GE Healthcare Camden Group Insights Blog

Hospitals are Not Hotels: Examining the "Discharge By Noon" Strategy

Posted by Matthew Smith on Aug 25, 2016 10:11:15 AM

By Dominic Foscato, Senior Vice President, and Nehal Koradia, RN, MBA, Manager, GE Healthcare Camden Group

12noon1.jpgMost healthcare organizations have goals of shifting care from acute to ambulatory settings while maintaining or improving quality and satisfaction. That goal has not led to a drop in occupancy rates in every geographic market. Inpatient volumes continue to increase in many markets due to demographic changes, Medicaid expansion, and physician recruitment and consumer engagement projects.

Managing consistently high inpatient occupancy has created many ingenious tools/processes across the country. Healthcare providers have tried many approaches to solve inpatient capacity problems, but many have failed due to poor communication, lack of prioritization, fragmented approaches to change management, misaligned stakeholders, or unclear objectives. Not all of those ideas will solve the main problem (bed shortages) and some may negatively impact cost, quality and other desired outcomes.

Capacity_challenge.pngGE Healthcare Camden Group helps organizations design and implement new approaches to managing capacity/throughput challenges. Clinical leaders often ask our team to conduct three-to six-month studies to model their operations in a virtual environment while posing 3-4 key strategic questions and developing a macro capacity model using the following framework:

  1. Define specific objectives and create leadership committees responsible for the engagement decisions, timeline, and communication
  2. Analyze one-to-two years of available data from various sources to create a simulation model
  3. Create workgroups consisting of staff, department leaders, and clinicians to validate the model and assess potential impact of process or volume changes

One of the key strategic questions that we are asked to model is whether or not ‘Discharge by Noon’ or similar measures may inadvertently create more challenges than it solves. We typically find the following to be true:

  • Optimal patient flow dictates that beds are available when needed
  • Focus must be on the “occupancy overlap” when census spikes for 2-3 hours quickly followed by large numbers of discharges
  • There is a need to reduce ‘empty/unused bed time’--particularly when there is demand
  • Manage to ‘discharge order response’ times
  • Ideal flow would have discharge curve about 90-120 minutes ahead of bed request curve by type of bed needed
  • Achievable goals drive results
    • Generic ‘Discharge by ‘X’ as a house-wide goal often have higher observed/expected LOS ratios and rarely earlier discharges
    • Alternatively, we analyze which nursing units or hospital services need inpatient beds and then focus the care team on prioritizing activities to produce timely discharges



But remember, it is not just about discharging a certain number of patients before noon when thinking about patient flow/throughput. If your organization already has a goal for discharge time, or is considering setting one, we recommend performing a thorough review by asking these types of questions:

  1. To prevent congestion, how many beds do you need? When do you need these beds?
  2. Which units or services need more beds? Which have too many?
  3. How will you design solutions that align the care team around designation, communication, and execution so that a patient can successfully be discharged in the morning?

Our most successful clients take a very structured approach to answering these questions and defining their capacity strategy. They balance the use of advanced analytic modeling with feasibility studies. The outputs from this process allow them to establish clear goals and expectations that motivate their entire organization. By setting reasonable and achievable unit/service level goals that contribute to solving organizational objectives (i.e., lower LOS, higher quality/satisfaction), the implemented changes have a higher impact and are more sustainable.

Inpatient Occupancy Planning

Foscato.jpgMr. Foscato serves as a senior vice president with GE HealthcareCamden Group responsible for the overall design andimplementation of solutions, thought leadership and solution development. Mr. Foscato has deep domain expertise in improving clinical operations, implementing enabling technologies, optimizing revenue cycle and patient access functions for healthcare providers to deliver more effective patient care and financial performance. He also assists clients with activating strategy leveraging GE’s world-renowned management and leadership systems. He may be reached at dominic.foscato@ge.com.


KoradiaN.jpgMs. Koradia is a manager with GE Healthcare Camden Group. She has been leading healthcare organizations through transformation initiatives for over nine years. Ms. Koradia has worked with many large academic centers and community hospitals to transform their operating rooms, decrease readmission rates, increase early morning discharges, and reduce ER wait times by utilizing simulation modeling. She may be reached at nehal.koradia@ge.com.

Topics: Dominic Foscato, Nehal Koradia, Hospital Discharge, Occupancy Overlap, Inpatient Occupancy Planning, LOS, Priority Discharge, Hospital Occupancy, Length of Stay

Population Health 2.0: Activate Your Strategy Through a PHSO

Posted by Matthew Smith on Aug 18, 2016 11:12:27 AM

By Graham Brown, MPH, CRC, Vice President, and Lucy Zielinski, Vice President, GE Healthcare Camden Group

population_health.jpgWith the transition to value-based payment, medical practices are aligning with Accountable Care Organizations (“ACOs”) and clinically integrated networks (“CINs”). These enabling business structures, with the new payment models, require a new level of support to medical practices. A true Population Health Support Organization (“PHSO”) is the perfect fit in a dynamically evolving delivery landscape.

