September, 2015:

Designing Physician Compensation Plans to Meet Changing Business Models

HFMA Magazine September 2015

Designing Physician Compensation Plans to Meet Changing Business Models

Downstream Revenue: Evaluating the Financial Return of Clinical Alignment Tactics

HIStalk Practice – Downstream Revenue: Evaluating the Financial Return of Clinical Alignment Tactics:

Downstream Revenue: Evaluating the Financial Return of Clinical Alignment Tactics

Hospital-based medical practices have increasingly become a major component of a health system’s clinical integration strategy. Over the past 30 years, many employed physicians have not viewed hospital-based practice models in a positive light. Governance, organizational structure, and leadership in the typical hospital operational model remain foreign to many physicians coming from private practice. These physicians have struggled with the perceived bureaucracy of hospital systems, and often become frustrated and disillusioned with the relationship.

Hospitals have also struggled to justify ongoing financial support of these physician practices, which on their own frequently operate at a loss. The physician-hospital relationship has historically been one of mutual distrust and perceived competing interests. Developing an employment relationship with physicians without a foundation of trust and a clear understanding of the role and objectives of each party typically results in strained relationships and constant conflict over operations and finances.

The investment in any hospital-employed or -affiliated group is significant. Without an accounting of the impact the group has on the downstream revenues brought into the health system, the parent organization naturally exerts pressures to reduce medical group expenses and losses. Analysis of downstream revenues is much broader than reviewing an individual practice or physician P&L. This would include referrals to specialists within the health system, ancillary services such as lab and radiology, and inpatient admissions. Development of the methodology to quantify the downstream impact of the practice’s physicians has been a historic challenge for every group and parent organization. To effectively and efficiently monitor downstream revenues, organizations often utilize business intelligence tools to evaluate the revenues, expenses, and contribution margin of the health system’s broader ambulatory (i.e., specialists) and hospital service lines.

Ultimately, technology in combination with a strong commitment from executive leadership drives downstream revenue within healthcare organizations. Ongoing analysis of this revenue is critical to both the enterprise and its affiliated physicians. Just as organizations want to understand the value practices bring, providers likewise want to understand their overall contribution to the organization – for business reasons and for personal satisfaction.

Accurate analysis allows healthcare organizations to grow through acquisition and alignment, with the confidence to make informed decisions based on a complete understanding of return on investment. They can build their brands within their communities and grow the number of patients under their care.

Health systems, hospitals, and academic medical centers can no longer afford to write blank checks to acquire practices. To achieve success in a value-based world, they must dedicate the resources – including experienced leadership and technology – to measure and drive downstream revenue.


Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.


Clinical Documentation Improvement: Challenges & Best Practices

Clinical Documentation Improvement- Far Beyond ICD-10

article here

Patient Portals – Placing Patients in the Driver’s Seat

Some time ago, the use of the word portal often implied some type of SCI-FI connotation on time travel. One could conjure up the idea of traveling into the future or back in time such as the popular movie “Back to the Future” took us in the 1980s.

Today, given so many healthcare technological advances, the word portal takes on a new meaning. According to Wikipedia, “Patient Portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers, such as physicians and hospitals.” Patient portals are a wonderful tool that allows the patient to take control of managing one’s own healthcare needs. So, how do we convince patients to see the patient portal option as a means to place them in the driver’s seat?

The answer is quite simple: ensure that providers are the champions for using the patient portal and actively participate in its usage with the patient. Let’s face it, most patients today embrace technology. They use email and more recently, they use texting as a way to communicate with family, friends, and significant others. Many Electronic Health Record (EHR) vendors have created ways to transmit text messages from their patient portal software to patients’ cell via text. These same vendors have developed user friendly patient portals that provide numerous services that patients demand such as:

  1. The ability to make or request non urgent appointments
  2. Easy access to lab results
  3. The ability to request prescription refills
  4. Make payments online in a secure fashion

And the list goes on…..

But, with all of our tech savvy abilities, we as patients thrive on interacting with our health care team. After all, we still embrace the “human touch”.

During a recent revenue cycle and clinical system implementation for a large health system, I noticed one of the larger sites (specialty practice) used front desk staff to promote the use of its patient portal. The staff did its best to explain what the portal could do for the patient and patients were given a flyer from the marketing department explaining many of the benefits when using the patient portal. Patients seemed genuinely interested and often commented on how difficult it was to reach their provider regarding appointments, obtaining lab and diagnostic testing results, and just questions in general that needed answers. They often asked the front desk if they signed up and used the portal, would their provider interact with them via the portal! The front desk staff’s reply was less than convincing.

Interestingly, a key missing ingredient for the successful usage of the patient portal for this site is providers championing the use of the patient portal with their respective patients.

During the clinical implementation phase of this project, two key components were missed:

  1. Selecting a provider champion for the patient portal and
  2. Providing key training sessions for providers to understand how this technology could assist them with providing excellent care in an expeditious manner, improve patient satisfaction, and from a business perspective, meet the Stage II Meaningful Use Requirement (5% of the patient population actually uses the patient portal!)

As a result of preliminary metrics on patient portal usage, one of the post go-live initiatives that have been recommended for this site will be to circle back and work with the Chief Medical Officer (CMO) for this large specialty practice to champion patient portal usage and, in conjunction with the vendor, offer mandatory educational sessions about the patient portal and its many benefits for all providers. Providers will be encouraged to talk about the patient portal and its benefits during the patient visit. By showing a keen interest in the patient portal and stating their commitment to using it to better communicate with patients, the hope is that patient portal usage will increase for this site.

Vendors, in recent years, have provided remarkable “bells and whistles” when designing user-friendly patient portals. By and large, patients are not turned off by this technology, they are just looking for that connection with their provider that places them in the driver’s seat on the road to good health.