5 ways to reduce staff turnover by promoting wellness

The nature of a healthcare organization is to help others improve their health, but it would save money and reduce turnover if these organizations also focused on their own employees by promoting healthy living and wellness for them.

"There's a huge cost to employers when there's turnover of any kind," said Susan Moriconi, vice president of human resources at Omnicell, a medication and supply automation company based in the San Francisco Bay area. "But when an organization is invested in and committed to the health of their employees ... those people will want to remain with their employer and make a career. Which means organizations can retain institutional memory and scale of knowledge that people gain while they're working." Additionally, healthy employees are both more productive and genuinely happier people.

Moriconi shared her list of five approaches healthcare organizations can take to help reduce turnover costs by promoting healthy living for their own employees.

1. Develop a wellness program

"Programs exist where companies can offer health benefit programs with scaled healthcare premiums if an employee has undergone biometric testing or other screenings made available to them," said Moriconi. Other programs offer financial incentives, like a reward of $75 for having a health screening provided by the company. Offering access to an on-site gym, exercise classes with fitness trainers at no charge and educational courses on healthy lifestyles is also beneficial to employees and employers alike.

2. Support from supervisors

Support from top leadership is incredibly important and influential. When an approach to wellness is initiated and championed by a CEO, employees see it as encouraging.

3. Offer flexible schedules

"Managers should help employees have flexible schedules which would allow them to take advantage of the programs offered," Moriconi said. It's one thing for a company to simply offer health and wellness opportunities, but it's much more beneficial if they take a proactive approach at making sure their employees have the time to take advantage of them.

4. Create work-out rooms to work in

Many companies these days are creating rooms with treadmills where people can hold a meeting or have a conference while walking.

5. Employee engagement

"Allow employees to pick something new they would like to do – a new healthy food or activity they've never tried – and reward them for it," suggested Moriconi. "Offer stress-busting challenges and have employees participate in them a couple times a week over the course of a few months." They can then earn points toward programs such as scaled premiums.

Source: healthcarefinancenews

Control costs, improve care with holistic healthcare management

Large and small healthcare systems across the country are facing a tidal wave of management and cost pressures--a confluence of new regulations, oversight, quality requirements--that are about to get even more complex. The impending changes in reimbursement, regulations, and closer scrutiny of patient outcomes are just the tip of the iceberg.

CFOs, CEOs, and their entire leadership teams are increasingly coping with continually soaring costs (which have led to staff layoffs when hospitals find no other way to meet budgets), shortages of personnel and supplies, increased waiting time, and changing relationships between providers and payers. Given that hospital costs are already among the highest in the nation, it's clear that the pressures to find ways to effectively manage and improve patient outcomes are only going to get worse.

Talk to the CEO/CFO of any hospital system and odds are he or she will be able to cite pockets of success. But ask about the overall impact on the patients and the bottom line, and most would admit falling short.

And that is the problem in a nutshell: Healthcare system improvement is being attacked in "the C-suite" in isolated pockets instead of looking at the whole. The CFO focuses on cost. The CMO looks at quality of care. The CIO is sure that IT will be the solution to most of the problems. The CEO is thinking about whether to join a new provider network or negotiate partnerships with other providers or payers. And radiology institutes streamlining that may throw a monkey wrench into cardiology's processing patients. Department heads innately focus on ensuring that their people are working most effectively and efficiently ... often at the expense of other treatment units. No wonder there is negative synergy created, when improvements in one area cause worse performance in another.

To navigate through the increasingly complex landscape of healthcare, healthcare managers, particularly those charged with watching the bottom line, need to start looking at things more holistically, so that improvements that impact cost and service can be synchronized horizontally--not just vertically.

Actually, the model for success may lie in the movement towards patient-centered care, where practitioners work together to coordinate all the treatment a patient receives--and to make sure that all the components are working together and not in conflict with each other. If you think of the "patient" as the healthcare system, the metaphor is a perfect fit.