Strategically, a PHSO aims to integrate providers, hospitals, payers, and services across the continuum of patient care. The interoperability between each of the entities reduces fragmented patient care and serves as the bridge between healthcare silos. A PHSO is the key platform to help providers transition into the new world of medicine by providing infrastructure for physicians to reshape and drive patient-centered care and engagement via efficient management of patient populations. It is a sound structure for those starting and maintaining a CIN, or simply for those managing medical practices that are evolving to meet the demands of the future delivery system. Much like Management Service Organizations (“MSOs”) of the past, a well-designed PHSO may also support physicians who wish to remain and thrive in private practice but still collaborate with other providers across the continuum.

Setting the Objectives

The objectives of a PHSO are three-fold: support physicians in sound financial management, quality improvement, and infrastructure needed for population health. These include moving the needle on quality measures and outcome performance, controlling total cost of care, and providing improved patient access to medical care. The goal is to improve patient loyalty and experience, ultimately keeping patients in the organized system of care. The PHSO also acts as an aggregator of key patient and administrative data; so it may become the conduit for the transfer of knowledge critical to success in managing the health of populations.


So how is the PHSO of tomorrow different from the MSO of the past? The PHSO is a vehicle to connect all the dots for the transformation from the old fee-for-service to the new value-based payment models. There are many benefits to organizing and operating a PHSO to support physicians’ transition to value-based care delivery, including:

  • Integrating physicians with the organized delivery system of care, which supports ACO and CIN initiatives
  • Providing a contracting vehicle that allows and supports providers to assume risk and manage it effectively.
  • Coordinating the care management services across the continuum and managing transitions of care from one setting to another
  • Enhancing system interoperability to exchange and share data among the providers to support care delivery
  • Improving financial performance and managing the complexities of practice management
  • Ensuring compliance with CMS programs, such as MACRA, and avoiding payment reductions
  • Supporting consumerism by creating a unified brand focused on consumer experience and loyalty
  • Managing the revenue cycle and coding processes (i.e., diagnosis coding, chronic care management requirements, Hierarchical Condition Categories ("HCC")/Risk Adjustment Factor ("RAF) to support value-based contracts
  • Providing education to physicians—both employed and independent—on topics such as industry trends, leadership, care redesign, etc.

Whether physicians are employed or independent, the PHSO can support them equally while providing a vehicle for improved operational and financial performance.  

Where to Begin

Systems should begin by assessing their employed medical groups and conducting outreach to independent, affiliated medical groups to determine needs, timing of the value-based transition, and identify the gaps. These become the starting points for core PHSO services. An existing CIN, ACO, or MSO could evolve to become the PHSO. The key to success is either designing a new or adapting an existing organization to fill the identified gaps of support services needed to be successful under changing reimbursement and care delivery models. Lastly, the PHSO can be used to gain new relationships while strengthening existing relationships with physicians. These partnerships will allow the collective organizations to ultimately improve the health of the populations they manage.

The healthcare delivery system and corresponding reimbursement models are undergoing significant change…which is unlikely to slow down. The old ways to practice medicine will no longer work in the world of a value-based payment system. A transformation of current practice structure, business strategy, and partnerships along the continuum of care will play key roles for success in the new healthcare world.

  Population Health Support Organizations, PHSO

BrownG-470185-edited.jpgMr. Brown is a vice president and clinical integration practice leader with GE Healthcare Camden Group and has over 25 years of experience in the areas of payer negotiations, program administration, and change management with healthcare provider, payer, government, and human service clients. He is an experienced leader in business planning and implementation for clinical integration and accountable care organization development across the U.S. He may be reached at g.brown@ge.com.


ZielinskiL-069442-edited.jpgMs. Zielinski is a vice president with GE Healthcare Camden Group. With over 25 years of experience in the healthcare industry, she specializes in helping private and hospital-owned medical groups achieve top financial and operational performance. Such optimization is achieved through physician-hospital alignment—including clinically-integrated networks, strategic planning, practice transformation, coding and revenue cycle improvement, physician compensation plan design, and health information technology, and data analytics optimization. She may be reached at Lucia.Zielinski@ge.com.


Topics: ACO, CIN, Lucy Zielinski, Graham Brown, Population Health Support Organization, PHSO

Demystifying Length of Stay Projects

Posted by Matthew Smith on Aug 16, 2016 11:39:35 AM

By Dominic Foscato, Senior Vice President, and Bree Theobald, Vice President, GE Healthcare Camden Group

Length of StayWhen educating healthcare executives to lead high-occupancy organizations, one of the fundamental outcomes-based measures to monitor is Length of Stay (“LOS”). Usually, the organization has tried many approaches to solving capacity problems but many have failed due to some of the following reasons:

  • Competing priorities
  • Misaligned incentives for key stakeholders (physicians and hospitals)
  • Perception of negative impact to revenue for percentage of charges and per diem payers
  • Poor communication within and between departments
  • Not aligning care models around the consumer experience
  • Lack of data to drive transparency and accountability

When healthcare leaders approach us with a LOS problem, we ask them the following questions before advising on how to proceed:

  • How do you define LOS? Current/in-house, discharged average LOS severity adjusted (comparing observed to expected benchmark)
  • Is it isolated to a specific hospital, department (Emergency Department (ED), Post Anesthesia Care Unit (PACU), etc.), nursing unit, service, disposition, time of year, day of week?
  • How much of a LOS problem is felt by a mid-afternoon census alert? Could it be a throughput/flow issue instead

We then want to understand the internal dynamics, such as:

  • How would other leaders and disciplines respond to the three questions above? Does your organization have a single, consistent point-of-view?
  • How frequently are LOS measurements and key process measures reported? Are department/hospital/system clinical leaders reviewing these metrics and continuously improving?
  • Are incentives aligned for the key stakeholders (especially those that are not in your organization)? How can you influence those groups to help you achieve your goals?

