As reimbursement becomes increasingly tied to patient experience/satisfaction and patient outcomes, organizations are searching for service excellence programs that would enhance their ability to effectively deliver care and fulfill the obligatory requirements to meet future reimbursement guidelines. Millions of dollars are spent each year (and will be spent!) to achieve improved results, but what is really necessary to get to those results and is the cost worth it?

Creating true patient care excellence typically requires an organizational culture shift—one focused on accountability and results. This starts with the commitment of leadership to this initiative. All too often this simply becomes the “flavor of the month” that ultimately does not achieve the expected results and yet comes at a high cost.

Hospitals around the country are engaged in what some characterize as merger mania: should we merge or should we remain independent? The Board plays an important role in critiquing the answers to the “Why Merge?” or “Why Remain Independent” questions. Their challenge lies in taking the long term view of national and local industry trends. Hospital executive teams tend to develop strategic plans encompassing a relatively short time frame of three to five years. Boards, on the other hand, have to look well beyond this short time frame and leverage the depth and breadth of their knowledge of various industry trends and life cycles. This continuity of involvement should enable them to ask the tough questions regarding the strategic plans that can assist the executive team in reaching sound conclusions about the direction of a hospital or health system. This level of involvement is actually their fiduciary duty.

A RAC is a Recovery Audit Contractor. The federal government established RACs to manage entitlement programs—on the one hand, they don’t want to cut benefits, but on the other, they want to cut fraud and abuse to avoid unnecessary costs. Although they’ve been around for a few years, RAC auditors are starting to ramp up medical necessity audits—these audits may mean some unexpected interruptions to the cash flow.

With more than two decades of Revenue Cycle experience under my belt, I can almost script the calls I get from CEOs and CFOs regarding their Revenue Cycle. All it takes is several months of bad financials and the critical eye turns—not to expenses—but to the idea that somehow we’re not collecting all of the money that we could be collecting. To many, the Revenue Cycle hides some great financial panacea. If you’re wondering if you’re leaving cash on the table, there are few quick calculations you can do to determine if you’re right.

No decision – except perhaps the selection of a CEO – looms larger for a board than that to merge with another organization. If you’re part of a hospital or health system executive team or a board member and are starting to evaluate the strategic merit of a merger or merger-like transaction, it’s critical to understand the reasons for this consideration—not just the general reasons but very specific reasons why your organization should consider changing the way it has been conducting its corporate business to date. Do your homework up front. Usually the CEO and executive team present a strategic direction to the board for approval; however, the decision to merge, consolidate or affiliate with another organization is the board’s alone. Without a strong majority of board members reaching agreement on the compelling reasons to consider a merger or merger-like affiliation, embarking down the road to a merger will prove costly and time consuming, with the prospect of failure looming.

What are the specific characteristics of a successful interim executive? What is the optimal structure of an interim assignment so that organizations can leverage interim management with confidence and get the most from the engagement? In this conclusion to my blog series on interim management, I'll address these questions so that organizations seeking interim support can get the most from their engagements and position their permanent hire to hit the ground running.

In the highly competitive and dynamic world of hospital operations, vacancies in C–Suite positions occur regularly and for many reasons: Voluntary resignations, retirements, mergers or acquisitions and terminations. No matter the cause, executive-level vacancies can create critical voids in direction and leadership, may weaken an organization’s position, and can hinder the recruitment of a qualified professional. So what are the options? How can an organization best position itself for success even in the face of a gap in leadership?

In this final installment of the series People, Places, Things: How to Close an Inpatient Facility, Retain Ambulatory Services and Make a Difference, we’ll dive into Things. What things? Well, the most important of these things will enable you to get reimbursed for the care that you provide—and can determine if your transitioned facility will have the cash flow it needs to be sustainable. But before you can worry about that, you have to know two other things.

Every day one reads about layoffs, downsizing, cuts and a disgruntled workforce. While many industries have experienced this for years, now it seems like the healthcare industry is struggling to deal with ongoing financial pressures, increased focus on patient quality and safety yet still maintain a satisfied highly competent workforce. In today’s environment, nurses are constantly at odds with trying to balance the organization’s financial targets with their intrinsic need to provide safe patient care and they want to feel satisfied that their patients’ needs are met. Is this even possible?

The decision to transition from inpatient to ambulatory services will affect every aspect of your organization, from your people to your culture and will redefine your role in the community. It will also, by necessity, impact your facility. In part two of this series, People, Places, Things: How to Close an Inpatient Facility, Retain Ambulatory Services and Make a Difference, we’ll analyze how your Place may have to change. When you review your existing physical plant, you have to think about three things: who your patients are, what your patients need and how to manage the space you no longer require.

Care delivery at hospitals has evolved over the last 50 years from an inpatient focus to today’s predominantly outpatient model (in fact, some of our recent hospital clients have outpatient revenues in excess of 75% of their total). As the delivery model has changed, so has the hospital’s physical configuration—the result of advances in healthcare delivery technologies, new space planning standards and federal regulations like HIPAA.

It’s getting harder and harder for healthcare organizations to balance their obligation to patients with the need to fund operations. In markets with two or more hospitals, competitive and reimbursement pressures are forcing hospitals to face uncertain futures. While some will close and many will be absorbed by other organizations, a few will make the decision to shutter inpatient services but maintain an ambulatory presence. If you have considered that option and would like to know more about how to set the stage for a successful transition, this three-part series of blogs is for you.

Are you focusing on healthcare integration and thinking about acquiring physician practices? When it comes to acquiring practices, hospital executives are divided: some are eager; others are very reticent. The reticent ones remember the 1990s and the wave of physician acquisition as hospitals snatched up as many practices as they could. When these acquisitions failed to provide anticipated bottom line impact—and generated significant additional costs—the idea of a hospital-owned physician practice fell from favor. Now that two decades have passed, the concept is coming back into vogue; without learning from the mistakes of the past, however, we’ll be doomed to repeat them.

I’ve been in the consulting world since 1999. During that time I’ve participated in scores of consulting projects in every conceivable market—from tiny rural hospitals to some of the largest health systems in the country. I’ve even worked oversees to bring best practices to other markets. As it gets harder to operate profitably, many hospital executives and boards turn to consulting firms, whose objectivity and knowledge of leading benchmarks can make the difference and help turn goals into actual plans with milestones and accountabilities. But consulting is an investment. Here are five ways to prepare for a consulting engagement in order to get the most out of it.