Transitioning to Fee-for-Value with Insight into the Mid-Cycle

By 2020, fee-for-value reimbursement is projected to represent 83% of your revenue—up from 43% today and 14% in 2010. As the industry transitions to accountable care, clinical operations will become a critical driver of your hospital’s bottom line.

The mid-cycle, or the middle of the revenue cycle, is where clinical improvement initiatives will have the greatest revenue impact and enable you to evolve with reimbursement changes yet to come.

The Advisory Board Company estimates that the average 250-bed hospital stands to gain as much as $11.3 million in revenue through improvements to the revenue mid-cycle. As margins become tighter and as providers take on more risk, it’s important to capitalize on this opportunity. With insight into the mid-cycle, you can identify a single source of truth that gives your clinical and financial leadership common ground to get the fee-for-value conversation started.

Visibility Into the Mid-Cycle

Without visibility into your revenue mid-cycle, it can be difficult to understand how your clinical operations tie to revenue. There are many different factors to consider, and often, they become a moving target in a hospital’s attempts to prepare for a fee-for-value future.

The transition to ICD-10, for example, has huge revenue implications. Gaining visibility into your revenue and the potential effects of ICD-10—and coding and documentation in general—is the crucial first step towards understanding your fee-for-value landscape. You will understand not only what improvements need to be made, but also exactly how they will impact your bottom line.

With analytics at the mid-cycle, you can accomplish several important objectives:

• Discover improvements in acuity case mix through analytics and benchmarking data from more than 1,000 of your peers
• Minimize compliance risk and prevent take-backs by identifying revenue at risk
• Prepare for ICD-10. Learn about new documentation requirements and how to identify exactly which codes and which physicians need better documentation
• Use physician scorecards to isolate performance improvement opportunities and enhance the ROI of your CDI programs
• Aggressively manage revenue by recovering underpaid claims and missed charges

Taking Action on Improvement Opportunities

Engaging and coaching physicians around documentation improvements is key to driving change in the mid-cycle. It’s important to engage them around data they find meaningful and actionable. Physicians are scientists at their core and healing patients is their goal. Benchmarking data, which offers comparisons across the facility and the country, enables you to appeal to both sides of their minds, the analytical and the compassionate.

Beyond this, it’s helpful to create action and accountability plans to drive change. An enterprise performance management system enables you to:

• Drive results on your most impactful initiatives
• Track and maintain key initiatives in one centralized location and address delays and negative performance variances
• Assign a single point of accountability for each initiative and monitor progress in real-time
• Measure the impact of strategic and operational goals
• Deliver smart action plans and best practices across the most critical areas of the hospital
• Increase employee productivity and efficiency

When you integrate the capabilities of a performance management solution with data analytics, you get a complete, closed-loop solution that enables you to identify and drive improvement initiatives from start to finish.

Conclusion

In the transition to a fee-for-value future, it’s important to have access to a comprehensive picture of your documentation and coding performance so you can quickly spot your biggest opportunities to improve revenue capture. Couple this with a performance management system that enables you to define action and accountability plans to ensure change across the organization. In the end, you get deep insight into your financial health while achieving key business objectives in less time, with fewer resources and with a greater impact on your bottom line.

A version of this article appeared in the HFMA Mass Media Journal