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HFMA: Revenue Cycle, Reimbursements Share the Spotlight

Rene Letourneau, for HealthLeaders Media, June 17, 2013

In early 2010, the Cleveland Clinic set up an enterprise risk management steering committee and work groups to focus on specific problems and strategize solutions. Kolodkin will share the lessons learned.

"[My] objective is to give more information to healthcare organizations about enterprise risk management and share some of our experiences at the Cleveland Clinic as part of the presentation. Some organizations may have thought about it and may be at different stages of the process, and we are trying to give them a pragmatic approach as far as how to initiate it."

Healthcare providers need a solid EMR program now more than ever as they prepare for an onslaught of newly-insured patients—and their inevitable impact on reimbursements and the revenue cycle—thanks to the Patient Protection and Affordable Care Act, Kolodkin recently told me.

"It's different than a risk like giving the wrong medication to a patient, but you still have to have a strategy for dealing with it. You may have greater utilization from people that you wouldn't have had before. Importantly, Medicaid reimbursement will be less than commercial payers. Those are risks, so how are you going to address them? What are you going to do to mitigate them? You may decide to use more allied health providers like nurse practitioners and physician assistants or you may introduce wellness programs for things like diabetes and other diseases so you can keep this population from becoming inpatients."

Kolodkin and his co-presenter Angela Hoon, partner at audit, tax, and advisory firm KPMG, will discuss these and other risk factors currently affecting healthcare providers and put them in the context of building a high-level ERM strategy, according to Kolodkin.

"One of the things we will emphasize repeatedly is that a lot of the time people think ERM in healthcare is about patient safety, exposure, liabilities, and how to make hospitals safer for patients. That's true, but it's not what an ERM looks like at the big picture level where you are trying to make it a governance tool."

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