Once we’ve obtained a high-level understanding of the challenge(s), the next step is to understand stakeholder involvement, alignment, and expertise.

Case Study

Here’s a common scenario where health systems engage GE Healthcare Camden Group, coupled with our approach to improving operations:


  • 450 bed, Level I Trauma Center in medium-sized city
  • State Medicaid expansion and physician recruitment have increased demand for IP beds
  • Hospital is working through many solutions: co-locating patients, redesigning hospital beds, planning for IP and ED expansions, managing internal projects on discharge timing, readmissions, and bundled payments


The Performance Improvement department has recently assessed LOS and reported to its Senior Leadership Team that the organization has a LOS problem.

Our Solution:

  • Perform a ‘Flash Discovery’ by conducting key stakeholder meetings and data analyses
  • Create/Modify a Steering Committee charged with engagement oversight, communication, resource allocation, and executing decisions
  • Conduct a 3-5 month ‘Capacity Strategy’ engagement to model operations and unique patient pathways around 3-4 key strategic questions
Follow-on initiatives include:
  • Create highly efficient/effective, daily multidisciplinary rounds to discuss each patient’s plan for the stay/day, progress towards transition/discharge with all key members of the care team
  • Re-allocate beds to services based on historic demand, budgeted volume or other initiative to mirror the patient placement matrix
  • Redesigning Case Management to ensure appropriate staffing, staff utilization, resource utilization, workflow and expectations align with efficiently delivering healthcare
  • Target specific patient populations for administrative or clinical LOS opportunity (e.g., pneumonia, heart failure, hips/knee replacement)
  • Reduce elective variation in the Operating Room and create a more predictable outflow with ‘priority discharges’ to better align demand and availability of beds



  • Each healthcare market is unique, but in this example, the hospital was losing patients to competitors due to capacity issues. By creating organizational alignment, studying LOS and process metrics and selecting a few initiatives to impact LOS, the client reduced severity-adjusted LOS and created capacity to treat new patients.
  • By treating more patients, referring physicians and network facilities were more engaged as the hospital was now more ‘accessible’ and information more widely trusted/understood.

There is great power in taking more of a transformative approach with this as a major initiative well supported by leadership, data driven, and executed in a way that involves a number of change management tools to help drive and sustain change.

  Capacity Management, Length of Stay

Foscato.jpgMr. Foscato serves as a senior vice president with GE HealthcareCamden Group responsible for the overall design andimplementation of solutions, thought leadership and solutiondevelopment. Mr. Foscato has deep domain expertise in improvingclinical operations, implementing enabling technologies, optimizingrevenue cycle and patient access functions for healthcare providersto deliver more effective patient care and financial performance. He also assists clients withactivating strategy leveraging GE’s world renowned management and leadership systems. He may be reached at dominic.foscato@ge.com. 


Bree_Theobald.pngMs. Theobald has been leading healthcare organizations through transformation efforts for 8 years with GE Healthcare Camden Group, focusing on utilizing simulation modeling and advanced analytical tools to optimize capacity, whether that be inpatient, procedural, or clinic capacity. This has allowed organizations to improve access for patients, streamline operations and improve financial performance, while also creating a culture of continuous improvement. Currently, in her role as a vice president, she has spent the last five years navigating and aligning academic medical centers to deliver measurable improvements. She may be reached at bree.theobald@ge.com. 

Topics: Dominic Foscato, Bree Theobald, Capacity Management, Occupancy, Length of Stay

Preparing for Episode Payment Models—Next Up: Cardiac Care Bundled Payments

Posted by Matthew Smith on Aug 15, 2016 9:53:21 AM

By Andy McNerney, Manager, GE Healthcare Camden Group

shutterstock_458338498.jpgCMS’s newly proposed Episode Payment Models (“EPM”), focused on cardiac care, is the second major push to mandate the national adoption of bundled payments’ in recent years. Perhaps your organization was spared as you watched 67 other markets forced to bundle joint replacements. If your reaction was only to feel lucky that you dodged the swipe of our government’s hand instead of better preparing your service lines for episode based care delivery, then it’s time to organize regardless of which markets are selected this time around. 

These cardiac mandates have been proposed under the umbrella of EPMs, and participation will qualify physicians towards Advanced Alternative Payment Models (“APMs”) credit suggests CMS’ intention to roll out more. Although a cardiac episode presents very different challenges than a joint replacement, the way your service line approaches the episode care design, standardization, and monitoring process is very similar. If you haven’t already started enabling your service lines to execute on a bundle, don’t wait for a government dart to land in your market to do so. Instead, start developing work teams responsible to design and standardize processes across the pre-acute, inpatient, and post-acute setting as well as work teams dedicated to the reporting and monitoring of outcomes and engagement of patients across the entire episode.

