Healthcare Strategic Growth Blog

Widen Your Outpatient Planning Opportunities

Posted by Charles Glover on Nov 1, 2021 9:39:24 PM

How APCD Insights Can Empower Healthcare Growth Planners

By Charles Glover and Sean Conway

The trend toward outpatient healthcare is here to stay, and for several reasons revolving around cost savings. For starters, while outpatient facilities may vary in size and services offered, they are almost always less expensive to build than traditional hospitals. Second, without the need for extensive nursing units and housekeeping functions required within a hospital, they are more affordable to operate. Finally, staffing expenses are lower as offices are typically closed on nights and weekends.  

There are other factors driving the increase in outpatient care, including:

  • Changes in insurance reimbursement rules, and the adoption of site-neutral payments, are incentivizing providers to rethink their care delivery strategy.  
  • New technologies and better drugs have allowed medical tests, procedures, and therapies to be provided outside of acute care settings. (Rehab Insights)
  • The easier access to care, along with the potential for lower out-of-pocket costs, has made outpatient care a popular choice for patients.

With all these pressures pushing the development of outpatient care, healthcare growth planners need solid strategies for tracking patient movement, leveraging trends in reimbursement, and addressing physician leakage. In this post, we’ll discuss which data is the right data for planners to use to access the critical information needed for informed outpatient planning.  

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The No Surprises Act: Its Impact on Payer and Provider Negotiations

Posted by Michael Shipley on Sep 28, 2021 3:01:35 PM

Be Equipped to Address the Fallout of this Legislation 

By Stephen Burgess, Ancore Health, and Michael Shipley, Stratasan

On July 1, 2021, the Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management issued an interim final rule to implement fundamental parts of the No Surprises Act (NSA). Despite the disarming title, the No Surprises Act will lead to many surprises, around lack of parity in reimbursements within a market. In upcoming years, payers and providers will be forced to evaluate their value proposition, market positioning, customer/patient transparency, and data analytics.

The NSA contains key protections to hold consumers harmless from the cost of unanticipated out-of-network medical bills. According to the Kaiser Family Foundation, “surprise bills lead the list of affordability concerns for many families; 2 in 3 adults say they worry about unexpected medical bills, more than the number worried about affording other health care or household expenses.  Surprise bills can number in the millions each year.”

While the major implications of the NSA will benefit consumers, the severity of impact that this legislation will have on payers and providers will depend on how they react. In this post, we’ve worked to summarize this new law and discuss some of the ways that both providers and payers can be prepared to act.

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Tags: market reimbursement analyzer, reimbursement, payer negotiations

Your Budget Has Been Slashed! Now What?

Posted by Lee Ann Lambdin on Sep 20, 2021 4:46:32 PM

How to Succeed in the Midst of Challenging Dynamics

By Lee Ann Lambdin

Note: This post is an excerpt from my SHSMD 2021 conference presentation. You can download the slide deck from this presentation here.

It’s true, the COVID-19 pandemic has been unlike anything our healthcare system has seen in recent history. In many cases, teams have been short-staffed and budget dollars reallocated. How can growth departments rebound from such challenges, often with no additional resources? By learning from those familiar with overcoming similar obstacles. 

Staying nimble and adaptable in the face of challenges is something many veterans know how to do well. Experienced leaders are accustomed to making adjustments when there are unplanned changes, budget reductions, or higher demands on the same few resources. 

Over the past year, I’ve worked alongside and advised numerous Stratasan clients as they’ve navigated shifting priorities and supported their staff through COVID-19 related challenges. In this post, I’ll share how I’ve seen these hospitals respond and how we can all learn from their experiences.

I’ll also share some of Stratasan’s story of rebounding from loss. I’ll provide some of the insights we’ve learned on how to focus priorities, make risk/reward calculations, and automate more.

