Published: April 1st, 2021
Published: April 1st, 2021
This blog post is taken from a recent interview HealthStream conducted with Joanne Aquilina, CFO at Bethesda Health in South Florida. We talked about her view of the current healthcare financial climate and asker her to forecast what’s ahead. This post excerpts the conversation.
Ms. Aquilina agrees the key to achieving good patient and financial outcomes is strong physician relationships. She highlights the importance of the CFO’s commitment to this end. “Over the last two to three years, my involvement with physicians has grown significantly. I am part of a team that is focused on improving clinical documentation by upgrading the process and technology used by our clinical documentation improvement specialists who round on patient floors to verify doctors are documenting appropriately.” Appropriate documentation is critical for coding accuracy, which, in turn, ensures appropriate reimbursement from payors, benefitting the physician and the hospital.
With the advent of Medicare bundled payments, hospitals and physicians are now partnering to manage patient care from the acute to post-acute setting.” As a CFO, Ms. Aquilina says, “I am involved with these opportunities, whether it’s about optimizing technology or establishing a patient navigator role at the hospital.” She and her team work with physicians to follow the care of patients for 30 and 90 days after they leave the hospital to appropriately manage bundled payments and avoid costly readmissions.
Collaboration, Facilitated By Clinically Integrated Networks
Ms. Aquilina sees the formation of clinically integrated networks (CIN) as the next level of collaboration between CFOs and physicians. As healthcare reimbursement moves to a value-based care model, the CIN works to improve patient care while reducing operating costs and redundancy. Employed and affiliated physicians negotiate collectively with payers on reimbursement arrangements.
By combining several small care systems into one that connects physicians, hospitals, and post-acute providers, networks can improve efficiency and quality. The ability to share patients’ clinical and financial data across the network creates a more complete view of the patient than the more siloed, traditional fee-for-service model.
“Our CIN is still in its infancy,” she says. “We haven’t yet applied for Medicare’s Shared Savings Plan or formalized any agreements with our managed care partners, but we’re seeing increased interest from our medical staff providers. Based on our prior partnerships, doctors are welcoming the opportunity to offer high quality care as we manage the topline – the revenue side – together.”
The Power and Role of MACRA
Another opportunity for collaboration between physicians and the CFO is the Medicare Access and CHIP Reauthorization Act of 2015, better known as MACRA. “We have a team working with our physicians from a technology standpoint to make sure our EHR system is set up to comply with all MACRA components,” explains Ms. Aquilina. “I think they’re on the right path,” adding, “one of our primary care physicians is leading the charge to educate the rest of our employed physicians.”
She believes physicians respond better hearing from a peer rather than hearing from their hospital employer’s C-suite. A director on her staff shares data with the doctors and works individually with each practice, communicating the implications of non-compliance.
A Need to Reduce the Stress of Documentation and Complex EHR Systems
When it comes to documentation and EHR issues in general, the biggest stressor for physicians, she says, is the sheer number of mandated requirements. “This has added time to their day. Their biggest concern is the time it takes with each patient, especially a new patient, to check off each bell and whistle in the electronic program versus simply facing the patient and talking to them.” At least one of Bethesda’s affiliated physicians has hired scribes in his practice to enter information on the computer so he can focus on his patient, notes Ms. Aquilina.
For some physicians, Bethesda’s EHR upgrade to better accommodate MACRA-required changes was challenging. Others took it in stride. “Tech-savvy doctors viewed going from the old system to the new system as something they could easily manage,” she explains.