Content Area
Alignment and
Integration
Key Issues and Topics
Definition
What is the medical practice administrator’s role in…
Alignment and
Integration Strategies
focus on the critical legal,
operational, financial and
strategic issues that arise
when physician
practices, health systems
and hospitals pursue
efforts to successfully
align and integrate.
Choosing the right business model for the medical
practice:
• Economic forces and competition driving
alignment and integration
• Assessing your practice’s readiness for evolving
healthcare
• Physician-to-physician alignment options, e.g.,
mergers, acquisitions, IPA
• Physician-to-system alignment options, e.g.,
service line agreements, co-management, joint
ventures, PHOs, MSOs, employment, medical
directorships
• Strategies for staying or becoming independent
• Clinical integration
Managing physician practices within a health system:
• Distinctions between physician-owned vs.
hospital-owned practices
• Physician involvement in health-systems
governance
• Case studies/best practices
• Clinical integration
Compliance and Risk
Management
What is the medical practice administrator’s role in…
Keeping the practice compliant while operating at
maximum efficiency and providing high quality care:
• Fraud and embezzlement
• Governmental audits – Recovery Audit
Contractors; Medicare Administrative
Contractors; Zone Program Integrity Contractors;
Medicaid Integrity Contractors
• HIPAA
• Information technology (IT) security
• Mitigating technological disasters
Understanding the legal implications of new business
models, i.e., ACOs, clinical integration:
• Stark Law
• Clinical integration and anti-trust
• Applying for waivers
Compliance and Risk
Management describes
the processes and
practices by which
healthcare organizations
ensure that their
practices are protected
from medical
malpractice and adverse
legal events.
Health Information
Management
What is the medical practice administrator’s role in…
Creating operational and strategic efficiencies with
technology:
• Practice management software optimization e.g.,
data mining, benchmarking, population health
• EHR life cycle – selection, implementation,
optimization, sunsetting
• New office technologies, e.g., iPads, apps, patient
portals, smart phones, telemedicine, social media
• Outsourcing/Insourcing IT services
• Health information exchanges/sharing data with
the community
• Reputation management/defense
Managing compliance:
• Meaningful use
• eRx/e-prescribing, managing refills
• ICD-10
Health Information
Management describes
the comprehensive
management of health
information and its
secure exchange
between consumers,
providers, government
and quality entities, and
insurers. HIT also
includes the use of
technology to create
operational efficiencies
and improve the
management of
healthcare services.
Patient Care and
Quality
What is the medical practice administrator’s role in…
Maximizing practice efficiencies:
• Lean operations
• Patient flow
• Responding to negative quality data in a timely
manner
• Incorporating evidence-based practices
Fostering patient responsibility:
• Patient education
• Patient engagement
• Shared decision making
• Patient communication best practices
Managing patients:
• Customer/patient service
• Managing the high-risk patient
• Patient registries
• Patient satisfaction, patient surveys
• Population health
Partnering in the continuum of care/ Implementing
new care delivery models:
• Care coordination
• Patient-centered medical homes
• Patient-centered medical neighborhoods
• Accountable care organizations
Measuring quality
• Selecting quality metrics
• Measuring quality
• Benchmarking quality
• Communicating quality outcomes
Patient Care and Quality
refers to the systems and
processes that result in
efficient operations
while ensuring patient
safety and high-quality
care.
Professional and Staff
Development
What is the medical practice administrator’s role in…
Developing and maintaining a high-performing team
• Physician and staff relations
• Physician-Administrator teams
• Disruptive behavior
• Staffing/staff ratios/right-sizing
• Staff performance management and development
• Practice culture
Managing organizational change
• Leading change
• Change management
• Organizational culture
• Physician recruiting/retention
Career management and development
• American College of Medical Practice Executives
• Career advancement
• Networking
• Re-tooling your career
Professional and Staff
Development refers to
the processes and
practices through which
healthcare practices
optimize the
performance of the
people in their
organizations.
Revenue and Cost
Strategies
What is the medical practice administrator’s role in…
Managing providers
• Physician compensation planning
• Improving physician productivity, e.g., RVUs,
quality, patient satisfaction, citizenship
• Using financial reporting to increase productivity
• Correct coding
Maximizing internal processes and staff productivity
• Revenue cycle management
• Improving billing claims, denial management,
collections
• Using Relative Value Units to track profitability
and costs
Managing payer relations
• Payer contracting and negotiating
• Evaluating payer mix
• Fee schedule analysis
• Evaluating value-based payment structures
• Evaluating new payment models, e.g, bundled
payment, shared savings, episodes of care, global
payment, and capitation
Revenue Strategies and
Cost Containment
encompasses the
processes and operations
and strategies by which
companies continuously
monitor, modify and
implement programs for
maximum financial
results.
Learning Level Descriptions
Basic – Designed to develop a general understanding of a topic or a knowledge area.
Intermediate – Designed to develop a working knowledge of a topic or a knowledge area or
build on a basic curriculum.
Advanced – Designed to develop in-depth expertise in a topic or a knowledge area.
Health Innovation Pavilion Sample Abstract
Bundled Pricing – Lessons Learned from 28 Years of Practical Experience
Revenue Strategies and Cost Containment
Basic
Traditional
While bundled pricing came to the healthcare industry more than 25 years ago, recent
healthcare legislation has led to the re-emergence of bundled payments for episodes of care as
a viable alternative to the traditional fee-for-service reimbursement model. Whether you’re
integrated with a hospital or practicing independently, a properly designed bundled-payment
arrangement can benefit your practice. Learn how to overcome the challenges associated with
bundled-payment arrangements in order to reduce costs and improve the integration of care
delivery.
This session will provide you with the knowledge to:
• Describe bundled-payment implementation strategies
• Articulate the administrative and management aspects of packaged-pricing arrangements
Are You Bundled? Physician Alignment in the ACO Environment
Alignment and Integration Strategies
Intermediate
Traditional
Amidst today’s healthcare reforms, hospitals and physicians must align in order to succeed. A
successful bundled-payment solution packages and presents physicians’ services and fees as a
comprehensive episode-of-care payment, allowing providers to more readily identify what costs
and risk to leverage in physician engagement. Using a case-study approach, this session will
explore payment and reimbursement models, how and why physicians should align themselves
with providers and payers, and the key components of risk-based alignment models.
This session will provide you with the knowledge to:
•
•
Determine the appropriate alignment model for your circumstances
Describe the key components necessary for alignment
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