The Proposed Model

Three major components make up the mandatory EPM proposal:

1. Cardiac Bundles: Inpatient admissions will be paid under a bundled payment for Acute Myocardial Infarction (“AMI”) episodes and Coronary Artery Bypass Graft (“CABG”) episodes for the next 5 years as follows:

  • Episode length: 90 days post-discharge
  • Mandated Markets: 98 random markets (rural markets excluded)
  • Downside Risks and Gains: Phased in over time and max out at 20 percent in the final years
  • Target Price: Weighted to hospitals’ historical performance in year 1 and transitions to one regional price in year 5
  • Quality and patient satisfaction scores influence financial gain or downside risk

2. Cardiac Rehabilitation (“CR”) Incentives: CMS will incent cardiac rehabilitation services utilization post-discharge within the 90-day episode period through retrospective payments as follows:

  • First 11 CR Services post-discharge from CABG or AMI admission: $25
  • Remaining CR Services in 90-Day Episode: $175

3. CJR Addition: Surgery for Hip Fractures was added to the current CJR mandate and will only immediately affect those hospitals in CJR mandated regions.

Not surprisingly, the proposed cardiac bundles are designed with very similar objectives to the CJR bundles: reduce unnecessary utilization such as readmissions, incent discharge placement to the appropriate care setting, promote care coordination across providers, and improve quality through care model design and standardization. As such, organizations embracing this cross-continuum care delivery work for the first time should start by establishing work groups that represent the following four areas:

  • Inpatient Clinical Redesign: While some patients present as non-emergent cases, many are through the emergency department when episode expectations can’t be set in advance, as is done with pre-surgical joint placement classes. These cardiac episodes contain both surgical and medical care making physician engagement even more important. Form a work group now that identifies opportunities to improve quality and develop a standardized care approach. Consider the following representatives: cardiovascular surgeons, cardiologists, hospitalists, case managers, social workers, operating room leadership, supply and implant purchasers, emergency room physicians, and a strong physician lead driving change.
  • Post-Acute Care: Similar to CJR, a work groups’ time should be spent standardizing discharge placement protocols and identifying preferred providers (SNF, HH, IRF, Cardiac Rehab providers, and others) who commit to sharing data, adhering to best practice protocols, and meeting quality requirements. Much more important for cardiac bundles will be transitioning patients back to OP partners and processes dedicated to managing the chronic conditions that led to the original admission. Consider the following representatives: Post-acute care managers, SNFists, Cardiac Rehab clinicians, inpatient case managers, cardiac services line leaders, and other care coordinators.
  • Quality and Reporting: Monitoring your bundle performance as real-time as possible and ahead of the quarterly report from CMS will keep your care teams engaged and promote a culture of continuous improvement. Utilize representatives from finance and data / analytics to research dashboards and tools that help identify care delivery and cost variation and allow care coordinators to identify and track bundle patients in your system.
  • Patient Engagement: One major variable differs greatly to the CJR bundle—the patient population. Unlike an elective joint patient, this population has greater co-existing chronic conditions and will naturally have more unplanned services and complications which make achieving your objectives more unpredictable. Successfully engaging patients can make the difference and justifies the need for establishing a patient engagement work group. This work group should take a more social view and identify programs and tools to assist with adherence to treatments and medication management, compliance with Cardiac Rehab care plan and follow-up appointments, adherence to dietary and nutrition regimes, and social support services. This group may be an extension of other population health initiatives identifying high risk patients through risk assessment tools and empowers them with tactics and technologies to manage their recovery and prevention.

We recognize that resources are scarce, competing initiatives are many, and establishing work groups and initiatives without an actual mandate or direct incentive can be a tough sell. If you are not able to organize your operations and select service lines around the above work teams for the simple reason that it’s best for patients in your community, then do so under the assumption that bundles are here to stay, and the works needs to get done to succeed within them.    

Cardiac Care Bundled Payments

mcnerney.jpgMr. McNerney is a manager with GE Healthcare Camden Group. His primary area of focus is bundled payments strategy, design, and implementation. Mr. McNerney also specializes in system and service line strategic planning and new business development for a variety of healthcare organizations. He may be reached at andrew.mcnerney@ge.com 




Topics: Bundled Payments, CMS, Andy McNerney, Cardiac Care, Episode Payment Models

Two New Infographics to Help You Understand (and Explain) MACRA

Posted by Matthew Smith on Aug 11, 2016 2:53:14 PM

Healthcare_Infographic.pngAs you've likely learned, the Medicare Access & CHIP Reauthorization Act of 2015 (“MACRA”) intends to reform Medicare payments to physicians over the next several years via two pathways:

  1. The Merit-Based Incentive Payment System (“MIPS”)
  2. Alternate Payment Models (“APMs”), which will take effect starting in 2017

These two new infographics, created by the American College of Rheumatology and the American Academy of Neurology, respectively, illustrate the two pathways and provide a visual reimbursement timeline. Links to full-size renderings of each infographic are available beneath each graphic.

