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Patrick Sulzberger, CPA, CHC - MGMA-GKC · 3 The greatest danger in times of turbulence is not the...
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Patrick Sulzberger, CPA, CHC
Transcript of Patrick Sulzberger, CPA, CHC - MGMA-GKC · 3 The greatest danger in times of turbulence is not the...
Patrick Sulzberger, CPA, CHC
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My connection to continuous improvement
My connection to strategic positioning and change readiness
My connection to YOU
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The greatest danger in times of turbulence is not the turbulence – it is to act with yesterday’s logic
Peter Drucker
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Three major external forces are impacting the health care industry today
◦ Legislative / Regulatory
◦Demographics (aging population)
◦ Federal and State Deficits
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• “A critical part of HHS’s strategy is to give the American public the means to make more informed choices to ensure optimal health care by improving transparency regarding the quality and costs of health services, better coordinating care, fostering patient-centered care, and promoting consumers’ participation in their health and health care.”
(source: Department of Health and Human Services)
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Better
Health
Better
Value
Better
Care
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Acute care hospitals penalized for readmission of patients within 30 days
Diagnoses impacted include AMI (acute myocardial infarcation), CHF, pneumonia
New for 2015 ◦ COPD, elective total hip arthroplasty (THA)
and total knee arthroplasty (TKA).
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Penalty for Fiscal 2015 based upon 2010 – 2013 performance
“Excessive” readmission penalty (minimum of 3% ) on the specified DRG’s
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PPS hospitals - no additional payment for conditions not present upon admission (i.e. acquired during the hospital stay)
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Payment reform driving
Innovative payment arrangements
ACO’s
Collaboration
Acquisition
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Where is the opportunity in this change?
How are you positioned to capitalize?
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External
Environment
• ACA
Considerations
Internal
Considerations • SWOT
Strategic
Decisions • Flexibility
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Who is your “customer”
◦ Employers
◦ Insurance
◦ Patient
◦ Referral sources
◦ Hospital
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Your Facility
◦ Best value setting?
◦Quality reporting?
◦ Transparent prices?
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◦ Bundled Service Considerations
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Definitions
Services Patients Providers
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Are they initiating value-based initiatives?
◦ How can you add value?
◦ IT considerations
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Competitor?
Collaborative partner?
Relationship will drive strategic considerations
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Hospitals are diverse ◦ Tough decisions – what can we do well?
◦ Larger nimble
Your group is focused ◦ Need to be nimble Culture
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Rapid change creates chaos
Traits for consistent success
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◦Culture of “change readiness”
◦Goal alignment among stakeholders
◦Well developed Strategic Plan
◦ Leadership at all levels
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Currently, do our behavioral “norms”
◦ Allow us to respond to change constructively and timely to minimize risk
◦ Create advantages for the organization (and our customers)
◦ Provide a foundation for sustainable success
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Culture
CEO /
Admin.
Physicians
Staff
Managers
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What is ACA incentivizing?
◦ Efficiency
Continuous Process Improvement
◦ Eliminate waste
◦ Improving quality (not just care)
◦ Customer focused
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Physician engagement
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Better Care Coordination
Reducing Waste
Improving Outcomes
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Estimates indicate 56% of total Medicare expenditures relate to items physicians order or control, while roughly 10% is on the physician professional component
(source: Seminar held by the Center for Healthcare Quality and Payment Reform)
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External Environment
◦Medicare and ACA
◦OIG, HIPAA
◦ Commercial payers
◦Hospitals, clinics
◦ Self-insured employers
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Internal Considerations
◦Culture (staff and physicians)
◦ Evaluate
Strengths vs. Opportunties
Weaknesses vs. Threats
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Flexible ◦ Strategy How to achieve goals
◦ First Consensus about “where”
◦ Re-evaluate every 1 – 2 years
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We are a resource to help our clients position themselves for
sustainable success in a rapidly changing environment.
www.tsphealthcare.com
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LinkedIn https://www.linkedin.com/company/total-solution-
partners
Facebook https://www.facebook.com/TotalSolutionPartners
Twitter https://twitter.com/TSPHealthcare
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