ECG Management Consultants

In the fifth session of the ECG and Foley & Lardner LLP Web conference series, we discuss the key the role research can play in your hospital and what you need to know to maximize success. Our speakers share information on research program development strategies, critical regulations and risk areas, protecting intellectual property, and the current funding environment.

For the renewal of its 1115 Medicaid waiver, the state of California engaged multiple key constituents in work groups to develop a demonstration program based on four care delivery models for children with chronic medical conditions. Thereafter, the state issued a Request for Proposal (RFP) for innovative programs based on these models that would allow combining various state program funds to cover the costs associated with delivering care. CHOC Children’s developed an accountable care organization (ACO) medical home model for eight of the chronic medical conditions. This presentation discusses the four models approved by the state, the process that CHOC Children’s followed to develop a financial framework and care delivery model, and the CHOC Children’s proposal approved by the state.

In the fourth session of the ECG and Foley & Lardner LLP Web conference series, we discuss the key compliance issues facing pediatric hospitals. The presentation explores what the “C-suite” needs to know about compliance, what to look for in a compliance officer, the top five compliance issues for children’s hospitals today, and the importance of fair market value opinions in physician/hospital arrangements and compensation.

ECG and Foley & Lardner LLP invite you to join us for the next installment of our Pediatric Business and Healthcare Delivery Series, where we will discuss organizing innovations for the delivery and payment of healthcare services in the current health reform environment. Physician-Hospital Alignment in Pediatric Healthcare: Contemporary Alignment Strategies in the Reform Era will examine recent responses to alignment pressures and two case studies of physician-hospital alignment in pediatric healthcare.

Regardless of your beliefs about the long-term effectiveness of payment reform, physician organizations within children’s hospitals will need to adapt to a payment environment that rewards value over volume. As payment models shift toward a focus on value and reimbursement becomes increasingly linked to measurements of quality and efficiency, physician organizations within children’s hospitals will need to ensure this new focus is incorporated in the day-to-day actions of their physicians. The most effective mechanism to accomplish this goal is to modify today’s physician compensation structures to better align with organizational goals in a value-based payment environment. This presentation addresses, and is intended to stimulate discussion about, a variety of questions related to performance-based physician compensation.

The second session of the ECG and Foley & Lardner LLP Web conference series focuses on innovation in organizing the delivery and payment of pediatric healthcare services in the current health reform environment. It discusses integration work that is occurring and how those pilots are, or might be, applied to pediatric healthcare delivery systems. Topics include public policy, ACO population-based approaches, structures and models for delivering accountable care, and, finally, an example provided by Nationwide Children’s Hospital’s Partners for Kids, a pediatric physician/hospital organization.

Serving the pediatric population remains one of the most complex challenges in healthcare delivery. Children’s hospitals, pediatric programs, and physicians face economic uncertainties as elements of the legal/regulatory landscape change and healthcare payment and care delivery reforms begin to take shape. While a great deal of attention has been paid to Medicare and the Medicare ACO effort, equally important is the application of the Triple Aim principles to those at the beginning of the healthcare delivery spectrum. This first session of a six-part series delves into the current state of children’s healthcare, as well as the impending challenges confronting providers, such as economic, legal/regulatory, and structural challenges. We also will provide an overview of the current environment from the perspective of policy makers (NACHRI), commercial payors, and individual children’s hospitals.

The healthcare industry is undergoing a time of unprecedented change that will require hospitals and physicians to work more collaboratively to reduce the cost of care while improving quality. Regardless of the exact changes to be implemented as a result of the Patient Protection and Affordable Care Act (PPACA), lowering cost, improving quality, and increasing access will be paramount to success. This will require that hospitals and physicians rethink their business strategies and implement more integrated care models. This article shares key insights that pediatric cardiologists should consider when evaluating alignment with hospitals and reviews the Professional Services Agreement (PSA) structure as an alternative to employment.

On March 23, 2010, President Obama signed healthcare reform into law with the Patient Protection and Affordable Care Act (PPACA). The healthcare reform legislation initiated the process of change, but the path for successfully realizing the broader vision remains largely unclear. This presentation provides a framework on how children’s hospitals can be successful under PPACA, which includes the changes they should anticipate as well as strategic considerations for alternative reimbursement arrangements.

As healthcare experts, we repeatedly hear common concerns from pediatric hospitals and affiliated specialty practices. It is important to recognize that solutions in the pediatric sphere are unlikely to come in the form of specially designed pediatric solutions or rescue packages. To address these concerns, the pediatric sector needs to adapt to new realities, develop focused solutions, learn how to operate more efficiently, and be willing to reform the institutional culture. This Insight focuses on what we see as the current realities and suggests priorities for action by pediatric organizations.