To read more of GE Healthcare Camden Group's thought leadership surrounding MACRA, please link to the Insights Blog articles below:

Making Sense Out of MACRA and Alternative Payment Models

Top 10 Actions to Take Now to Prepare for MACRA

MACRA: How the New Merit-Based Incentive Payment System Will Impact Physician Practices

National Association of ACOs: MSSP Commitment Hinges on MACRA Advancecd APM Bonus Eligibility

MACRA-the-Big-Idea.pngFor full-size rendering click here


For full-size rendering click here


Topics: Infographic, MACRA, Alternative Payment Models, MIPS, Merit-Based Incentive Payment System, APM

The Patient Experience Report Card: Gauge Your Readiness

Posted by Matthew Smith on Aug 9, 2016 3:06:45 PM

By Jeff Gourdji, Partner, Prophet and Laura Jacobs, MPH, President, GE Healthcare Camden Group

report cardThere's probably no organization in the healthcare universe that isn't at least talking about patient experience. But after interviewing hundreds of them, from small providers to massive hospital systems, we've learned that most are still struggling to attain optimal performance. They want to make patients happy, but they are unable or unsure how to achieve consistent results.

They've got legitimate reasons for lagging behind: While they all know patient satisfaction is important, many are in merge-or-die mode, which comes with a host of regulatory scrutiny. More pressing problems, such as controlling the cost of care, are demanding top executives' attention. Almost all hospital CEOs say patient experience is on their radar, making it into the top-10 list of concerns. But it rarely cracks the top three.

Smart organizations know that has to change. As the competitive landscape shifts to a world of mega-systems, patient experience will provide one of the few ways to differentiate, and ultimately succeed.

To understand the state of patient experience, Prophet and GE Healthcare Camden Group conducted intensive research among healthcare executives and created a maturity model based on our findings. We learned that most organizations fall into four broad stages of performance, and there are steps to take to transition from one stage to the next. An honest appraisal of where an organization is now is the only way to get better.

To continue reading this article in its entirety at Becker's Hospital Review, please click the button below for immediate access:

Patient Experience

Topics: Patient Experience, Laura Jacobs, Prophet

Making Sense Out of MACRA and Alternative Payment Models

Posted by Matthew Smith on Aug 4, 2016 3:57:47 PM

By Sabrina Burnett, Vice President, and Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

MACRA_Image.pngProviders may have developed a false sense of security that time is on their side—MACRA does not start until 2019, right?  While 2019 is the official date for the new payment models, performance beginning January 1, 2017, will determine 2019 payment adjustments.

CMS published the proposed rule defining their intentions under the new Quality Performance Program on May 9, 2016, and accepted comments on the proposed rule until June 27, 2016. CMS is expected to release the final rule by November, but their goal has remained firm: move 80 percent of Medicare payment to alternative payment models (“APM’s”) by the year 2020.

Path of Advanced APMs

While it may make sense for the majority of providers to initially go down the path with Merit-Based Incentive Payment System (“MIPS”), here is the critical information providers should know if they plan to participate in an Advanced APM.

MACRA outlines significant incentives to encourage providers to participate in Advanced APMs, including a 5 percent bonus starting in 2019 and an exemption from MIPS. The Advanced APM program, unlike MIPS, has no potential penalties. However, participation will not come easy. CMS set the standard high and challenges providers to satisfy the Advanced APM criteria.

  • Advanced APMs require providers to accept risk for delivering coordinated, high-quality care. As proposed, Advanced APM models must be a CMS Innovation Center model, a Medicare MSSP ACO, a demonstration under the Health Care Quality Demonstration Program, or a statutorily required demonstration and must meet the following additional requirements:
    • Utilize certified EHR technology
    • Report quality measures comparable to MIPS measures
    • Assume more than nominal financial risk

Initially only the following five Advanced APMs will be recognized under the new rule:

  • Medicare Shared Savings Program (“MSSP”) (Track 2 and Track 3)
  • Next Generation ACO Model
  • Comprehensive Primary Care Plus
  • Comprehensive ESRD Care Model
  • Oncology Care Model

Exclusions Apply

To the dismay of some, three programs have been excluded:  MSSP Track 1, Comprehensive Care for Joint Replacement (“CJR”), and Bundled Payments for Care Improvement (“BPCI”).

CMS will add new payment models and continue to modify models in coming years that satisfy the criteria to qualify as an Advanced AMP. Until 2021, participation requirements for Advanced APMs are only for Medicare payments or patients.

If your organization is trying to determine if moving to an Advanced APM makes sense, you should conduct an organizational self-assessment to identify current capabilities and those still needed to achieve status as an Advanced APM. It is imperative to understand the clinical and technical capabilities, resources, and skills necessary to be successful.

Key Considerations

  • Do you have progressive financial and clinical data analytics and reporting capabilities?
  • Are you prepared to invest in technology and care model redesign to improve clinical quality, reduce inefficiencies, improve provider/patient engagement, and optimize financial performance?
  • Do you understand the financial implications of the new reimbursement methods and the extent to which costs must be reduced and where and how providers will be incentivized to achieve these objectives to produce improvements in care coordination and quality?

