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Top Challenges & Opportunities for Spine in 2011
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Top Challenges & Opportunities for Spine in 2011

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  • 1. Top Challenges & Opportunities for Spine in Top Challenges & Opportunities for Spine in2011: Healthcare Reform, Accountable Care 2011: Healthcare Reform, Accountable Care Organizations, Outpatient Growth & More Organizations, Outpatient Growth & More December 15, 2010 December 15, 2010 Nicola V. Hawkinson DNP, RNFA, RN CEO & Founder, SpineSearch Copyright © SpineSearch LLC 2010 Copyright © SpineSearch LLC 2010
  • 2. Five Biggest ChallengesHealth Care ReformDeclining ReimbursementHow to Decrease OverheadStaff RetentionIncreasing Efficiencies Copyright © SpineSearch LLC 2010
  • 3. Five Biggest OpportunitiesNew TrendsMinimally Invasive Spine ProceduresEducation AdvancementElectronic TechnologyGrowth of Outpatient Care Copyright © SpineSearch LLC 2010
  • 4. Five Biggest ChallengesHealth Care ReformDeclining ReimbursementDecreasing OverheadStaff RetentionIncreasing Efficiencies Copyright © SpineSearch LLC 2010
  • 5. A New Day for Health Care In America Copyright © SpineSearch LLC 2010
  • 6. Affordable Care ActComprehensive healthcare reform law enactedMarch 2010Two Parts: The patient protection and Affordable Care Act (3/23) Healthcare and Education Reconciliation Act (3/30) “Affordable Care Act” www.healthcare.gov Copyright © SpineSearch LLC 2010
  • 7. Affordable Care ActHealth Insurance Reform Hold Insurance companies more accountable Lower healthcare costs Guarantee more healthcare choices Enhance the quality of care Copyright © SpineSearch LLC 2010
  • 8. Affordable Care Act Small business tax credit to provide healthinsurance coverage, 2014 Represent the largest middle class tax cut inhistory Increase health insurance coverage to the 32million currently uninsured Set up a new competitive private healthinsurance market Copyright © SpineSearch LLC 2010
  • 9. What Are The 18 Immediate EffectsAmend to pre-existing conditions Appeals ProcessSmall business tax credit Indoor tanning service coSenior drug rebate Enhance fraud abuse checksYoung adult extended coverage Medicare expansion rural areasNo lifetime insurance cap Deductions for BC /BSAdult with pre-existing cov. Nutritional content disclosurePreventative care options Improved coverage for earlyEnd of Recissions retireesTranparency of Insurancy Co Improve consumer info on web Encourage investment in new therapies
  • 10. The Effect Of Reform On ASCIncrease growth of outpatient servicesCloser to center of care deliveryBecome a center for multidisciplinary services Copyright © SpineSearch LLC 2010
  • 11. The Effect of Reform on ASC Movement toward outcomes orientedreimbursement focus - coordinated care – outcomes Potential for the shift towards outpatient orienteddelivery systems Copyright © SpineSearch LLC 2010
  • 12. Five Biggest ChallengesHealth Care ReformDeclining ReimbursementDecreasing OverheadStaff RetentionIncreasing Efficiencies Copyright © SpineSearch LLC 2010
  • 13. Revenue Cycle ManagementMaintain physician compensation levelMaintain ASC profitabilityImprove collections process from: self pay, high deductible plansImprove contract negotiation with ins. CompaniesRecruit new MDs Copyright © SpineSearch LLC 2010
  • 14. Physician Compensation Increasing number of patients Declining / standardization of reimbursements Understanding of the competitive landscape Decision makingWhat is the best strategic plan to sustain profitability Copyright © SpineSearch LLC 2010
  • 15. ASC ProfitabilityDecrease overheadRetain staffExpand profitable service linesMarket specialized servicesRevenue must exceed operational costs Copyright © SpineSearch LLC 2010
  • 16. ASC Profitability Increase expenses / constrained reimbursement Improve productivity without substantiallyincreasing cost Non-physician Providers Copyright © SpineSearch LLC 2010
  • 17. Improve Collections From Patient to Payment 1. Eligibility 2. Claim Status 3. Reimbursement4. Billing5. Payment Copyright © SpineSearch LLC 2010
  • 18. Improve Contract NegotiationKnowledge of current contractUnderstanding the competitive landscapeAssociated cost vs. payment for servicesGroup vs. Private practice Copyright © SpineSearch LLC 2010
