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Revenue Cycle Exchange: Rising to New Financial Challenges

Analysis  |  By Christopher Cheney  
   March 28, 2016

Executives at this year's Revenue Cycle Exchange in San Diego say they're making significant progress accounting for alternative payments models, transitioning to new electronic health record systems, and boosting patient experience.

This article appeared in the May 2016 issue of HealthLeaders magazine and was based on Christopher Cheney's online column from March 28, 2016.

There is light at the end of the revenue cycle transformation tunnel.

Southwest General launched Medicare's bundled payment program for congestive heart failure in January 2015. "There was a million dollars at risk, and the question was, 'Do you budget for that? Do you budget for the potential shared savings? One of the reasons we chose CHF was that the data showed that if we were successful, we had an opportunity to get a check from Medicare for over $1 million," says Jill Barber, MHA, director of managed care and payer strategy at Middleburg, Ohio-based Southwest General Health Center, a 358-bed facility.

"And again," she says, "the question was, 'Do you budget for that? Do you plan for that?' What we chose to do is just say, 'If we lose, there will be some other contingency planning to fall back on.' Still a risk, but not incorporated into the budget. We actually felt we were going to be successful. For us, CHF and that $1 million opportunity represented a 'fish-in-a-barrel' opportunity. How hard could it be? We needed to save Medicare $80,000 and the rest would be for us."

As part of the effort to ensure bundled payment success, post-acute strategy is key. At the onset of the bundle, Southwest General closed its skilled nursing facility. "We didn't want to force leaders in our organization to be focused on volume and keeping days of stay ramped up and bodies in beds, which is the exact opposite of working with an alternative payment model like bundled payments. For many reasons, we chose to close our SNF and work with our community SNFs because there was capacity in the market."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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