There is not a one-size fits all strategy, so it is important to know your readiness to participate in an Advanced APM, the different care delivery needs of the community, the scope of risk to be taken, and have the infrastructure in place that will be necessary to achieve success.


sabrina_burnett1.pngMs. Burnett is a vice president with GE Healthcare Camden Group. With 20 years of professional experience, Ms. Burnett delivers a wealth of skilled leadership in health management processes and solutions-based planning and execution. She has in-depth knowledge of the post-acute industry and a thorough understanding of the healthcare market, payer reimbursement methodologies, including managed care requirements and strategies, and knowledge of relevant state and federal regulations and actions. She may be reached at sabrina.burnett@ge.com


MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at marc.mertz@ge.com.  



Topics: Marc Mertz, MACRA, Sabrina Burnett, Alternative Payment Models, APM

Top 10 Actions to Take Now to Prepare for MACRA

Posted by Matthew Smith on Jul 29, 2016 10:11:44 AM

By Marc Mertz, MHA, FACMPE, Vice President, and Lucy Zielinski, Vice President, GE Healthcare Camden Group

shutterstock_124411828.jpgMost medical groups celebrated the repeal of the sustainable growthrate (“SGR”) and the associated cuts to the physician fee schedule. The SGR was replaced by the Medicare Access and CHIP Reauthorization Act (“MACRA”), a proposed CMS rule that is designed to encourage medical groups to pursue advanced payment models and accountable care.

MACRA replaces several Medicare reporting systems and creates two new programs: the Merit-Based Incentive Payment System (“MIPS”) and Advanced Payment Models (“APMs”). Both programs have pros and cons, but because they are currently scheduled to begin to measure performance on January 1, 2017, medical groups have little time to prepare.

Here are 10 actions your group should be taking now to prepare for MACRA.

  1. Determine your path. The MIPS program replaces the former EHR Incentive (Meaningful Use), Physician Quality Reporting System, and Value-based Payment Modifier programs with four measures of cost, quality, information technology (“IT”) use, and clinical practice improvement activities. How well your group performs on these measures compared to your peers will determine whether your Medicare payments are increased or cut by up to 9 percent by 2022. The APM path is for groups that are willing to take up- and down-side risk under new payment models, including select ACOs, medical homes, and bundled payments. APMs offer a 5 percent bonus payment.

    Many groups would rather avoid the reporting requirements, uncertainty, and potential payment reductions of MIPS. Unfortunately, qualifying for APM will be a challenge unless your group is already in a qualifying program – especially given the January 1, 2017 proposed start date. This aggressive timeline is one of the criticisms of MACRA, and CMS may push back the start date in the final rule. At this point, a vast majority (some projections are as high as 90 percent) of medical groups are expected to pursue MIPS, at least initially. Groups that start under MIPS can apply to move to APM in subsequent years.

