Declining reimbursements, high deductible health plans and uncertainty from government payers are the key issues keeping hospital and health system CFOs across the country up at night. But many are developing innovative ways to address these issues with population health and waste eliminating strategies.
A panel of CFOs discusses their top priorities at the Becker's Hospital Review 8th Annual Conference in Chicago. The panel, moderated by America's Healthcare Leaders Founder, CEO and Publisher Dan Nielson, included Pittsburgh-based UPMC Physician Services Division CFO Ann Evans; Fountain Valley, Calif.-based MemorialCare HealthCare CFO Karen Testman; and Chicago-based Northwestern Memorial Healthcare Senior Vice President and CFO John Orsini.
The key priorities for the panelists include:
• Integrating hospital and physician practice acquisitions
• Developing population health infrastructure
• Improving access to care
• Selecting EMR/IT platforms
• Focusing on ambulatory and outpatient care
• Lowering the cost of care
• Optimizing current cost structures
• Maximizing advanced practitioners
The panelists took a deeper dive into outpatient investments, acquisitions and operational efficiencies to lower the cost of care.
Outpatient investments
Ms. Testman said MemorialCare's focus is shifting from the inpatient hospitals to the ambulatory and outpatient care clinics. Many patients never make it to the hospital because physicians resolve their issues in the outpatient setting.
"Our focus has been trying to buy lower cost alternatives for our patients, which is why we decided to invest heavily in freestanding ambulatory surgery centers," said Ms. Testman. "In our market, most of our competitors have ASCs as well as hospitals. We've invested in our own freestanding imaging centers whereas most of our competitors are doing that on an HOPD basis. It's been a good thing for us to get into that world"
MemorialCare recently partnered with dialysis company Fresenius to better coordinate care for patients with kidney disease. Ultimately, the system hopes to prevent the need for dialysis and when patients do need it, encourage home dialysis instead of dialysis at the more costly outpatient centers.
The health system also turned its focus to consumerism with a concierge program, which takes backend employees and moves them to the front end of the process as the patient's point of contact. MemorialCare applies the concierge program to certain elective procedures and collects payment upfront; if patients aren't able to pay, their surgery is canceled.
"We always had a program in place for service collections and attempted to collect upfront," said Ms. Testman. "What makes this different is our employees are specially trained in customer service and collections…and we will go forward with canceling or postponing cases."
Integration
Northwestern's focus over the past several years has been acquisitions and integration. "We've been careful to integrate and maintain performance," said Mr. Orsini. "The integration with our IT has helped us make sure our performance hasn't slipped with the integration with the hope that when the investments are complete, our performance will continue to rise even further."
Integration on the business side is challenging, but integrating cultures is even harder. Mr. Orsini said both sides should work together to move in the same direction to prevent culture wars from derailing the transaction.
"Northwestern is very deliberate and focused in finding the right partner," he said. "We've looked at smaller tuck-in deals that we haven't done because it wasn't a cultural fit or there were other things constricting the structure of the deal."
UPMC has also experienced significant growth through acquisitions. The health system now includes 25 hospitals and more than 600 other physical locations. In some cases, practices are under-utilized with two or more unused exam rooms at any given time.
"Our organization has grown tremendously over the past few years by merging, joint venturing and acquiring practices," said Ms. Evans. "Now we have to step back and consider whether we have the best physical footprint for our organization."
Operational efficiencies
UPMC is also creating operational efficiencies and patient satisfaction with biometrics; when patients arrive at the physician's office and use an automated system to check in. As a result, the front desk staff that formerly spent time at registration moved to the back end to manage referrals and help patients navigate the system appropriately.
"We've gotten good feedback on that," said Ms. Evans. "I was a little bit of a skeptic initially of the biometrics because of the population in Western Pennsylvania — it's second only to Florida as the largest elderly population. But what happened in our organization is we got great feedback."
The system also mandated all employed physicians provide same-day appointment access, which means the physicians are available if patients call in needing a specialist in short order. That doesn't mean the patient will see the specialist of their choice, but a specialist will be available to see them.
"That's not the protocol our physicians were used to operating under," said Ms. Evans. "That's underway now and a big initiative for us."
Despite the changes in healthcare and challenges for leadership, all three panelists were bullish on the healthcare industry moving toward value-based care.
"The industry in general is going to survive," said Mr. Orsini. "It draws empathetic, caring people that want to figure things out. We are facing what every other industry, except higher education, has faced. If you look at other industries, they've all gone through periods of consolidation and excess capacity. The reality is that healthcare has a lot of excess capacity so we will squeeze that out as an industry and technology will allow people to better care for themselves overall."