Holistic patient-centered care applies in another way. The one thing that can align all the components of a healthcare system is making sure everyone is looking at the system from the patient's perspective. Getting "macro" around how you deliver care to a patient and how the patient receives that care is not easy, but developing that perspective throughout your organization can help you decide where and how to deploy unified and coordinated improvement efforts.

Taking this holistic view of your organization, shaped by the patient's perspective, today is an urgent component in developing a high-performance healthcare culture that can address the myriad of challenges ahead and significantly affect the successful management of costs.

The C-suite, as well as leadership at all levels, must think and act more holistically to synchronize performance improvement to achieve a tangible difference in patient and institutional success.

Source: fiercehealthfinance

Study: Docs increasingly using social media to share medical info

Research published this week in the Journal of Medical Internet Research finds a growing number of physicians using social media to share medical information and stay up to date. American Medical News previously noted YouTube being used in that way, with physicians using videos to present research papers or talks from professional meetings.

In the JMIR survey of 485 practicing oncologists and primary care physicians, 24.1 percent used social media daily or many times daily to scan or explore medical information, while 61 percent did so weekly. Just 14.2 percent contributed new information daily, though 46 percent added material weekly.

The researchers had expected those who view social media positively to be more engaged with it. They found 57.5 percent of respondents considered social media to be beneficial, engaging, and a good way to get current, high-quality information. Roughly the same percentage said that social media has helped them to care for patients more effectively, while 60 percent said it improved the quality of patient care they delivered. Not surprisingly, ease of use and usefulness were the determining factors in doctors' use of social media for sharing information among peers.

With colleagues pointing them toward relevant research and other information, social media can effectively be part of physicians' continuing professional development, the authors said.

Wendy Sue Swanson, an Everett, Wash.-based pediatrician and avid social media supporter, has on several occasions talked about social media as an effective way to share credible health information with patients. Other doctors use Facebook, Twitter and YouTube to engage with patients and market themselves.

Though the debate rages on about the appropriate use of social media by physicians, one bit of advice that could help busy docs is to organize incoming information into customized groups or themes. "Perhaps the most useful is the list I've titled 'essentials,' wrote physician blogger Mark Ryan in a post on KevinMD.com. "When I have only a short window of time, I can skim the essentials list and get high quality information in short order."

Source: fiercehealthit

Medical device M&A activity remains steady

The number of mergers and acquisitions in the medical device sector has been steady over the past three and a half years, according to research and publishing firm Irving Levin Associates’ new report The Medical Device Acquisition Report, Second Edition, 2012.

During the period covered in the report (January 2009 through June 2012), the medical device M&A market accounted for 632 transactions. The 88 deals announced in the first half of 2012 amount to about 14 percent of those deals, a level of activity that is on target to match or exceed the average number of deals transacted in each of the previous three years.

Comparing the number of transactions that were announced in the first six months of 2012 (88) to those announced in the comparable period in 2011 (89), the level of activity appears to be stable. The current year is on track to at least meet the 173 deals announced in all of 2011, according to the report.

The dollar value for transactions for the first half of 2011 was $48.15 billion compared to $14.9 billion for the first half of 2012. The drop in dollar value was primarily due to a $21 billion transaction in April 2011. However, dollar volume for the first half of 2012 exceeded the $13.9 billion reported for the entire year of 2009.

Medical device M&A dipped in the third quarter of 2012 compared to earlier in the year, but it has since rebounded nicely, said Steve Monroe, partner at Irving Levin Associates.

 “We are not quite sure why the volume of medical device M&A dropped so much in the third quarter, other than the usual summer slowdown, concerns about the European debt crisis and our own uncertainty with regard to the ... elections,” said Monroe. “That said, in October, healthcare M&A volume across the board spiked up, and there were 12 medical device deals announced, compared with 19 in the third quarter.”

Although Monroe is optimistic about the future of medical device M&A activity, he believes the uncertainty surrounding the implementation of the Affordable Care Act may slow growth in the sector in the short term.