  2.  Educate and engage your providers. Under the current performance based incentive programs, groups are rewarded for simply reporting data. If you start under MIPS, you will receive bonuses or pay cuts based on your actual performance against other groups. Active provider participation and engagement are imperative for improving your performance on the MIPS measures for cost, technology use, quality, and clinical practice performance. Start now by educating your providers on MACRA and the crucial role they play in your group’s success. Inform them that their scores will be published on Physician Compare for public consumption. Evaluate your physician compensation plan to ensure that incentives are aligned with your MACRA objectives.
  3. Assess your current technology. Health IT (“HIT”) is foundational to MACRA, which requires participants to use certified electronic health records technology (“CEHRT”). While the number of meaningful use measures has decreased, groups may have HIT challenges relating to interoperability and the exchange of information. Although vendors have made great advances in recent years, gaps still exist, and the development of new capabilities and analytics continues. To meet MACRA requirements specifically relating to the collecting, monitoring, and reporting measures and scores, groups may require additional IT capabilities beyond the CEHRT. Additionally, there is an increase in the use of Qualified Clinical Data Registries (“QCDR”) to collect clinical data to better manage the delivery of care, ultimately improving the quality.
  4. Know your quality measures. APMs typically have a prescribed set of measures based on the program whereas, under MIPs, providers have the option to select measures. However, MACRA does require that quality measures used in APMs be comparable to those used in MIPS. Knowing your quality measures, and if applicable, selecting the right measures, is key as your group’s performance will be determined based on how you compare to peers. It is important that you identify the measures applicable to your group, considering your provider specialty mix and patient population, and then create workflows to support the data capture of such measures. A good place to start is the Quality and Resource Use Report (“QRUR”) since this report compares your scores relative to your peers by calculating the standard deviations from the national mean for both quality and cost. There is also a high-risk bonus adjustment that is based on ICD-10 coding, so accurate diagnosis coding assignment is critical.
  5. Track provider performance. Monitoring your group’s performance at an individual provider level on a consistent basis is vital since every point matters. Groups need to track performance monthly and compare the values to peers as well as targets. Your exceptional performance scores do not guarantee success since your current performance is compared to future benchmarks, which are unknown at this time. Also, CMS has allocated millions of dollars to reward high performing providers who land above performance thresholds, so aiming high may get you additional dollars.
  6. Form a steering committee. Whether you pursue APM or MIPS, it will be important that your group is strategically aligned and that your efforts are coordinated. Much work will be necessary to ensure that your group has capabilities for measure selection, data capture and reporting, workflow analysis and/or development, training, and performance monitoring. A multidisciplinary steering committee consisting of physicians, management, IT, other providers, and staff can be a powerful way to align the group and to address the broad array of tasks. The steering committee will be charged with creating the MACRA strategy and a high level work plan. Members will oversee the plan’s progress, timeline adherence, and provide direction for resolution of any obstacles impacting the plan.
  7. Implement a change management program. Success under MACRA will require strategic and operational changes; change can be difficult to implement and even more difficult to maintain. Consider using a formal change management program that will combine a well-executed plan for change with the leadership needed to sustain that change over time. When executing tactical plans and projects, many groups focus solely on technical change strategies, while change management, like GE’s Change Acceleration Process (“CAP)” program, focuses on both the technical changes and change leadership. Change leadership is an essential, but often overlooked aspect of change strategy; it addresses the human or cultural component that provides the spark needed to activate change. Change leadership will align, mobilize and motivate all stakeholders with a shared vision to support the MACRA program, making success a reality.
  8. Consider partnership opportunities. APM and MIPS both present challenges, especially to smaller groups, that might be easier to overcome with partners. APMs require a group to take downside risk. Groups that do not have experience with risk or have a small patient population can benefit from joining an independent practice association (“IPA”), physician-hospital organization (“PHO”), clinically integrated network (“CIN”), or ACO that can provide care management capabilities, as well as spreading actuarial risk over a larger population. Success under MIPS will require technology resources, care management, and practice operational capabilities that may not be financially sustainable for small groups. Medical groups that have patient-centered medical home (“PCMH”) status receive full credit for achieving the MIPS Clinical Practice Improvement Activities measure, so groups should consider joining a network or hiring an MSO that can provide resources or capabilities to support a PCMH.
  9. Develop care management capabilities. Success under MACRA will require that groups deliver value by improving quality, outcomes, and patient experience while reducing costs. Use data to understand how your group performs today and where there are specific opportunities to improve. Then work with your physicians and staff to develop and implement care management capabilities that support higher performance. You should also look outside the walls of your group to partner with other providers, community resources, and your patients to more effectively manage the health of your population.
  10. Create a roadmap in 2016. MACRA reporting is scheduled to begin in January 2017; hence, the time is now to create a plan and roadmap. Understanding your group’s current challenges will be important as you develop your roadmap. Once you activate your plan, monitor your progress monthly and make any updates based on the final rule. Even if MACRA reporting is delayed, you will have a head start.

If groups take these 10 actions, they will be in a better position to transform the care that is delivered based on the Triple Aim of better care, better experience, and lower cost. And they will be rewarded financially under MACRA.


MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at marc.mertz@ge.com.  



ZielinskiL.jpgMs. Zielinski is a vice president with GE Healthcare Camden Group, with over 20 years of experience in the healthcare industry. She specializes in helping private and hospital-owned medical practices achieve top financial performance by guiding physicians through practice development, strategic planning, coding and revenue cycle process optimization, and electronic health record system implementation. In her health system leadership roles, she has successfully managed the revenue cycle for over 2,000 physicians. She may be reached at lucia.zielinski@ge.com.



Topics: Medical Groups, Lucy Zielinski, Marc Mertz, MACRA, CAP, Change Acceleration Program

5 Key Questions to Ask when Building an Analytics Framework for your Healthcare Organization

Posted by Matthew Smith on Jul 28, 2016 11:30:09 AM

By Shaillee Chopra, PMP, Senior Manager, GE Healthcare Camden Group

shutterstock_258948038.jpgAs the healthcare industry continues to make the shift towards value-based care models, organizations are faced with an increasing need to invest in technology platforms that offer analytics-based decision making. Faced with rapidly evolving strategic needs and surrounded by abundance of technology choices, healthcare executives struggle to conceptualize an effective approach to creating an analytics framework for their organization. Rather than adding one more product to the portfolio, organizations want to create an information framework that drives decisions and is action oriented.

Following are key strategic questions to ask when building an analytics platform for your organization. This approach ensures that you are able to successfully outline a data and analytics strategy that leverages adequate and accurate data across the network to create an action-oriented knowledge framework that is closely aligned with the value proposition.

1. What are the key problems you wish to solve?

Key to establishing an analytics framework that drives decision making and actions within the organization is to ensure that you start with the end in mind. What are some of the key objectives that your organization wants to achieve? Is facilitating transitions of care within the integrated network an immediate need? Is your organization aiming to capture market share by offering competitive services and offerings? Is referral management and reducing patient outmigration (often referred to as ‘patient leakage’) an area of concern? Is entering into value-based contracts one of the long-term goals for your organization? Succinctly outlining end goals guides what problems need to be solved for and helps conceptualize knowledge framework that will assist with the decision making.

2. What type of data is required to build this information framework and at what frequency?

Value-based goals and metrics often require harmonized data across the continuum. Atypical data types include, but are not limited to, billing data, inpatient EMR data, outpatient EMR data, ambulatory data from employed and affiliate provider practices, claims data from payors, HIE data, external pharmacies data, bedside monitoring, and at-home monitoring data.

