Leveraging Your Employed Physician Group for Payment Reform Success

Reimbursement for healthcare providers is continuing to shift towards increased incentives for quality outcomes and cost management, as insurers (particularly CMS) focus on reducing fee-for-service payments and increasing the amount of risk taken on by providers. As examples of this, recently, we have seen CMS release its regulations for Accountable Care Organizations (ACOs), which will reward providers who are able to reduce CMS’s per capita patient costs and have seen several announcements of private insurers developing bundled payment programs for particular full episodes of care. The greatest success under these models of reimbursement will be earned by the provider organizations who are able to most quickly change care processes to account for these incentives.

Increasing the Value of Your Employed Physician Group

Hospitals and systems have mixed results when employing increasing numbers of physicians, that according to the influx of calls we have fielded from our clients. They want to know the best way to engage these physicians to improve results, citing significant practice losses, physician apathy, and frustration from administration that employment has not had more of an impact on the hospital and the care delivered within the community.

Transitioning to ACOs: Six Strategies To Implement NOW

"But what should I be doing NOW?" Several CEOs have asked us that question, as they struggle with how to make an effective transition from a market that incents volume to one that incents quality and efficiency. We can't stress enough the importance of preparing NOW for the new incentive structure. Those that aren't are losing ground to their competitors.

Baby Steps Towards ACO Development

While not all (or even many) organizations are equipped to develop an ACO by 2012, organizations should be building the infrastructure and competencies necessary to facilitate entering the ACO market when it is strategically prudent to do so. The release of the CMS Accountable Care Organization (ACO) regulations has sparked questions from executives about how quickly their hospitals or health systems will enter the ACO market (private or CMS) given the amount of risk and complexity involved.

Preparing Compensation Plans for Pay-For-Performance

The healthcare reform law has essentially signaled the beginning of the end of the fee-for-service (FFS) as we know it. The likely replacement is some variation on a pay-for-performance (PFP) model. While this shift won’t happen overnight, now is the time to start thinking about the future of your employed physician compensation plan.

Medicare and Physician Rates

With the 21%+ sustainable growth rate cut in place, it will be interesting to see the next step. We believe there will be a permanent solution, but it will not be pretty. In particular, we believe that specialists are at risk, the most likely victim of the budget cutting knife.

Physician Compensation: Having the Tough Conversation

Judging by the interest in our physician compensation webinar, this is a hot topic. Considering that Medicare rate cuts are discussed annually, and that operating costs continue to increase, some private practices are left wondering how they?re going to survive. The net result is that physician incomes are declining and the market trends indicate that this will continue. Faced with increased operating losses, managers of hospital employed physician networks are struggling to align physician compensation with productivity. This very often puts the physicians and the administration at odds. The following points will help you craft a structured, on-point message and strategy to manage physician compensation issues.

Developing a REAL Marketing Plan

Many hospitals or health systems with an employed physician network struggle to find additional ways to drive profitable volume through their primary care practices and increase referrals to their specialty practices that will generate inpatient volume. When these practices are not seeing the volume or payer mix needed to support them, physician retention often becomes an issue, as the employment model is not sustainable without sufficient production.

Accountable Care Organization Readiness

Accountable Care Organizations (ACOs) are receiving increased interest, from the Brooking-Dartmouth demonstration sites to the interest in Washington related to the floundering reform efforts. ACOs are designed to hold a group of physicians and other providers responsible for the quality and cost of care provided to a discrete population. Holding providers accountable for results seems an obvious next step in the evolution of the healthcare system.