Cover Story
The Role of HCCs in a Value-Based Payment System
Documentation of chronic conditions is increasingly important as hospitals move toward value-based payment models.
By Donna M. Smith, RHIA and L. Gordon Moore, MD
From the President’s Desk
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Expanding on thoughts in his October 2017 column in hfm, HFMA President and CEO Joseph J. Fifer, FHFMA, CPA, discusses consumerism fatigue and its potential impact on healthcare stakeholders as well as consumers. |
HFMA Video Spotlight
Video: The Future of the Revenue Cycle
HFMA and Navigant surveyed 125 hospital and health system CFOs and revenue cycle executives to learn about next-generation revenue cycle management trends. Erick McKesson, director for Navigant, summarizes the findings in this video.
Early Edition
Creating Value in the Medicaid Expansion: A Strategic Framework for AMCs
Academic medical centers that work with states to find mutually beneficial Medicaid strategies may find themselves well positioned in an era of value.
By Michael J. Schwartz, MBA, MS and William T. Eggbeer, MBA
Rethinking Health Care’s Triple Aim
Achieving health care’s Triple Aim has proved elusive, but it may be yet be achievable through a process of engaging rising-risk patients in their own care through daily self-reporting.
By Jim Evans
Healthcare Matters
Health Insurance and Hospital System Financing at a Glance
Healthcare leaders should understand the fundamental differences between health insurers and hospital systems in terms of financing structures and key performance metrics.
By Kurt J. Wrobel, FSA, MAAA
Features
6 Practices for Effective Managed Care Contracting
Certain practices are critical to effective contracts between health plans and provider
organizations.
By Debra L. Ryan and James J. Pizzo
Value-Based Payment and Commercial Healthcare Insurers: Getting Paid for Doing What’s Right
Healthcare providers may find that their managed care contracts include provisions that may have been beneficial under a fee-for-service payment model but are highly unfavorable under a value-based payment.
By Ryan Gillis and Paul Yun
Charging Appropriately for Emergency Department Visits
To determine a fair charge for an emergency department visit, a hospital or health system must separate its costs into three categories.
By David W. Young, DBA
Integrating Healthcare Revenue and Operating Models to Create a Sustainable Future
As the first step in any initiative, the analysis and strategy development for adopting a new revenue model is key to the success of implementation.
By Christopher J. Kalkhof, MHA, FACHE, Richard Bajner, and Jeffery Leibach
Special Feature
Strategies for Successful Value-Based Partnerships
The Executive Experience session at HFMA’s ANI 2017 brought together leaders from finance, clinical medicine, and health plans to explore ways to partner in value-based care initiatives.
Sponsored by EY
Focus Area
Accounting
The New Revenue Recognition Standard: Where Organizations Stand
As implementation time draws near for the Financial Accounting Standards Board’s new standards regarding contracts with customers, healthcare organizations should take steps to ensure their processes align with these standards.
By Brian Conner, CPA
Revenue Cycle
Transforming Medical Practices: Benefits of a Patient-Centric Approach
A medical practice’s strategy for success in today’s consumer-centric healthcare environment should be focused on reducing waste and addressing patients’ chief concerns at every point of contact with the practice.
By Mark Sidote
Columns
From the Chair
Healthcare Leaders: Be Molders−Not Seekers
For healthcare leaders, the effort to promote enhanced value should involve not just to searching for consensus but actively molding it.
By Carol A. Friesen, FHFMA, MPH
From the President
Fight Consumerism Fatigue
Consumerism may be slipping lower on healthcare leaders’ priority lists. Although it may not seem urgent, it’s more important than ever. Here’s why.
By Joseph J. Fifer, FHFMA, CPA
Eye on Washington
CMS Proposal: A Path to an Uncertain Future for 340B
CMS’s recent proposal to reduce rates for 340B-covered entities for separately payable outpatient drugs may be a sign to providers that they can expect to see the Trump administration take an aggressive approach to healthcare policy.
By Mark Polston, JD
Integration
Contemplating the Personal Side of Healthcare Integration
When considering a merger or affiliation, healthcare leaders can benefit from considering the proposed transaction from a personal vantagepoint, as if the corporate discussions regarding the transaction were a dialogue between individuals.
By Keith D. Moore, MCP and Dean C. Coddington
Capital Finance
How to Revisit Private Placement Debt
Hospitals should reassess the private placement debt they accrued in the recent constrained lending market to determine their best options now that the market has loosened.
By Kelly Arduino
Departments
Data Trends
Assessing SNF Providers by Overall Quality Rating
An analysis of skilled nursing facilities looking at their CMS star ratings identified trends favorable to not-for-profit SNFs.
HFMA News
HFMA Announces Best Article Award Winners
HFMA is pleased to announce the recipients of the Helen Yerger/L. Vann Seawell Best Article Award for outstanding editorial achievement in hfm magazine in FY17.
Supplements
HFMA Trendsetter
Premier: Tackling Bundled Payments
This article shares how Premier Inc. helped Adventist Health System successfully navigate bundled payment initiatives by offering a dynamic collaborative led by seasoned experts and user-friendly analytics that enable evidence-based decisions.
Executive Roundtable
3M: Implications of Value-Based Payment for Revenue Cycle Management
As organizations delve into value-based arrangements, they are modifying revenue cycle operations to accommodate this new type of payment, which can be challenging. In this roundtable, several financial leaders discuss how they are readying their revenue cycles for value-based payment while continuing to support fee-for-service.
Pulse Survey
athenahealth: How Leaders Stay Abreast of Regulatory Changes
When it comes to staying abreast of changes in health care, nearly 90 percent of healthcare leaders who responded to a pulse survey conducted at HFMA’s Annual National Institute (ANI) in June 2017 about changes to government payment and regulatory requirements feel very confident that they are staying informed about these topics.