“As 2013 plays out, especially with regard to getting ready for full implementation of (the) ACA in 2014, we will begin to see the outlines of the healthcare delivery system, and the players will begin to line up to make sure they are well positioned for it. One way will be through acquisitions, but we don't really know about the timing. It does appear, however, that deal sizes in the near term will be smaller as buyers will not want to risk too much without knowing the new rules of the game,” said Monroe.

Source: healthcarefinancenews

Many providers are rethinking the revenue cycle

The concept of revenue integrity holds contrasting-but-compatible views on the same subject: One lens is a micro view of the little details while the other lens is a macro view of the landscape. Together, they form a panoramic picture showing an end-to-end revenue cycle with all the pixilated points along the way. At least that is the financial community's vision of it.

Essentially, "revenue integrity" is a new buzz term for rethinking revenue cycle management, said Greer Contreras, vice president of revenue cycle coding for Dallas-based T-System.

"It revolves around the revenue cycle process but refers to a different way of looking at it in complex financial times," she said. "By adding 'integrity,' you are taking a holistic approach  -  another viewpoint to make sure pieces aren't falling off. Organizations have struggled a bit because the revenue cycle is often isolated and compartmentalized. They need to look at it as one piece."

Revenue integrity also consists of taking a close-up view of revenue cycle components. Depending on which and how many services are rendered, patient charges can take a long and convoluted path on the way to becoming a finished invoice. Without a fastidious system that uses data capture technology and seamless transference of patient insurance status, allowables, deductibles and co-payment information, healthcare providers can be losing serious amounts of money that is due to them, Contreras said.

"Financial leaders need to take a start-to-finish look at departmental deficiencies and the integrity of the entire cycle," she said. "It begins with getting the correct information at intake and diligence throughout the process until it reaches the back end."

Taylor Moorehead, partner for Carmel, Ind.-based Zotec Partners' west region, added that revenue integrity should ensure the value of every contracted service.

"If you have an agreement to receive $1,800 for every knee replacement surgery, revenue integrity means that you should be getting that amount every time," he said.

'Blur the divide'

Along with providing a clear information pathway, revenue integrity also stands for compliance, said Steve Everest, executive vice president of financial solutions for Houston-based Prognosis Health Information Systems.

"It means adhering to billing regulations, reporting standards and instituting efficiencies for sending information through the revenue cycle system while maximizing reimbursement for services provided," he said.

Prognosis specializes in serving small community hospitals, which collectively face greater financial and technological challenges than their "big city cousins," Everest said. As connectivity has advanced, he said, so have opportunities to improve revenues.

"They are trying to get better," Everest said. "Instead of laying everything on the back office to sort out after the fact, we're helping them blend the information upfront  -  getting both the financial and clinical groups to blur the divide. We're teaching our clients to address these things as they happen and head off a mess at the end."

Process integration

Revenue integrity is more than a term  -  it is a revenue model itself, said Kevin Arner, CEO of Jacksonville, Fla.-based PaySpan.

"Revenue has traditionally been an afterthought, but it is not something we can continue to manage in that way," he said. "It should begin at the onset of care and requires conversation on the functional capabilities of providers and a dialogue with payers. It should consist of integrating processes across the entire revenue life cycle. The old way doesn't really support the downstream business process that drives reimbursement."

The clinical community, to its credit, has evolved significantly in the quest to capture data at the point of care, said Arner.

"They've taken a big step forward and have done well with the capture," he said. "What hasn't adapted are the financial tools to support the process. They have been antiquated. Patient interactions are different than payer interactions."

Eyeing the middle

Rob Jones, director of revenue enhancement practice for Chadds Ford, Pa.-based IMA Consulting, believes that great attention has been placed on the front and back ends while the largest segment  -  the middle  -  gets neglected.

