7 Characteristics of Highly Successful ACO’s

rends toward providers joining Accountable Care Organizations have continued to rise, but not all ACO’s are created equal. It’s become clear that some ACOs out there aren’t achieving the kind of success that was originally hoped for by their creators. Why is it that some organizations are making a difference and others aren’t? We’ve identified some of the characteristics of highly successful ACO’s, so you can determine which organizations are making real progress and which ones are just doing it for publicity. Remember to value substance over style!

-       Are providers willing to take capitation risks? If so, it shows that they’re dedicated to the overall cause of making health costs and medical bills less of a challenge for their patients.

-       Do they have providers with a deep understanding of the organizations financials? If they do not, then it will be challenging to make a true shift to value-based care.

-       Is there a physician willing to tackle the disruption associated with potential financial cannibalization until new centers are built? It’s important to have someone step up who is willing to take risks.

-       Is there an active clinical leader dedicated to cultural evolution? It’s important not to play it safe, but to make a name for yourself in the evolving medical community.

-       Is physician compensation focused on value? The goal should be to improve overall care quality and create personalized experiences for every patient while rewarding physicians for adopting the value-based model.

-       Are there benefits designed to keep members within the ACO? Patients care about the quality of their care and working with the best physicians possible, but to truly create the best patient-ACO relationship, a benefits system being set in place will strengthen their brand-loyalty.

-       Are the value-models commercialized to build volume and improve brand recognition? The marketing team for an ACO needs to make sure they make it easy for patients to understand what makes your organization so great and ensuring that when they think about their ACO options, they remember your name.

Ultimately, ACOs can be great in theory, but without a strong physician leader and a team dedicated to igniting change in the industry and local medical community, the efforts could fall flat. Everyone can get behind the cause for lowering health care costs, but is your organization doing everything they can? 

10 Things You Should Know About the Medicare Payment Data Release

Last week, CMS released a report summarizing the Medicare billing data for physicians across the country. Doctors panicked and patients attempted to understand what all these steep numbers meant, meanwhile buzz terms like “healthcare price transparency” and “reimbursement rates” flew around with more aggressive velocity than ever before.

For those that are unsure what this billing report really means, we’ve given you a breakdown. Read on to learn everything you need to know about this release.

1.     The report shows which physician specialists are getting paid the most and approximately how much they are receiving from CMS.

2.     So what are these payments supposed to cover? Medicare fees are supposed to cover the physician’s actual work, overhead costs for their equipment, malpractice insurance and other costs. What are those “other” costs though?

3.     It shows amounts paid but doesn’t delineate where specialties with high overhead costs come into play. For example, Radiation Oncologists incur significant overhead costs to provide their specialized services, so they get reimbursed much more to cover those costs.

Information provided by The Wall Street Journal. Source: Centers for Medicare and Medicaid Services

4.     There are tons of dollar amounts being shown, but the figures do not correlate to patient levels or success rates, so the impact of the costs cannot be easily determined.

5.     The report was supposed to help catch Medicare fraud activity, but it doesn’t do this very effectively. This is because it lumps a lot of physicians into groups regardless of outside factors like overhead costs.

6.     The goal of displaying this data was that exposure would change overall behavior.

7.     The database does not break out payments by PC and TC. Rather, they are aggregated, explaining why the numbers seen in the Wall Street Journal article are so steep.

8.     Separate from the aggregated data, there is also a larger dataset of information which is HUGE and includes the following information for each physician in the country:

·         Average charge/CPT code

·         Number submitted/CPT code

·         Average amount per procedure code

·         Billing addresses of physicians

·         Procedure performed in a “facility” or “non-facility”

·         POS codes for procedures

9.     This dataset file is too big for Excel, but if you link the text file to Access you can use it.   We learned via the RBMA chatter, that some have had success this way, saying, “Once I got a query result I used Excel to manipulate and analyze the data.” Keep this in mind if you’re looking for a way to sort the data yourself.

10. This big number: $121 million. As in, the sum of what the top 10 physician billers charged for Medicare in 2012.

Important links for learning more:

Dataset:

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier.html

WSJ Article:

http://online.wsj.com/news/article_email/SB10001424052702303873604579492012568434456-lMyQjAxMTA0MDEwMTExNDEyWj

WonkBlog Summary of Physician Responses:

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/04/10/wonkbook-why-doctors-are-upset-about-the-medicare-payment-data-release/

Metropolitan Ministries' Annual Bridge Builder's Breakfast

The smell of pastries and coffee filtered through the air at Metropolitan Ministries’ Annual Bridge Builder Breakfast yesterday while the essence of hope flourished. Bustling with some of Tampa’s most involved community members, this year we had plenty of reasons to celebrate. Metropolitan Ministries’ quote of the year has been, “Hope can grow anywhere,” which is brought to life in the Miracle Place, their newest addition to their efforts in solving problems even in the most hopeless of situations.

Miracle Place provides a place for 50 new families to live and is home to a new preschool, partnership school for children from kindergarten through fifth grade; new after-school programs and extended dining facilities. The Tampa community has worked hard to build Miracle Place and it will enable Metropolitan Ministries to double their efforts in helping families and individuals in need of assistance and a fresh start.

http://www.youtube.com/watch?v=UbdGXPjFv4I

We have come a long way, but the road has not come to an end just yet. The building is built, but the rooms are all empty so Metropolitan Ministries is now turning to the community looking for donations to help furnish the rooms, making them feel like home to those that will live in them. With 50 new units to furnish and doubled operating costs, Metropolitan has a lot of work to do, so we called in the troops… or should we say, the Bucs?

