Tight Reimbursements Meet Sophisticated Rev Cycle Processes

Rene Letourneau, for HealthLeaders Media , March 31, 2014

As population health management becomes the norm and new reimbursement models take hold and threaten to erode revenue, the CFO of a large Pennsylvania teaching hospital unveils his plan to improve collections.

Like many healthcare leaders I have spoken with recently, Michael O'Connor, senior vice president and chief financial officer at WellSpan Health, a 572-bed community teaching hospital in York, PA, sees shifting reimbursement models as a major threat to this organization.

"I think the biggest challenge that we face is actually going to take many years to resolve, which is navigating the change from fee-for-service to being paid to care for populations," he says. "We are trying to make sure we make changes in our delivery system and delivery model both from the clinical and patient services perspective and make sure we are synchronizing that with payment models with commercial payers."

Keeping pace with new value-based payment structures designed around population health management requires a comprehensive approach to clinical care with a particular focus on primary care, O'Connor says.

"We have an integrated delivery model, so we have professional services, ambulatory services, and institutional services. Where it starts is on the professional side, specifically with regard to primary care," he says. "We are very far along with developing patient centered medical home capabilities. All of our primary care practices are patient centered medical homes, and most are quite advanced."

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1 comments on "Tight Reimbursements Meet Sophisticated Rev Cycle Processes"

jkuriyan (4/1/2014 at 9:40 AM)
Both the author and the doctor seem to confuse the meaning of the term "population health management". Dr. Kindig (U of Wisconsin)has defined this term very carefully in publications and in his Blog - and refers to not only the treatment of patients but also the effort to improve "social determinants" - such as the living environment of the patients, their access to care, availability of nutritious food etc. Clearly that is NOT what is being proposed here. What is being done is better described as "managing health of populations." Some day, when Big Data programs work, these programs could become a part of "population health". Meanwhile let's not confuse the two terms.




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