ECG Management Consultants

In an effort to respond to changing dynamics in the healthcare environment, hospitals and health systems are finding themselves in the physician practice management business, much as they did in the 1990s. As with the earlier wave of acquisitions, there is often considerable pressure to get the deal done quickly, and the question of how to assimilate these practices into a cohesive physician network often gets short shrift. As a result, many hospitals are left with a mixed bag of acquired practices - for the individuals who are tasked with managing the revenue cycle for these acquired practices, this scenario can become unmanageable quickly. Consequently, if the professional revenue cycle is not managed effectively, billing costs will rise, collection rates will drop, and accounts receivable will increase to a point that the value of the acquisition is lost. This Executive Briefing explores the models, tools, and expertise necessary to achieve a professional fee revenue cycle that is scalable, improves financial performance, and supports the organization’s mission, vision, and strategic initiatives.

Once it has been determined that there is a positive financial impact on reimbursement from operating under provider-based status, the next logical question is, “How do we implement this decision?” Due to the complexity of hospital and physician billing processes, implementation will impact all parts of the revenue cycle, beginning with operations and extending through IT systems and staff training. This presentation identifies the critical operations elements that should be evaluated before moving forward with provider-based designation. Furthermore, this presentation discusses how best to address the fundamental revenue cycle, IT system, and clinical operations implications of implementing provider-based billing.

As a medical group grows through acquisition, it is important that the organization’s billing model is easily scalable, improves financial cycle performance, and supports the organization’s mission, vision, and goals. This presentation details the key steps and tools for designing, implementing, and managing a contemporary revenue cycle model. It also reviews the framework used at one organization to assess the revenue cycle model, the models that were considered, the action plan used to reorganize more than 80 FTEs without disrupting cash flow or performance, and the tools employed to monitor and manage effectiveness.

The current and future trend toward value-based reimbursement methodologies, such as global payments, will require that provider organizations establish revised internal and external financial arrangements to support sharing of risk and opportunity associated with these types of risk contracts. These arrangements include the funds flow and risk sharing mechanisms between the health plan and provider provider organization, the arrangements for sharing risk among multiple participating provider organizations and ultimately compensation arrangements for primary care and specialty physicians. This session explores a range of models related to each of these elements of revised risk arrangements and discusses the merits and challenges associated with each option.

It is important to have a standardized approach to assessing the performance of the revenue cycle process. This presentation illustrates the significance of evaluating organizational, financial, and operational performance in order to provide a comprehensive perspective of revenue cycle performance.

By focusing on critical issues, this presentation outlines both the fundamental questions and key task areas that are essential to best practice approach to physician acquisition. Topics include possible financial, operational, and political impacts of the relationship; the physician group’s ability to possibly drive the health system service line operations and strategies; and the preferred model of the relationship. A subsequent discussion and breakdown of key tasks further examines the processes that will lead to a successful health system/physician relationship.

The number of physicians in groups grew from 28,000 in 1965 to 600,000 in 2008. Independent and hospital-affiliated medical groups are investing in the systems required for performance accountability, which is beginning to be linked to reimbursement. This presentation assesses the framework for understanding and tracking physician performance by examining physician productivity and compensation, the physician selection process, and organizational structure. In addition, it describes the strategic, revenue, expense, and quality opportunities associated with this growing trend and addresses the role of IT in physician/hospital alignment.

Medical group and employed model growth are significant, as physicians seek to become part of larger, more leveraged organizations. A properly organized physician network can have a dramatic impact on the delivery of services, as well as on financial performance. This presentation provides case examples of specific opportunities to monitor and enhance the performance of employed physicians. Cost and revenue opportunities are examined in areas such as physician productivity and compensation, reimbursement and contracting, expense management, staffing, and revenue cycle management.

Too often hospitals lose money on underperforming employed physician practices. Many organizations focus on recruitment and acquisition but not on practice operations. This case study-rich presentation examines practical solutions for improving the financial performance of employed physicians. It also supplies information on how to assess your practice and quantify the financial opportunity for improvement by evaluating physician incentives and compensation, practice operations, revenue cycle and pricing, practice governance and management, IT opportunities, quality initiatives, and more.

Many hospitals slowly begin to employ hospital-based physicians and then find themselves with over 20 physicians and a multimillion-dollar budget. As an organization considers increasing the number of its employed physicians, it is important to think about the decision-making process for evaluating such opportunities. This presentation demonstrates how hospitals need to define the returns on physician strategy not only in terms of physician practice operations but also in relation to the hospitals’ larger strategic objectives.