The Right Tools for the Job: ASSEMBLING YOUR IMAGING STRATEGY

Transcription

1 The Right Tools for the Job: ASSEMBLING YOUR IMAGING STRATEGY How to provide access to care in response to Anthem s Imaging Clinical Site of Care Review Policy and the evolving healthcare marketplace

2 According to Modern Healthcare, the recent lawsuits surrounding Anthem s imaging policy have hospital leaders, radiologists and other providers wondering what the future holds. Though it is unclear right now, the trend of outpatient imaging services shifting to freestanding facilities seems here to stay. Anthem s policy will likely affect hospitals bottom line with rural facilities feeling the biggest impact. Rich Bajner, a managing director at Navigant, says that losing even a few CPT codes for radiology services can make the difference between a large health system recording a profit or loss. Smaller hospitals are already struggling to stay open, and patients may not have easy access to freestanding imaging centers. With Anthem being the largest for-profit managed-care organization in the Blue Cross Blue Shield Association, other payers may follow suit to explore other routes to cost savings. And it s not just payers that favor lower cost imaging; patients are shopping around for lower priced services as well as cutting their out-of-pocket healthcare costs. As a result, imaging providers need to develop tools to position their programs for success in a cost-conscious environment. For hospitals impacted by Anthem s policy as well as those looking to ensure financial security in the future, implementing some short-term strategies will assist in better management of your imaging department ultimately resulting in increased profitability. 2

3 A Blueprint to Retain Patients and Avoid Reimbursement Denials Project: The Foundation Tighten the patient preauthorization process Benefit Ensure your hospital will not have claims denied which may frustrate patients and lead to bad debt Implementation: While referring physicians are still the primary means for preauthorization, imaging programs are taking on more of the preauthorization process to ensure it happens as efficiently as possible. Use these guidelines to optimize your preauthorization strategy and operations. 3

4 Project: The Foundation Take Ownership of the Preauthorization Process Having control of your preauthorization process can provide value in a number of ways Strengthened Payer Steerage Payers are steering patients to lower-cost settings. Imaging provider preauthorization ownership allows organizations to contest these efforts. Minimized Financial Losses Convenient access means patients are not turned away, even if their exam hasn t been authorized. Continued Physician Employment Hospitals have increased centralized coding and billing; preauthorization is a similar function that can also be owned by the hospital. Increased Value Proposition Preauthorization tends to be a burden for referring physicians. Imaging preauthorization ownership will strengthen referrer relationships. 4

5 Ensure Accountability for Preauthorization Success In order for your preauthorization model to be successful, someone must be accountable for the program. You can achieve this a few different ways: Establish accountability within imaging by assigning individuals by modality. Their sole purpose is to ensure preauthorization is obtained successfully. Create a dedicated centralized preauthorization team that manages preauthorization for all types of procedures. Conduct training sessions with RNs and radiologists to teach the clinical side of imaging. Contract with a third-party vendor to manage and obtain preauthorization. Project: The Foundation 5

6 Project: The Foundation Centralize your Payer Intelligence One of the hardest aspects of preauthorization is knowing the unique expectations and demands of the payers in each market. Because of this, it is beneficial for imaging programs to have a centralized knowledge database that can be easily updated as staff learn more about various payer requirements and preferences. One example of this is a radiology-specific payer guide to help imaging staff efficiently obtain preauthorization. It s important to include the following key information in the payer guide: 6

7 Verify that Imaging Orders are Appropriate and Complete The preauthorization process begins with an imaging order. Inaccurate or incomplete information can lead to a denial. You can reduce the risk of denials by implementing one of the following tools to ensure that orders are appropriate, and that patient information is accurate and complete. Which tool is the right one for you? Project: The Foundation Create an ordering guidebook that recommends exams based on patient indications. It should provide CPT codes for common exams and list capabilities and locations of all imaging sites. Design a comprehensive referral guide to support referring physicians. The guide should include ordering guidance, payer contact information, and a list of patient details necessary for preauthorization. Develop an online tool to help referring clinicians identify the most appropriate exam to order. 7

8 Project: The Foundation Have Imaging Clinicians Review Orders in Advance An order that is considered appropriate will be authorized even if it isn t the best exam for a particular patient. Therefore, it is so important to have a clinician review all preauthorized orders in advance of patient appointments to catch and quickly rectify any issues. One way to address this is to instate a three-tier quality control system for preauthorization. 8

9 Project: The Foundation Track and Benchmark your Preauthorization Performance Imaging leaders must track performance and benchmark their preauthorization efficiency against their competitors if they hope to become the provider of choice in their markets. Here is one example of an effective preauthorization performance strategy used by Greyjoy Imaging to help track whether preauthorization numbers are received prior to patient appointments. Referral Patient referred for scan, calls imaging center to schedule Initial Request Automated fax sent to referring physician office to remind staff of need for preauthorization number Worklist Generated Once exam scheduled, preauthorization worklist created Reminder If preautorization not secured, Greyjoy alerted every 24 hours as a reminder to call referring physician office 9

