Clients
Providers
|
Payors
|
Harvard Medical Faculty Physicians
Harvard Medical Faculty Physicians at BIDMC (HMFP), a multi-specialty academic physician practice with over 700 staff members experienced serious financial deterioration following the merger of the BI and NEDH. Physician staff was leaving the institution in large numbers which led to a significant decline in patient volume and revenue. Decline in morale among existing staff resulted in reduced productivity which further depressed practice revenue.
My solution involved the development of a physician productivity measuring tool that benchmarked department volumes as measured using work RVUs with external data sources including MGMA surveys. The tool assessed overall productivity as well as determined how reasonable physician compensation levels were when integrated with productivity measurements. Aligning incentives properly resulted in a volume increase of 15% in the practice’s largest department of medicine.
At the same time I performed the modeling required for the practice to implement a split billing model that increased hospital/physician practice revenue by $2.5 million. The new billing mechanism added $1.0 million to HMFP’s bottom line.
Northeast Physician Hospital Organization
Northeast Physician Hospital Organization (NEPHO) at Beverly Hospital, a 200 physician multi-specialty practice had just severed its affiliation with Partners Community Health Care (PCHI), the largest physician network in Massachusetts. NEPHO was placed in the difficult position of having to renegotiate all of its major managed care contracts within a very tight timeframe.
My solution was to organize a billing database of NEPHO’s two largest payors and to design a model that calculated the practice’s existing payment as a multiple of Medicare payment levels for over ten specialties. This model was used to ensure that payment renegotiation with the two payors resulted in payments that remained at the levels provided under the previous PCHI agreement. Without this analytical support NEPHO could have ended up with payment reductions of 20 – 30 percent.
Harvard Vanguard Medical Associates
Harvard Vanguard Medical Associates (HVMA), a multi-specialty physician practice with more than 1,000 staff members was concerned that the fees it was paying to selected hospitals under the Medicare Senior product offered by one of the major payors was excessive compared to current Medicare inpatient and outpatient payment rates.
My solution was to identify the hospital specific Medicare inpatient and outpatient payment rates for the group of institutions doing business with HVMA. I applied these rates to detailed Medicare senior product claim data for the hospital group and calculated the expected Medicare payment level. HVMA was then able to compare current payment rates to the Medicare rates and identify the hospitals where current fees were excessive compared to Medicare. This information provided the evidence needed for HVMA to renegotiate lower payment rates for these hospitals in following years.
