Hospital Best Practices and Recommended Strategies
- Use Rural Health Value’s Performance Improvement and Financial Risk Management tools to adopt performance measurement and reporting that is designed to improve patient care, increase population health, and lower per capita cost, and to determine how best to minimize risk or optimize benefit relative to value-based care.
- Use Rural Health Value’s Innovations & Demonstrations resources to learn more about new healthcare payment and delivery models that are emerging across the nation.
Grow services and maximize fee-for-service reimbursement to increase cash reserves for successfully transitioning to a value-based system by focusing marketing efforts to:
- Promote imaging, laboratory and rehabilitation services to local providers, schools and the general public to build community awareness of available services
- Share quality of care provided at the hospital to build community awareness and increase transparency
- Leverage high quality and outcome scores as a point of competitive differentiation for regional service marketing purposes and as a competitive asset
- Educate community on core competencies as compared to competitors
Increase efficiency and maximize fee-for-service reimbursement to prepare for value-based purchasing:
- Expand primary care services
- Increase referrals
- Control expenses
- Increase service revenue
- Expand services based on community needs
- Grow volume in specialty and acute care services as well as ancillary services
- Invest in facilities and technology
- Participate in the 340B Drug Pricing Program
Grow the swing-bed program to maximize revenue under fee-for-service to prepare for a value-based system:
- Target swing-bed average daily census (ADC) at a minimum of 4.0 (best practice level)
- Build community awareness of the swing bed program since it is access to care within the community
- Grow swing-bed volume by marketing to the community as ‘rehabilitation services’
Improve emergency department (ED) operations and point of service collections:
- Use data to identify and address issues
- Target improvement of ED admissions (acute/observation) as a percentage of ED visits to approximately 8% to 10%
- Target observation days as a percentage of total acute days at the rural hospital best practice range of 15% to 25%
- For physicians, track:
- ED admissions for acute and observation
- Left without being seen (LWBS), door to admit time and door to provider time. Best practice rural hospitals target 17 minutes for door to provider median time.
- Transfers
- Reduce over-utilization of ED services and costs
- Educate public on the appropriate use of the ED to improve the number of low acuity cases in ED and fully implement an ED redirect program
- Implement processes for collecting co-pays and deductibles through the adoption of an ED re-direct program
- Deemed non-urgent patients, with EMTALA requirements met, are escorted back to registration before the physician provides final services and prescriptions
- Offer assistance in scheduling the patient in a primary care clinic or provide patient payment options for continuation of ED treatment
- Implement a policy to notify Medicare patients in writing that they did not meet inpatient criteria and that they are now in observation status, which requires them to be financially responsible for the outpatient co-pay
Use key performance indicators (KPIs) to drive performance:
- Monitor and benchmark KPIs as defined by the 2012 Financial Leadership Summit Summary
- Use the Flex Monitoring Team’s CAH Financial Indicators Reports (CAHFIR) Data Summary Reports for comparing indicator medians by state
- Use the Road to Value: Financial Strategy to Transition to a Value-based System Guide and tools to develop and drive financial strategies to survive the transition to value-based payments
Use the Critical Access Hospital Financial Pro Forma (an Excel-based financial modeling tool) to explore long term financial projections under the current Fee For Service (FFS)/cost-based reimbursement systems.