3 Ways to Use Hospital Price Transparency Data for Competitive Advantage

by John Harris, Director
and Clare O'Mara, Senior Associate

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Shifting a $1 trillion dollar industry from confidential contracts to publicly published pricing is a massive transformation. In the middle of recovering from the COVID-19 crisis, hospitals are responding to this transformation. Background: The hospital price transparency rules require consumer-friendly tools to help individuals shop for hospital services based on price. They also require hospitals […]

3 Key Factors to Analyze as Cardiac Procedures Move to Outpatient

by Mark J. Dubow, Director
and Ross Shuster, Manager

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By recategorizing procedures previously designated inpatient only, CMS is actively redirecting a significant number of cases to Hospital Outpatient Department (“HOPD”) and community-based ambulatory surgery center (“ASC”) settings. We have discussed the impact this will have on outpatient surgery, and strategies to prepare. This outpatient shift will also affect cardiac services, creating both risks and […]

Launching a Community Oncology Center: 5 Key Considerations

by Meredith Inniger, Manager

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Rapid evolution in diagnostics and treatment for cancer care, innovation through genomics and predictive analytics, the continuing shift toward value-based care are hastening the migration of oncology from hospital settings to community-based centers.  This raises the question: Is now the right time to invest in a community oncology center? The experiences of multiple health systems […]

5 Key Benefits of a Service Line Management Structure

by Lynda Mischel, Principal
and Meredith Inniger, Manager

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Often service lines are just a marketing tool, branding assorted practices as a specialty service line without connecting the services in a meaningful way. By establishing a management structure for service lines, hospitals and health systems can create an organized system of care for patients to progress smoothly from service to service. As health systems […]

3 Questions Every System Should Answer Following the Medicare Hospital Outpatient Prospective and ASC Payment System Final Rule

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 […]