Conventus: Maintaining healthcare practice profitability without sacrificing patient care
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The document discusses strategies for maintaining profitability in healthcare practices while enhancing patient care amidst regulatory challenges and the shift to value-based reimbursement models. It emphasizes the importance of effective workflow analysis to optimize operational efficiency and the role of provider time as a key asset. By implementing continuous workflow improvements, practices can achieve increased reimbursements, better care quality, and higher satisfaction for both patients and staff.
Conventus: Maintaining healthcare practice profitability without sacrificing patient care
- 1. <Confidential>1 The Future is Now: Maintaining practice profitability without sacrificing patient care
- 2. <Confidential>2 The Landscape Increasing Legislative & Regulatory Requirements Reimbursement Uncertainties New Payment Models New Delivery Models Physician Alignments
- 3. <Confidential>3 Welcome to The New Healthcare Paradigm Maximize Patient Care Time + Minimize EVERYTHING ELSE = Better Quality Care + Decreased Risk + Better Reimbursement
- 4. <Confidential>4 Get ready for Value-Based Purchasing In 2016, CMS will apply Value-Based Payment formulas for Medicare fees All physician practices with 10+ eligible professionals Payments based on national quality of care and cost of care benchmarks Quality/Cost Low Cost Average Cost High Cost High Quality +2.0x* +1.0x* +0.0% Medium Quality +1.0x* +0.0% +1.0% Low Quality +0.0% =1.0% -2.0% *Eligible for an additional +1.0x if reporting clinical data for quality measures and average beneficiary risk score is in the top 25% of all beneficiary risk scores.
- 5. <Confidential>5 Reinventing your Practice Risks Operational Clinical Regulatory & Technology MPL & Legal Financial
- 6. <Confidential>6 Operational Risks Question: What is the most valuable asset in your practice? Answer: The Provider's Time!
- 7. <Confidential>7 The Value of a Practice Minute Schedule $1.49 Check-In $1.30 Room-In $1.62 Patient Visit $7.50 In-Office Follow- Up $1.62 Check- Out $1.30 Post- Visit Follow- Up $1.75 Billing $1.74 Total=$18.32 Source: Mary S. Applegate, MD, FACP, FAAP, Clinical Asst. Professor of Medicine, The Ohio State University College of Medicine
- 8. <Confidential>8 Workflow Analysis -An established process describing: A series of tasks (activities) How they are accomplished (steps) By whom (people) In what sequence (order) At what priority that accomplishes a defined step(s) in an activity
- 9. <Confidential>9 Workflow Analysis What's In It for My Practice? Health Insurance Exchanges Value Based Purchasing v. Fee For Service Patient Engagement Streamlining Practice Based on DATA New Technology Works for Practice
- 10. <Confidential>10 Workflow Analysis What we've learned from CARE Certification Program on-site sessions: Management Attitude: “Everything is fine” Time Constraints Call Volume & Triage Duplicative Efforts Lack of Coordination between Front & Back Office Lack of Teamwork Patient Non-Compliance Physician Attitude: “We don't have time for customer service.” “We tried that & it doesn't work.”
- 11. <Confidential>11 Workflow Analysis How To Do a Workflow Analysis 1. Select a Process – Start Small! 2. Involve Staff! Collaborate! 3. Identify Current Activities/Steps – List or Graphic 4. Identify Issues/Bottlenecks Data! 5. Identify Improved Activities/Steps – List or Graphic 6. Test (PDSA) Data! 7. Modify & Train
- 12. <Confidential>12 Workflow Analysis Processes To Analyze Patient Flow Through Office (through-put) 1. Scheduling/Appointments 2. Reception 3. Waiting 4. Rooming 5. Clinical Exam 6. Check Out 7. Follow Up/Care Coordination Revenue Cycle Management/Billing/Claims Referrals Diagnostic Testing
- 14. <Confidential>14 Continuous Workflow Improvement Do Study ActPlan
- 15. <Confidential>15 Workflow Analysis Resources: Capko, Judy, Secrets of the Best-Run Practices, Greenbranch Publishing Cohen, Frank, Lean Six Sigma for the Medical Practice – Improving Profitability by Improving Processes, Greenbranch Publishing Institute for Healthcare Improvement, PDSA Worksheet, http://www.ihi.org/resources/pages/tools/plandostudyactworksheet.as px Woodcock, Elizabeth, Mastering Patient Flow Using Lean Thinking to Improve Your Practice Operations, MGMA
- 16. <Confidential>16 The Results Increased reimbursements Improved quality of care Higher patient & staff satisfaction Lower risk of malpractice
- 17. <Confidential>17 For Details For a personal presentation, contact Susan Lieberman, MBA Vice President, Risk Management Conventus Inter-Insurance Exchange 877-444-0484, x466 slieberman@nipgroup.com www.conventusnj.com