"These are the aspects of coding and compliance  -  all the dots in the continuum of care within the revenue cycle need to be connected," he said. "We've relied on technology to push information from front to back, but the challenge is only as good as the people who program it and if it is not programmed by experts, there will be gaps. The emphasis is to focus on systems and people so that everyone involved truly understands the complexity from beginning to end."

The claim form may be the most important document in the entire process, Jones said, because it is the catalyst for getting revenue in the door. The form is structured to capture a comprehensive data profile that puts the entire revenue cycle in motion, he said.

"By the time it hits the business office, the staff should be working on getting that claim paid," said Jones. "This is a process with no short cuts  -  it should include everyone, from front to back."

Source: healthcarefinancenews

4 Areas Where Better Documentation Can Improve Hospital Revenue

Clinical documentation improvement programs at hospitals usually conjure up notions of coding and health information management, but CDI goes much further. A main tenet of a successful CDI program is that it should lead to an increase in the hospital's revenue because most hospitals fail to capture the actual severity of illness of patients due to inadequate physician documentation.

CDI programs help hospitals better interpret coded data for comparisons, benchmarking and quality reporting, and the resulting documentation improvement benefits the bottom line in a plethora of ways, says Paul Weygandt, MD, JD, vice president of physician services for J.A. Thomas & Associates, a healthcare compliance and documentation firm.

Dr. Weygandt, an orthopedic surgeon, used to be vice president of medical affairs at Conemaugh Health System in Johnstown, Pa. He has been with JATA for the past eight years, helping hospitals that may be losing money from inadequate documentation. He says documentation problems do not just affect physicians and coders — the impact runs all the way up to the C-suite.

"Many CFOs historically have thought of CDI as a branch of the HIM department for the sole purpose of improving their coding," Dr. Weygandt says. "It really is a collaborative process. That's the key."

Here, he explains four areas that impact a hospital's revenue that could also be improved through a successful CDI initiative.

1. Case mix index. CMI is an essential measurement for any hospital CFO and financial department. CMI measures the relative cost needed to treat a hospital's Medicare population, and it explains the types of patients the hospital treats (by co-morbidities, complications, gender, etc.). Basically, it reflects the average severity of illness of all Medicare patients treated at the hospital. The higher the CMI, the more high-revenue services the hospital performs.

Documentation directly impacts CMI. For instance, if physicians are too vague in their descriptions, the result could could be undercoding, which lowers the CMI and leaves revenue on the table. "The starting point [of CDI] is CMI," Dr. Weygandt says. "Every CFO relates CMI to revenue and to any case-based payment methodology."

2. Management of recovery audit contractors. It's no secret that Medicare RACs are aggressively pursuing hospitals and health systems for potential overpayments. In the third quarter of the 2012 federal fiscal year, Medicare RACs collected $657.2 million in overpayments — the highest total of any quarter in the program's history.

A CDI program can refine and clean up a hospital's claims, which could both provide payment justification to RACs and allow a hospital to spend less administrative resources on managing the RAC process. "Hospital CFOs are acutely aware of short-stay admissions and observation stays monitored [by RACs]," Dr. Weygandt says. "Correct coding of medical necessity for admission is a huge revenue cycle focus. And that's all driven by physician documentation and medical necessity for admission."

3. Quality standards and readmissions. Under the Patient Protection and Affordable Care Act, Medicare readmissions penalties are now under way across all hospitals. Hospitals stand to lose portions of their Medicare funds if their readmission rates are too high, and Dr. Weygandt says readmissions and other quality standards — such as hospital-acquired infections — are often defined by documentation.

This is where the finance, HIM and clinical departments must collaborate. This is especially true for the hospital CFO and CMO. Dr. Weygandt says in order for a hospital to maintain high clinical quality scores, thus maintaining appropriate revenue, CFOs and CMOs must incorporate each other's mindsets into their strategic planning. CFOs must be mindful of clinical standards, while CMOs must be aware of the hospital's cash flow — and better documentation connects the two ideas together.

