Hayes' Healthcare Blog

The Importance of Optimizing Operational Business Processes

Posted by Rosie Montemayor on August 31, 2016 at 9:00 AM

Prior to becoming a healthcare consultant, I was an operations manager for an academic medical organization for over 20 years.  During my tenure, my main focus was to ensure all areas of the business process were in place and adhered to by the staff.   My goal was to work towards making processes more efficient.  This was an ongoing effort that I think too many organizations have lost sight of today.   I wanted to become a consultant to share with other organizations how to improve upon their day-to-day struggles.

This blog focuses on the areas that I have experienced to be key business processes that still challenge organizations today. So, what can optimization do for you?  “Optimization can make something better, more efficient, improve outcomes/results that will set the bar to establish best practice.”

There are two major areas that are frequently targeted for optimization within a healthcare organization: clinical and revenue cycle.  These areas have a significant impact on an organization’s bottom line as it relates to patient satisfaction and revenue.  The goal when looking at optimization is to improve upon processes and workflows that have an impact to these two key areas.  So with this in mind, when was the last time your organization conducted an optimization project to review business practices?  Was it recently?  If no, then please read on to learn more about key processes to review.  If you conducted one recently, use this as a checklist to see if there is an area that you might have missed in your optimization project.

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Topics: EHR optimization, system change management

How to Effectively Manage Your Optimization Process after Go-Live: MOP IT UP!

Posted by Tamarah Alexander on August 24, 2016 at 9:00 AM

A new system implementation can really stir up a lot of dust within your organization!  Between trying to mitigate risks,
 complete required tasks, consolidate and contain the limits of the scope, reduce redundancy, design new workflows, and reconciliation, it really can feel like the needs of your end users are being sucked into a vacuum. An implementation is not “one size fits all” but it can feel like it in the beginning when you are introduced to the new technology and learn how others are using it in the industry.

Once you have completed the “hammering of the nails” behind the build, it is important to evaluate what has been done and what is not truly completed yet.  Once the dust of the go-live has fallen and settled on the floor, it’s time to “M.O.P. I.T.” up and begin the optimization process.

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Topics: EHR go-live support tips, Change management, System optimization

The 21st Century Revenue Cycle Leader: 3 Key Factors for Success in the Evolving Healthcare Environment

Posted by Steven M. Wagner, PH.D., M.P.A, on August 17, 2016 at 9:00 AM

By Steven M. Wagner, PH.D., M.P.A, Executive Director Medical Practice Income Plan; Clinical Instructor in Health Policy, Finance and Administration, Department of Medical Education, Texas Tech Health Sciences Center El Paso at the Paul L. Foster School of Medicine, faculty instructor for Independence University, and Research Fellow at the Centers for Healthcare Research in the School of Advance Studies for the University of Phoenix.

Healthcare leaders need to look at the bigger picture of healthcare reform rather than narrowly focusing on its separate components. Fragmented legislation and grants led us to where the healthcare industry stands today, and only integrating networks of components in healthcare can lead us to successful reform. Success means that healthcare becomes accessible and affordable with or without insurance to all payors, quality outcomes take into account the functional and holistic health of the patient, and patients are satisfied and feeling well.

The hard reality is that in the end, everyone in the industry will be dealing with less revenue because the over-arching goal for the US government is cost containment. Only when leaders take all the changes into account will we, as an industry, be able to facilitate truly beneficial change. To make that happen, revenue cycle leaders need to be able to integrate cost, quality, and access into our routine processes of patient care, frequently analyze outcomes including the patients’ self-perceived health statuses, and develop actionable solutions.

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Topics: revenue cycle management, value-based care, Hayes Thought Leadership Blog Series

The Two Sides of MACRA: Examining the Pros and Cons

Posted by Don Michaels, Ph.D. on August 10, 2016 at 9:00 AM

The shock and awe of the April release of the 962-page Notice of Proposed Rulemaking (NPRM) for the Medicare Access and CHIP Reauthorization Act (MACRA) has started to wear off as the healthcare industry continues to dig into the details. Slogging through the NPRM is an intimidating but necessary chore as healthcare organizations try to determine how it affects them.

MACRA represents change – significant change – in the way Medicare providers conduct business so it’s not surprising that much of the feedback has been negative. People dislike and fear change regardless of the reasons for it or the potential positive outcomes. Adding to the resistance is the fact that in recent years, changes in the healthcare industry have been aimed at providers like water from a fire hose and “change fatigue” is starting to set in. Lastly, providers know that most governmental changes to reimbursement have meant fewer collections for their practice. At best, they have been trained to hope that these types of changes are revenue neutral.

Despite the negative reviews, MACRA and the NPRM that puts it into action is not all bad. In fact there are several positives to be taken from the new law. Here is a look at the major pros and cons of MACRA.

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Topics: cms, Fee-for-service, value-based care, MACRA

7 Ways to Plug High Deductible Health Plan Revenue Leaks

Posted by Paul Fox on August 3, 2016 at 9:00 AM

According to a recent report, three out of four employers now offer high deductible health insurance plans, up from just over two out
 of four five years ago.  At 22 percent of employers, it’s now the only option and nearly half of employers plan to make high deductible plans the only choice by 2018.[1]

high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher patient deductibles than a traditional plan. Choosing an HDHP is required if an individual wants to take advantage of the tax benefits of a health savings account (HSA/FSA). HDHP’s make employees personally responsible for a higher portion of their family’s healthcare costs, with the goal of motivating them to comparison-shop for medical services.

With an HDHP, consumers pay for all their medical services — at the insurer’s negotiated rate — until they meet their deductible. After that, consumers typically are responsible for a co-pay, normally 10 to 35 percent of the service — until they reach their out-of-pocket maximum. If payment isn’t collected at the time of service, the provider is left having to bill the patient for the remaining self-pay balances after a normal 20-40-day adjudication period. Most studies suggest the longer the self-pay account goes unpaid, the less likely it becomes that the provider will ever collect.

Can your organization survive under those financial terms? Most would answer an emphatic “no!”

There’s no question that HDHP’s are adding financial stress to healthcare organizations. Here are seven strategies you can use to help prevent revenue loss as a result of the growing use of HDHP’s.

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Topics: high deductible health plans, revenue cycle management, Healthcare insurance

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