  • 19. Recruitment of New PhysiciansMaintain attractionUpdated business planNumbers don’t lieMarketing must be ongoingStaying ahead of the curve Copyright © SpineSearch LLC 2010
  • 20. Five Biggest ChallengesHealth Care ReformDeclining ReimbursementDecreasing OverheadStaff RetentionIncreasing Efficiencies Copyright © SpineSearch LLC 2010
  • 21. Decreasing OverheadStreamline tasksTransfer to electronicPaperless systemOptimize officeOR space Copyright © SpineSearch LLC 2010
  • 22. Five Biggest ChallengesHealth Care ReformDeclining ReimbursementDecreasing OverheadStaff RetentionIncreasing Efficiencies Copyright © SpineSearch LLC 2010
  • 23. Staff RetentionTurnover can be a facilities largest expense Up to 50% of a candidate’s annual salary (mgma.com)Programs focused on: Retention Continued education Internal promotion Copyright © SpineSearch LLC 2010
  • 24. Five Biggest ChallengesHealth Care ReformDeclining ReimbursementDecreased OverheadStaff RetentionIncreasing Efficiencies Copyright © SpineSearch LLC 2010
  • 25. Increasing EfficienciesConversion to Electronic Health RecordsElectronic Insurance submissionsStandardization of practice OR preference sheets Intake forms Discharge instructions Copyright © SpineSearch LLC 2010
  • 26. Five Biggest OpportunitiesNew TrendsMinimally Invasive Spine ProceduresEducation AdvancementElectronic TechnologyGrowth of Outpatient Care Copyright © SpineSearch LLC 2010
  • 27. Five Biggest OpportunitiesNew TrendsMinimally Invasive Spine ProceduresEducation AdvancementElectronic TechnologyGrowth of Outpatient Care Copyright © SpineSearch LLC 2010
  • 28. Minimally Invasive TechniquesIncrease in bone biologicsLess complex surgeryGreater emphasis on interventional proceduresMore spine procedures being done outpatient Copyright © SpineSearch LLC 2010
  • 29. Five Biggest OpportunitiesNew TrendsMinimally Invasive Spine ProceduresEducation AdvancementElectronic TechnologyGrowth of Outpatient Care Copyright © SpineSearch LLC 2010
  • 30. Educational Advancement In the shadow of a nursing shortage – TheAmerican Nurses Association will look towardsspecialized training / certification For physicians and advanced practice nursesalike education level may soon impact insurancereimbursement The Academy of Nurse Executives recentlycreated the first Nurse Manager Certification (AONE,2010) Copyright © SpineSearch LLC 2010
  • 31. Educational Advancement ASC’s can promote their employee retentionthrough offering educational opportunities andreimbursement Increase staff commitment, loyalty, drive success Improve quality patient care Copyright © SpineSearch LLC 2010
  • 32. Five Biggest OpportunitiesNew TrendsMinimally Invasive Spine ProceduresEducation AdvancementElectronic TechnologyGrowth of Outpatient Care Copyright © SpineSearch LLC 2010
  • 33. Electronic Technology Copyright © SpineSearch LLC 2010
  • 34. Five Biggest OpportunitiesNew TrendsMinimally Invasive Spine ProceduresEducation AdvancementElectronic TechnologyGrowth of Outpatient Care Copyright © SpineSearch LLC 2010
  • 35. Growth of Outpatient CareAmbulatory Surgery Center’s grew 38% from2003-2008Bureau of Labor and Statistics predict ASC tooutpace hospital growth by 45.4%Greater opportunities for MD, RN, NP, PA,Medical Assistants Copyright © SpineSearch LLC 2010
  • 36. Growth Of Outpatient Care Healthcare reform will further accelerate thegrowth of ASCIncrease need for integrated care Copyright © SpineSearch LLC 2010
  • 37. Customer ServiceThe Best Waiting Rooms Do Exactly The Opposite of What They Are Named For Copyright © SpineSearch LLC 2010
  • 38. Customer ServicePatients are ConsumersIncreased access to care = More choicesPremier serviceStand out from the competition Copyright © SpineSearch LLC 2010
  • 39. Crucial StepsService line capabilitiesService deliveryMarket sharePhysician alignmentManagement and infrastructure Copyright © SpineSearch LLC 2010
  • 40. ConclusionHealthcare reform is upon usASC’s must be preparedUnderstanding of: Competitive landscape Culture / vision Strategic Plan Copyright © SpineSearch LLC 2010
  • 41. Questions
  • 42. Thank You 306 East 15th St. Suite 1R New York, NYWWW.SPINE-SEARCH.COM 1.646.794.8656