Outline which data types are required to be updated in real time to support predictive analytics needs (clinical data elements such as diagnosis, problems, medications, etc.) and which ones can be brought in a retrospective format (claims, utilization etc.). This will assist you in establishing an integration architecture with various source systems across the network. Developing integration architecture also offers an opportunity to estimate realistic answers to how much the infrastructure will cost and how long will it take.

Consider building a data integration roadmap that outlines the sequence in which various data domains would be aggregated into the analytics platform. 

3. What is the data worth?

The relative importance of data from varied locations across a continuum of an integrated care network can influence your data acquisition strategy.  Key considerations include:

  • Data relevance. How relevant is the data type in your decision making process and what problems does it help solve for?
  • Data accuracy. Are all expected attributes of data accessible and transmittable? Is there minimal uncertainty due to workflow at the front lines?
  • Data frequency. Is the data available in a required format (discrete and structured vs. static image)? Is the data transmittable at a desired pace (updates to lab data might be required in real time to facilitate transitions of care; while claims data can be loaded in retrospectively to produce trends in cost-of-care)?
  • Data depth. Is there needed depth of historical data that is aligned with analytic needs (certain specialties such as oncology clinical historical data needs go farther back than primary care)?
  • Data consistency. Are the standardized vocabularies integrated into data domain offering consistent definition and interpretation of each data element?

4. What organizational capabilities need to be developed to support the future state?

It is important to identify key consumers of analytics within your organization early on. Understanding key information needs of the users, level of data literacy (ability to understand and interpret data) and the ability to exploit information offered via an analytics platform determines the pace at which your organization can adopt a knowledge-based decision making system.

Consider setting up a multidisciplinary data governance council that aims to provide:

  • Guidelines for management of the quality of data being leveraged across the continuum
  • Data literacy within consumers of analytics across the continuum
  • An operational framework that allows for maximizing data exploitation for the organization’s benefit

5. What are some key requirements for technology solutions that will aggregate and harmonize this data?

Product selection driven by clearly outlined end goals that the organization wants to achieve and key functional capabilities it wants to enable (care coordination, consumer engagement, increase market share, stop leakage) ensures that technology is successfully positioned as an enabler of operational workflows.

Key considerations when outlining requirements for an aggregation platform include:

  • Capabilities enablement. How does the technology platform operationalize key functional areas for the organization?
  • Product functionality. What are some of the key functionality needs to support operational objectives for the organization?
  • Data consumption abilities. What is the data footprint that the product can consume (clinical, financial, socio-demographic etc.)? What is the integration footprint with key healthcare technology vendors?
  • Product roadmap. What is the product roadmap, and how does it align with your organization’s strategic goals?
  • Speed to implementation. What is the product implementation methodology? What are the key resource needs from your organization, and what are key external dependencies that impact speed to market?

Transitioning to outcomes-based decision-making frameworks enables your healthcare organization to harness the power actionable analytics. You can leverage these best practice recommendations to avoid commonly observed pitfalls and implement a sustainable and scalable solution.

Digital Health, Advanced Analytics

Chopra.pngMs. Chopra is a senior manager with GE Healthcare Camden Group and specializes in developing and managing innovative technology portfolios for value-based and clinically integrated healthcare networks. She is highly experienced in leading information technology and consumer experience strategy development, as well as transformations to enable clinical integration, accountable care, and population health management strategies for organizations invested in innovation and transformation of care delivery models. She may be reached at shaillee.chopra@ge.com



Topics: Analytics, Data Analytics, Digital Health Strategy, Information Framework, Shaillee Chopra

Primary Care at a Crossroads

Posted by Matthew Smith on Jul 25, 2016 2:42:30 PM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

undefined-801852-edited.jpgMost primary care practices still operate based on a model developed decades ago: the hours of operation, appointment scheduling rules, staffing, patient flow, and office design were all determined based on physician preference. In an attempt to provide physicians with a more convenient practice model, we created a system that forced patients to accept long waits for appointments, inefficient office flow, and limited ability to communicate with their physicians outside of the exam room.

Yet physicians hardly fared any better in these offices that were actually designed with them at the center. Complex appointment scheduling rules and templates inherently led to mistakes and double booking, phone messages piled up, administrative work increased, patient appointments ran behind, and physicians inevitably spent hours working in the clinic long after patients had left.

While the typcial primary care practice doesn't really work for patients or physicians, in the absence of alternatives, we came to accept this model for what it was. But times are changing. A plethora of new providers are entering the primary care marketplace, and their growing popularity is as much an indictment on traditional physician-centric primary care practices as it is a reflection of new reimbursement models and rising consumerism.

To contunue reading "Primary Care at a Crossroads," please click the button below. You will instantly be directed to the online article published in CAPG Health's Summer 2016 issue.

Primary Care, Practice Management, Practice Transformation

MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at marc.mertz@ge.com.  

Topics: Practice Management, Primary Care, Primary Care Providers, Primary Care Access, Marc Mertz, Practice Transformation

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