Tampa Bay Buccaneers head coach Greg Schiano was kind enough to come speak at this year’s Bridge Builder’s Breakfast. He shared some insight on the sense of leadership he hopes to instill in his players and the franchise through their involvement with Metropolitan Ministries including; trust, believe, accountability and leadership. He also referenced a band he wears on his wrist that reads FAMILY, standing for Forget About Me I Love You. This is a mantra he has to remind himself of and teach to his team daily, but he said that is what Metropolitan Ministries does all day, everyday.  “Schiano’s level of passion as a volunteer and advocate for Metro is palpable, it is inspiring to see,” says Chris Christenberry, who serves on the organization’s Board of Directors.

The event was complete with success stories from some of Metropolitan Ministries clients coming to speak.  One man shared a story about the business he owned only a few short years ago until it crashed with the unlucky economy. His story was inspiring and humbling, reminding attendees that anyone can fall on hard times.

In the next year, we hope to see more of the community get involved with Metropolitan’s amazing efforts. The homelessness population grows in triple-digits each year in the Bay Area, which means that we have our work set out for us!

Chris Christenberry is Atlantic Health Solutions’ president and he serves on the Board of Directors at Metropolitan Ministries. Due to his involvement in the organization, Chris has lead Atlantic’s staff to appreciate the work and efforts of Metropolitan Ministries. It is our in-house philanthropy of sorts and we are proud to be such active volunteers.

Radiologist Archetypes & Mythbusters for Healthcare Marketers

Last week our team of experienced healthcare marketers sat down with Jayson A. Lord, MD to get an inside look at what makes radiologists tick.  Dr. Lord, who lives in Tampa, Florida and performs radiology for practices nationwide, discussed ways to understand radiologist motivators, tricks for how to get the good doctors involved with marketing and physician relations and spent time going through “Radiologist Mythbusters” which was a session where marketing representatives were able to state their radiologist assumptions in an open forum and discuss ways to overcome them.

One of the biggest questions Dr. Lord wanted to address was why radiologists often choose their profession. “Radiologists are typically very analytic thinkers, they love puzzles and problem solving. Radiology is the ultimate puzzle,” he said about his profession.  Getting to the root of why people choose certain paths in life intrigues Dr. Lord, and he drew from components of Jungian archetypes to explain physician motivators and the individuals who contribute to a practice’s success. The four quadrants of Jungian archetypes, which most people fall into, are The King, The Warrior, The Magician and The Joker.  As a King; individuals are filled with confidence and authority which can be a very good or very bad thing depending on the individual. The Warrior serves as a dutiful worker, while The Magician is able to utilize tricks and an engaging personality to “make things happen.”  The Joker is traditionally less motivated and looked at as the hopeless romantic of society. So which category does your radiologist fall into?

Lord says that most radiologists identify with the Warrior archetype. They want to show up to work, get through their stack of reads and move on with their systematic schedule.  Most radiologists that own their own independent practices, like Dr. Lord, fall into The King category, which can have both positive and negative influences on their work, but oftentimes responsibility rolls up the hill to the king, and most radiologists do not want to step out of their warrior roles to take on other responsibilities, leaving practices without a leader.

In order to get your radiologists more involved with marketing efforts, Dr. Lord says the key is finding your radiologist magician however. Traditionally introverted, radiologists love regiments and they need to be untrained from the clinical paradigm they’ve adopted in order to step outside of their comfort zone. In a group of radiologists, a magician can usually be found and if they are open to working with your marketing team, it can make all the difference in the world.

The key to getting started is setting up an opportunity for your radiologist to engage in a conversation with a referring physician where they will walk away feeling positive. After having a few encounters that go well, it will be less heartbreaking when they go on more challenging meetings.  It would be beneficial to set up a lunch with a clinical topic in mind to discuss for more introverted radiologists, but as long as the referring physician is engaging, a feeling of positivity can be fostered. We can compare this to someone learning to cook. If all you’ve ever made is grilled cheese, you would not delve into your first cooking adventure aiming to perfect soufflés or prepare a full Thanksgiving meal. You would start with the basics: baked chicken, some steamed veggies and pasta. The same can be said about easing radiologists into marketing efforts.

As healthcare marketing professionals, it is important to be able to read people, understand what their needs and motivators are, and to use that information to grow.  Figuring out what kind of radiologist you work with and finding your internal Magician could lead to exponential levels of success for your center.

Radiology's Future: Our Specialists

A recent survey performed by the American College of Radiology concluded that the job prospects for radiologists finishing their residencies have wavered over the past few years, but by 2014, the career playing field should be leveled.

Back in 2011, there were about 1,241 radiologists that were hired but only 1,103 in 2012.  Researchers project that in 2014, there should be back up to around 1, 227 positions.  Within the same study, researchers found that there is about one job per every radiologist that finishes their studies, but that job might not necessarily be in an ideal location or in their desired subspecialty.  The South, West, Midwest and the Mid-Atlantic states are the areas with the highest number of open radiologist positions, meaning that areas up North are practically impossible to find positions in after residencies are completed.

One positive thing about the millennial generation is that they are entering the work place with a stronger aptitude and openness towards change, allowing them the freedom to explore new regions for work and new frontiers of specialties.  Typically, graduates don’t mind relocating and are quick to adapt to their new surroundings.  Also, most of the graduates are open to going into a different field than they originally planned, which is something more seasoned radiologists would be more apprehensive about.  

The job market is progressively getting better each year for new radiology graduates, and it will continue to grow over the next few years, so it’s important for those specialists to stay on the radiology warpath if that is where their passions lead them. Industry changes may influence some, but we can still be confident in the future of our industry.

BONUS: Understanding Radiologists… in song: https://www.youtube.com/watch?v=qaGV3-INNk8