC.

Robert DeMichiei, UPMC CFO, says, “Pensiamo is helping us achieve our ultimate goal of providing higher quality patient outcomes while significantly reducing the total cost of care.”

Hospitals seeking to manage costs in a dynamic market can use the best-in-class purchasing approaches and cognitive power of Pensiamo’s full line of services to build a comprehensive supply chain solution that reaches beyond the medical and clinical costs to include all the factors that drive costs in a modern hospital system. Pensiamo helps clients improve their supply chain performance in five primary areas including strategic sourcing, procure to pay, value analysis optimization, healthcare technology management and M&A integrations. Pensiamo brings a unique, cohesive approach informed by facts, data and cognitive insights. 

“Our message in the marketplace resonates,” says Szilagy, “Pensiamo is made up of hospital operators with frontline experience, we are here to help.”

About Pensiamo

Pensiamo is the pioneering cognitive supply chain company helping healthcare providers and suppliers succeed in an industry rapidly transitioning to value-based care. The mission of Pensiamo is healthcare transformation through supply chain elevation.

Pensiamo advances each client’s supply chain to deliver best-in-class value by applying innovative approaches, informed by cognitive analytics, to achieve better patient outcomes at a lower cost of care. Pensiamo’s proven practices and deep healthcare expertise enable rapid transformation of supply chains regardless of their current state of maturity.

When it Comes to Retirement Tax Planning, Timing is Everything

by

By Scott Hanson

Ouch! Poor Tax Planning Hurts 

I’ve been an investment advisor for over 25 years and have worked with thousands of people. Over that period, I’ve been witness to some truly terrible (and avoidable) tax outcomes involving otherwise savvy and conscientious investors.

With that in mind, not a week goes by that one of my advisors doesn’t meet with a newly-retired person or couple who, much to their dismay, discovers that they’ve been badly overpaying their taxes. I’m not referring to the type of overpayments that come back to you in the form of an IRS refund. I’m talking about needlessly or accidentally overpaying the government tens of thousands of dollars that you’ll never see again.

The problem is that tax laws in retirement are frustratingly complex. Navigating the rules and regulations is no simple task, and the wrong decisions or advice can be the difference between a manageable tax bill and a staggering IOU to Uncle Sam.

Strategize Taxes Like You Strategize Investments

If you’re looking to retire in the next few years, you’ve likely spent a fair amount of your working life thinking about your investments and how they can best serve you in the future.

But if you’re like most folks who are on the verge of retirement, then you probably haven’t given nearly the same amount of attention or energy to your tax strategy as you have to your investment portfolio. Yet between a smart investment strategy and a smart tax strategy, the latter can actually be worth more to you in the long run. Simply, without a plan in place, needless tax errors or oversights could reduce your retirement savings by 10 or even 20 percent. [Read more…]