"There is a blurring between the silos of CMOs and CFOs," Dr. Weygandt says. "CFOs have to be more conscious of quality, and CMOs have to be more conscious of maintaining appropriate revenue, limiting readmissions and preparing for accountable care."

4. ICD-10. CDI initiatives are most closely linked to coding projects, and no coding project is bigger right now than ICD-10. CDI programs could directly help a hospital's ICD-10 implementation, which will affect a hospital's bottom line and budget planning in numerous ways — ranging from IT changes to staff training.

"ICD-10 will be a big transition for the revenue cycle," Dr. Weygandt says. "It's a perfect time for CFOs and CMOs to build the appropriate infrastructure for success, if they don't already have it."

Executive and physician leadership

Dr. Weygandt has more than two decades of experience as a physician leader and CDI specialist, and he reiterates that in order for CDI programs to be successful and assure appropriate hospital revenue, there must be physician buy-in. Hospital executives will need to put their physician relationship skills to the test, and selling the idea rather than ordering a mandate will lead to the desired result.

"A documentation program only succeeds with the cooperation of medical staff," Dr. Weygandt says. "I would push to have the program structured under the medical staff's direction to some extent. For example, it's easier to get physician cooperation if documentation initiatives are driven by physician leadership. If this is thrown at a medical staff, it may be accepted, rejected or somewhere in between."

Source: beckershospitalreview

Sustainability efforts could save healthcare industry $15B over 10 years

A study published last week by The Commonwealth Fund found that hospital sustainability efforts could save the healthcare industry up to $5.4 billion over five years and $15 billion over 10 years.

The study, which was sponsored by the Healthier Hospitals Initiative (HHI) and Health Care Without Harm (HCWH) through grants from The Commonwealth Fund and The Robert Wood Johnson Foundation, tracked nine U.S. hospitals or health systems that adopted sustainability initiatives into their waste management, energy use and operating room supply procurement practices. Each hospital realized significant savings, even those that made initial investments to adopt the sustainability program, according to the study.

"This study turns on its head the belief that introducing environmental sustainability measures increases operating costs," said Blair L. Sadler, an author of the study and a senior fellow at the Institute for Healthcare Improvement, in a press release.

HHI is a national campaign that began in April 2012 to implement a new approach to improving environmental health and sustainability in the healthcare sector. Eleven of the largest U.S. health systems, comprising approximately 500 hospitals with more than $20 billion in purchasing power, worked with HCWH, the Center for Health Design and Practice Greenhealth to create HHI as a guide for hospitals to improve sustainability.

The HHI is a set of six challenges for hospitals nationwide aimed at improving the healthcare sector’s environmental footprint that include engaged leadership, healthier foods, leaner energy, less waste, safer chemicals and smarter purchasing, said Gary Cohen, president and founder of HCWH. The HHI provides a free framework to support the nation’s hospitals in taking on the six HHI challenges.

 “One of the core mandates for healthcare reform is to reduce costs and eliminate waste in the system, so we’re offering a unique way to reduce waste literally, and through that, how to save money,” said Cohen. “And even more than that, if we’re going to address the epidemic of chronic diseases like obesity, asthma and diabetes, healthcare needs to play a role outside of the four walls of its facilities; it needs to create healthier communities and food systems so we aren’t getting our communities sick.”

Gundersen Lutheran Health System in La Crosse, Wis., was the first hospital system to sign up for all six of HHI’s challenges.

"This is not only good for the community, but you can really save money. Our $2 million investment saves us $1 million a year,” said Gundersen Lutheran Health System CEO Jeff Thompson. “The HHI set a high standard for us, and we signed up for all six challenges. It’s a great product to quantify best practices so people can get educated and be inspired.”

The report's authors suggest that given the return on investment, all hospitals should adopt programs, such as the ones offered by the HHI and noted that "... (I)n cases where capital investments could be financially burdensome ... public funds (should) be used to provide loans or grants, particularly to safety-net hospitals.”

Source: healthcarefinancenews