845 fifer presentation
Transcript of 845 fifer presentation
HFMA Update: Strategies for
Success in Today’s Marketplace
Joseph J. Fifer, FHFMA, CPAPresident and CEO, HFMA
Dixie Institute 2015
February 18, 2015
Joe Fifer
Joseph J. Fifer, FHFMA, CPA is president and chief
executive officer of the Healthcare Financial
Management Association. HFMA provides the
resources healthcare organizations need to achieve
sound fiscal health in order to provide excellent
patient care. With more than 40,000 members,
HFMA is the nation's leading membership
organization of healthcare finance executives and
leaders. In 2014, Fifer was named to Modern
Healthcare’s list of the 100 Most Influential People in
Healthcare.
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Agenda
• Leading the Financial Management of Health Care
• Delivering Value Across Traditional Boundaries
• Promoting Price Transparency
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Realignment Is Erasing Traditional Healthcare Boundaries
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Driven by demands for care transformation, the healthcare industry is
realigning at an an unprecedented pace.
The Triple Aim framework was developed by
the Institute for Healthcare Improvement in
Cambridge, Mass. (www.ihi.org).
SHARED GOAL
HFMA Changes Health Care
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OUR MISSION
Leading the
financial
management
of health care
OUR VISION
HFMA will
bring value
to the industry
as the leading
organization
for healthcare
finance
HFMA Services Carry Benefits Across Healthcare Boundaries
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Our core membership of financial professionals comes together with other healthcare leaders
through the wide array of services HFMA offers.
CAREER DEVELOPMENT
AND CERTIFICATIONFINANCIAL
PROFESSIONALS
OTHER
HEALTHCARE
LEADERS
HFMA SERVICES
MEMBERSHIP
CONTINUING EDUCATION
SMALL GROUP-FOCUSED
INTERACTIONS
INFORMATION ANALYSIS
AND PERSPECTIVE
STANDARD SETTING/
GUIDANCE DEVELOPMENT
ORGANIZATIONAL
PERFORMANCE
IMPROVEMENT
VIRTUAL AND FACE-TO-FACE
NETWORKING
Agenda
• Leading the Financial Management of Health Care
• Delivering Value Across Traditional Boundaries
• Promoting Price Transparency
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Beyond Traditional Mergers & Acquisitions
• An emphasis on value-focused
acquisition and affiliation
strategies
• An understanding that different
needs require different
approaches
• The emergence of new
organizational combinations
• A blurring of lines between
competitors and collaborators
• The need to change governance
and organizational structures as
systems change
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Mergers and acquisitions are occurring more frequently between organizations that are both financially strong
• Driven by strategy more than financial need
• Financially weaker organizations are more attractive if
they possess other strategic assets: market position,
affiliated physician networks, outpatient clinics, good
payer mix
• Significance of not-for-profit/for-profit status of potential
partners is diminishing
• Appetite for hospital-heavy acquisitions is diminishing
Mergers Occur Between Financial Equals
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New HFMA Value Report Focus: Critical Role of Physicians
• Alignment and employment options
• Compensation and incentives
• Financial support and sustainability of the physician enterprise
• Physician leadership and governance structures
• Population management capabilities
• Measure and benchmark performance
• Hold physicians accountable for costs
• Recognize importance of smooth onboarding and
credentialing process
• Balance employed specialists with adequate
primary care network.
Strategies to Manage Financial Support of Employed Physicians
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Population Management Capabilities: Realigning Incentives
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Source: HFMA Value Project Report, 2014
• Having timely information
• Reducing fragmentation of services
• Improving coordination of care
• Increasing access to care
• Engaging the patient
Additional Conditions for Effective Population Management
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CMS Seeks to Propel Industry Forward
“Today, for the first time, we are setting
clear goals –and establishing a clear
timeline --for moving from volume to
value in Medicare payments.
Our first goal is for 30% of all
Medicare provider payments to be
in alternative payment models…
by 2016. Our goal would then be to
get to 50% by 2018.
Our second goal is for virtually all
Medicare fee-for-service payments
to be tied to quality and value; at
least 85% in 2016 and 90% in 2018.”
--HHS Secretary Sylvia Burwell
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Sylvia Burwell. Progress Towards Achieving Better Care, Smarter Spending, Healthier People. HHS blog, Jan. 26, 2015.
http://www.hhs.gov/blog/2015/01/26/progress-towards-better-care-smarter-spending-healthier-people.html
Agenda
• Leading the Financial Management of Health Care
• Delivering Value Across Traditional Boundaries
• Promoting Price Transparency
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People and Media Are Speaking Out
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“Reference pricing?
That won’t solve
anything. Hospitals
will just shift the cost
elsewhere.”
“Do the deal and
prices go up
30%. Quality,
too. Yeah...right”
“Health systems
are carving up the
geography!”
Help Patients Make the Value Connection
• Patients and other care
purchasers expect more
transparency.
• Patients also expect to be better
off after receiving care than they
were before—they expect value.
• When you deliver value, make
sure that patients and other care
purchasers know it.
• Be transparent about how
realignment improves health
care for patients.
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Source: HFMA Value Project
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Our Payment System Was Not Designed for Price Transparency
• Historically, prices have served a wholesale
function
• Only recently have prices been viewed as retail
• Without transparency, neither consumers nor
hospitals could compare hospital prices
• With thousands of items, the chargemaster is not
“transparency-friendly”—and not reflective of
“price”
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Would this be a
reasonable pricing
system for buying a
truck? Yet, that is the
system hospitals and
doctors are REQUIRED
to use.
The Time Is Right for Transparency
In a system where. . .
– Charges are primarily used as a factor in a payment
calculation
– Actual prices are essentially invisible to the consumer,
and…
– Charges have little relationship to the service being
acquired
change is inevitable!
We all contributed to this situation—hospitals, physicians,
payers, the business community, and even patients.
We all need to work together to fix it!
Task Force Report
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• Clarifies basic definitions that are often misused
• Sets forth guiding principles
• Establishes roles for payers, providers, others
• Reflects consensus of key stakeholders
hfma.org/dollars
Price Information Resource for Consumers
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• Describes how to request price
estimates, step by step
• Clarifies what estimates may or
may not include
• Explains in-network and
out-of-network care
• Defines key terms
• Available for posting on your
website at no charge
• Hardcopies available for purchase
in bulk at a nominal price through
AHA’s online storehfma.org/transparency
ahaonlinestore.org
Patient Financial Communications Training
• Agenda for live training
on site for your patient
access staff
• Slide deck that can be
customized
• Sample financial
policies
• Coaching guidelines
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hfma.org/dollars
Recognition Signifies Commitment to
Community
• Recognition demonstrates commitment
to best practices in patient financial
communications
• Based on HFMA review of an application
and supporting documentation
• All provider organizations may apply
• Recognition valid for two years
• Adopters may use the phrase
“Supporter of the Patient Financial
Communications Best Practices” in their
marketing materials
• Makes a strong statement to your community
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hfma.org/dollars