3 Questions Every System Should Answer Following the Medicare Hospital Outpatient Prospective and ASC Payment System Final Rule (Part 1 of 4)

by Lynda Mischel, Principal
and Meredith Inniger, Manager

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One of the most impactful final rules released by CMS in recent months is the CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1736-FC). This rule includes several important policy changes, most notably the elimination of the Inpatient Only List on a phased schedule through CY2024 (when […]

Radiation Oncology Alternative Payment Model: 3 Things to Do Now

by Lynda Mischel, Principal
and Scott Stuecher, Manager

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CMS is launching a Radiation Oncology Alternative Payment Model (“RO Model”) that will profoundly affect radiation oncology economics, with a target start date of January 1, 2022. The RO Model will apply (or at least test) a bundled payment methodology affecting about 30% of eligible radiation oncology episodes. Revenue reductions may be as high as […]

Designing the Right Healthcare Service Line Governance Structure: 4 Key Considerations

by Lynda Mischel, Principal


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Prior to the coronavirus pandemic, healthcare CEOs ranked financial challenges (e.g., reducing the operating costs for staff and supplies, declining reimbursement) and increasing competition from other providers, among the top issues facing hospitals. But with coronavirus expenses straining hospital budgets, in 2020, a new element, service line optimization has become critical to hospitals’ ability to […]

COVID-19: Scaling Ambulatory Services to Maximize Volumes While Controlling Costs

by Lynda Mischel, Principal
and Meredith Inniger, Manager

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The pandemic has placed significant constraints on capacity, making volume growth, or simply maintaining normally budgeted volume levels, a formidable challenge. Organizations must implement novel clinical and administrative workflows that allow for the most efficient use of provider and patient time, ensure patient and staff safety, and drive bottom line performance. Many have opened services […]

Focus on Three Levers to Urgently Address Leakage

by Lynda Mischel, Principal
and Rudd Kierstead, Principal

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Among the many unexpected effects of COVID-19 is the loss of the “normal” patient population coming through physician offices to address their health concerns and seeking procedures. This lost volume has heightened the urgency to effectively address “leakage.” Research indicates that acquiring a new customer is anywhere from 5 to 25 times more expensive than […]

Creating a Business Plan to Define the Value of Virtual Care

by Lynda Mischel, Principal
and Caroline Polales, Senior Associate

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The pandemic provided an initial introduction to virtual care for many, and most patients and providers have responded positively, embracing its convenience. Health systems, hospitals, and other providers now need to take the time to develop a business plan that identifies opportunities to optimize virtual care platforms, drive revenue and adapt practices to effectively meet […]

3 Critical Planning Steps for Rationalizing Service Lines

by Lynda Mischel, Principal
and Kelvin Polanco, Associate

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COVID-19 has shocked the U.S healthcare system – forcing physician and administrative leaders to think critically about how their current service line models can be improved to better serve and treat their patient populations. Many service lines were designed to maximize patient throughput by offering multiple access points without much consideration for efficiency. As a […]

Address “Sacred Cows” to Get Past COVID-19 Shock

by Mark J. Dubow, Director
and John Harris, Director

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Every organization has sacred cows. The financial challenge from COVID-19 calls for large scale improvements. This has emboldened our clients to address sacred cows, making tough changes that were unthinkable a few months ago.  The time to act is now! Sacred cows to consider include: Underperforming Assets: Every organization has some assets that perform significantly […]

COVID-19: 5 Approaches to Creating Parallel Systems of Care During the Pandemic

by Mark J. Dubow, Director
and John Harris, Director

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Though COVID-19 has absorbed the world’s attention, hospitals must also effectively treat all of those patients who needed care before COVID-19 appeared. Many of these patients are deferring or skipping necessary care, often against their physician’s advice, for fear of contracting COVID-19 at a healthcare provider. Providers need to allay patient fears and establish effective […]