10 A Choose one or both. Which finishing detail works for you? Additional Sites B Clean Up Pricing A Additional Sites Detail A: Additional Sites Self-steer patients to lower cost sites Benefit Allow patients to remain in your health system network rather than being steered by the payer to low cost competitors Implementation: Opening a lower priced site can be risky and requires a large capital investment. To help determine if a low-cost site would help capture new market share, there are some factors to consider and questions to ask before moving forward. 10

11 Accessibility: Consider a location in an area where patients live or work. Offer convenient hours as well as extended days and weekends. In addition, offer ample parking or access to public transit. Questions for imaging leaders: Is there a geographic region where you could gain market share through a low-cost site? Are there price-sensitive consumers in that area who would utilize the new center? Volume Potential: Look at the number of patients payers in your market are steering toward existing lower-priced centers. This allows you to estimate the number of patients you are currently losing but could possibly retain at a lower priced site. Questions for imaging leaders: Are you currently losing volumes due to payer steerage? Should you focus your efforts to increase volumes on existing equipment rather than adding new machines and staff? Competitors: Understand who your lowerpriced imaging center competitors are. Be sure that your planned prices will make you competitive with the existing facilities. Questions for imaging leaders: How prevalent are independent or physician-owned diagnostic testing facilities in your market? Will you be able to compete with these facilities on price? Are your peer hospitals also opening lower priced facilities? A Additional Sites Did You Know? Clinical Demand Forecasting from Shared Imaging is used to solidify your imaging strategy. We provide the market data and predictive analytics you need to drive toward an effective diagnostic imaging plan to best serve your patients today and in the future. We work with you to assess how the utilization of services are expected to change over the next five years by assessing the following data: Population Demographics Clinical Indications Volume by Imaging Modality Competition At Shared Imaging, we pride ourselves on taking the longterm view and anticipating the needs of an ever-changing healthcare landscape so that you get exactly what you need to improve business operations and patient outcomes. 11

12 B Clean Up Pricing Detail B: Clean Up Pricing Consider cutting prices for imaging services at one site Benefit Maintain higher revenue at your hospital-based locations, but offer an alternative site for patients to continue receiving imaging care in your network Implementation: With the rise in patient-driven healthcare, imaging centers must be price competitive to maintain and gain patient volume. One way to implement price cuts is to leverage them to price sensitive patients that would possibly go elsewhere. This can be accomplished by offering patients appointments at all locations and allowing the patient to self-select the lower priced site of care. 12

13 With the continued push of imaging services to outpatient environments, hospitals should also look at building or expanding their freestanding imaging footprint. Impacted by Anthem or not, hospitals need to consider a long-term outpatient imaging strategy to prioritize access and ensure financial viability in a value-based health system. Every Step of the Technology Lifecycle Managed For You We don t just develop the solutions - we manage every step of the technology lifecycle on your behalf. The Shared Imaging advantage is that you choose the technology you want and keep it for a timeline that is customized to your needs. It s a seamless, comprehensive process that anticipates your clinical and operational requirements, and carries your enterprise to where you need to be next. 13

14 Ambulatory Expansion: It Meets All Project Requirements Ambulatory hits all 3 marks! Payer Steerage Providing lower-cost imaging in-network helps retain patients previously redirected to other freestanding sites. Risk For Total Cost Offering lower-cost imaging contributes to an overall lower cost of care. This is increasingly important in a value-based care environment. Consumer Demands Offering imaging in price competitive, accessible settings attracts patients shopping for care. 14

15 By bringing services to the patient, hospitals and healthcare systems can gain a competitive advantage in today s value-based health system. Moving outpatient imaging traffic to freestanding sites streamlines patient flow to drive efficiency and alleviates capacity constraints on hospitals. Ambulatory imaging enhances the value of the providers outpatient offerings. Placing imaging near physician offices and urgent care facilities creates more attractive services for patients and increases convenience for referring providers. Through our unique DI Revolution Dial, Shared Imaging consolidates all costs needed to deploy an imaging solution into a single monthly fee. 15

16 PROJECT RECAP What We Know The market, along with Anthem s policy, is steering imaging away from hospitals and into off-campus facilities. Retaining patients and avoiding denials along with expanding your ambulatory footprint is no small task. How CDF Gets You The Data Cinical Demand Forecasting (CDF) can provide the market data and predictive analytics you need to make strategic decisions when developing your expansion strategy. We supply a customer-centric framework for decision making that both illuminates opportunities and reveals potential gaps in service to best serve your patients. Justifying the Capital Investment Shared Imaging s DI REVOLUTION Dial functional service model. Not only does it provide a cost-effective procurement option, but also eliminates the financial risks associated with long-term capital investments. Shared Imaging retains ownership and operational responsibility for the imaging technology. Healthcare providers are faced with enormous ongoing challenges and pressures to reduce costs, increase efficiency, and improve healthcare environment. Despite uncertainty, your business needs to keep moving forward. Work with Shared Imaging to deliver the right diagnostic imaging today with flexibility for tomorrow. 16

17 Sources: Assemble Your Imaging Strategy Today