Articles  |   December 2015
Is it Time to Reevaluate the C-Suite?
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Education / CPD / Practice Management / Quality Improvement / Articles
Articles   |   December 2015
Is it Time to Reevaluate the C-Suite?
ASA Monitor 12 2015, Vol.79, 42-43.
ASA Monitor 12 2015, Vol.79, 42-43.
“I do not believe you can do today’s job with yesterday’s methods and be in business tomorrow.” – Nelson Jackson
As the dynamics of our country’s health care system change, so too must our methods of managing the intricate web of patient encounters. We have all heard the buzzwords “population health,” “bundled payments,” “full risk” and “value-based purchasing.” These phrases signal the movement from a reimbursement model predicated on frequency to one based on patient outcomes. In essence, the new reimbursement paradigm forces us to reconsider yesterday’s methods.
Traditionally, hospitals used their resources to report quality data, as required by the Centers for Medicare & Medicaid Services (CMS). They maximized reimbursements by capturing all patient comorbidities and by working with physicians to minimize the length of stay. This model improved the profit margin with medical DRGs such as CHF, AMI, stroke, pneumonia and COPD by standardizing care, improving quality and lowering costs. Surgical services were the financial engine for hospitals because of their high per-case contribution margin. Administrative oversight was limited mainly to staffing and support services since there was little need for standard evidenced-based practices. Recently, this dichotomy has expanded on a national scale with DRG improvement projects focused solely on medical disease states.
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