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Tags: strategic planning, healthcare strategic planning, SHSMD, COVID-19, SHSMD21

Make the Most of SHSMD 2021: 5 Tips to Maximize Your Time

Posted by Lee Ann Lambdin on Sep 13, 2021 1:07:23 PM

By Lee Ann Lambdin

The Society of Healthcare Strategy & Market Development (SHSMD) annual conference is the biggest healthcare strategy conference nationwide. With the goal of changing and leading the future, it’s a must-attend event for healthcare marketing, communications, business development, and strategic planning professionals. Headed into its 25th year, SHSMD Connections 2021 is taking place in person on September 19-21 in San Antonio, TX, and virtually on October 20-21. 

SHSMD Connections is primarily focused on education and it provides many opportunities to learn best practices you can take home and share with your team. I’d like to personally invite you to the session I’ll be leading titled “Your Budget Has Been Slashed! Now What?” It’s taking place on Tuesday from 11-11:50 am. I hope to see you there!

This year, the conference theme is “It’s a New Future: Change it and Lead it,” based on how much has changed and will continue to change for those of us who work in the healthcare industry. With so many healthcare marketing, public relations and communications, and strategic planning professionals expected to be on-site, hours of educational sessions, and more than three hours with keynote speakers, this conference can easily be an enriching experience. However, it can also feel like you’re drinking from a fire hose.

The keynote sessions are always great, but this year I’m particularly excited to hear Derreck Kayongo, Entrepreneur, Global Soap Project Founder, CNN Hero, and Former CEO of the Center for Civil and Human Rights lead the opening talk. Our team was so looking forward to this event, that we decided to sponsor it, and will be offering free margaritas at our booth afterward. (Come say hello at booth #117!)

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Tags: SHSMD

3 Signs It’s Time to Revisit Your Service Area Definition

Posted by Gavin Chance on Aug 31, 2021 8:15:00 AM

Key Considerations for Proactive Healthcare Planners

By Gavin Chance

A well-defined service area assists with targeted marketing and physician business development efforts. It can also help identify who your true competitors are by service line. 

Market transitions and population shifts can alter your service area. These changes can sometimes be subtle, but still come with noteworthy effects. It’s important to pay attention to the signs that indicate change and be ready to reassess your service area definitions when appropriate. In this post, we’ll discuss three important signs to watch for.

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Tags: healthcare service area, service area, service area growth, hospital service area

Analyzing COVID’s Impact on Healthcare Data Coding

Posted by Megan Reeves on Aug 24, 2021 3:33:35 PM

How Stratsan’s Data Process has Adapted to Maintain Data Integrity

By Megan Reeves 

New ICD and DRG codes are created every year by CMS. Why and how these codes are created and released is discussed in detail in this post. These diagnosis and procedure codes allow for:

  • Easy storage, retrieval, and analysis of health information for evidence-based decision-making
  • Sharing and comparing health information between hospitals, regions, settings, and countries
  • Data comparisons in the same location across different time periods

They are usually released in the fall, with an announcement at the beginning of Q3. This allows healthcare providers to prepare and plan for any changes to come. Codes then typically go into effect October 1, the beginning of Q4 of that year.  

While there is a standard schedule and process for when and how codes are released, COVID-19 is a unique situation and has triggered the creation of new codes outside the normal process. Creating a new set of codes outside the standard way of doing so, can lead to issues. In this post, we’ll discuss one such issue that our team has noticed—the spike in invalid and ungroupable DRGs—and how we’re addressing this problem for our clients.

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Tags: coding, healthcare data, COVID-19

Your Market Demographics are Changing: Are You Ready?

Posted by Megan Reeves on Aug 17, 2021 2:11:00 PM

Access the Latest Population Data for Better Strategic Planning

By Megan Reeves

The U.S. Census Bureau recently released the 2020 Census results, triggering conversations among marketers and planners everywhere about changing market demographics. These results track the nation’s diversity and how we’re evolving.

Key takeaways from the 2020 Census include the following:

  • The non-Hispanic white population nationwide got smaller, shrinking from 196 million in 2010 to 191 million in 2020
  • Almost all of the growth of the past 10 years happened in metropolitan areas
  • The share of children in the U.S. declined because of falling birth rates, while it grew for adults, driven by aging baby boomers
  • The nation’s 7.4% growth rate over the decade, the smallest since the Great Depression, was largely propelled by a Hispanic boom
  • Among all U.S. metro areas, the fastest-growing one was in The Villages, the Florida retirement community built on former cow pastures

For healthcare business development leaders, these population shifts should be a signal that it’s time to reevaluate their own market demographics, to ensure they’re set up to adequately meet the needs of their community. 

Stratasan, through the use of Esri's Tapestry Segmentation, is positioned to help in this endeavor.

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Tags: demographics, esri tapestry segmentation, tapestry segmentation, healthcare demographics

Responding to Shifts in the Healthcare Outpatient Market

Posted by Sean Conway on Jul 26, 2021 11:42:07 AM

How to Mitigate Risk and Evaluate Growth Opportunities 

By Sean Conway and Evan Elmore

UnitedHealth Group released its quarterly earnings report earlier this month and several changes in coverage caught our attention, particularly as they pertained to outpatient services.

United is to begin denying claims for certain types of services performed in hospital outpatient departments (HOPDs). They are the first major payer to do so. This will inevitably lead to an increase in care at other outpatient settings, such as Ambulatory Surgery Centers (ASCs).

This post will discuss why this should be of concern to HOPD invested health systems and how they can prepare to mitigate their risk. We’ll also consider how ASC management companies can take advantage of this opportunity for growth. 

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Tags: market reimbursement analyzer, reimbursement, outpatient, HOPD, ASC

Will Payers Follow Medicare’s Lead?

Posted by Michael Shipley on Jul 20, 2021 10:26:29 AM

How E&M Code Changes Will Impact Reimbursement Discussions

By Michael Shipley and Morgan Atkins

Beginning in Q1 2021, significant adjustments went into effect for how payments are calculated for physician services. These changes are the result of modifications to the Calendar Year 2021 Medicare Physician Fee Schedule (MPFS).

These updates will particularly help both primary care providers (PPC) and specialists that bill high volumes of Evaluation and Management (E&M) codes. It will hurt specialists who bill mostly for procedures rather than E&M visits. Consider these specialist examples:

  • An orthopedic surgeon who derives the majority of their income from surgeries, and bills few E&M visits. Their surgery reimbursement will go down, and the increase in E&M reimbursements may not be enough to cover the difference.
  • An endocrinologist who bills a lot of E&M visits for the management of diabetes will benefit from these code changes, receiving more for each E&M billed visit.

As summarized by Gist Healthcare, the implication of these changes will result in “higher pay for some primary care physicians and medical specialists, but reduced payment for many proceduralists.”

Our partners at Ancore Health provided a helpful summary of how reimbursement is calculated, and the impact of this update, in this blog post.

How will Payers Respond?

These changes, which make E&M coded visits more financially valuable, were a significant move by CMS to prioritize primary care and increase the focus on value-based interactions. The clear goal is to encourage more facetime with patients, which can give physicians the opportunity to catch health issues in earlier stages. Quality primary care patient interactions can happen when quantity isn’t the priority.

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Reversing Patient Outmigration and Physician Referral Leakage

Posted by Jennifer Keller on Jun 22, 2021 8:42:00 AM

Address Blockages and Pinpoint Opportunities for Growth

By Jennifer Keller

Retaining and improving bottom line profits is a key priority for healthcare planners and strategists. Often when considering how to grow, patient outmigration and physician referral leakage are top of mind. Patient retention and well-maintained physician relationships are key to maintaining a strong financial standing, especially for rural hospitals.

“25% of rural hospitals nationwide are at a high risk of closing unless their financial situations improve. Of these hospitals, 82% are considered highly essential to their communities,” according to an annual Guidehouse analysis.

Many hospitals within close proximity to large U.S. cities are facing a serious financial challenge: patients who outmigrate to urban hospitals. This can happen due to patient preference or a physician referral, but it’s leading to lost revenue either way. 

It’s important to note though, this is not solely a rural hospital concern. A strong physician relations strategy is needed in many large urban areas to ensure you don’t lose patients to the large competitor right down the street.

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Tags: physician referral, physician strategy, outmigration, physician referral leakage

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