There are profound and unprecedented changes coming to the American healthcare industry, and many healthcare organizations and healthcare executives are not only unprepared, but even unaware of the scope and implications of these changes. That concerns Mark Fromberg, CPA, MBA, a partner with the Healthcare Industry Group of Marcum LLP, an accounting and consulting firm that serves providers and payors in South Florida, helping them to understand the changing environment, interpret the new requirements and processes, and successfully navigate the transition to a revamped healthcare industry.

 

As the Affordable Care Act (ACA) and its myriad reforms and innovations are implemented over the next few years, healthcare organizations will be challenged to not only keep up, but also to essentially remake their approach to the delivery of care and the management of reimbursement systems. “Doctors and hospitals are going to have to create a new and different culture, a new way of practicing medicine and doing business,” says Fromberg. “Value-based purchasing and bundled payments are changes that will have an enormous impact, and they represent a true paradigm shift. The emphasis in the future will be on quality over quantity, and detailed measurement and reporting of that quality. This means that the entire system will have to shift to a new way of doing things. Doctors and hospitals have to change substantially, and Marcum has the expertise and industry experience to help them do that.”

 

Marcum offers a full range of consultative services to hospitals, skilled nursing facilities, physician practices, home health providers and other healthcare organizations. The company is part of the healthcare industry group within Marcum LLP, one of the nation’s largest and most highly ranked public accounting firms. With a team of highly credentialed professionals, Marcum excels at helping organizations with operations, revenue cycle management, technology and information systems, strategic planning, mergers and acquisitions and regulatory issues and compliance. According to Fromberg, Marcum’s experts are prepared to help healthcare organizations create the infrastructure that will prepare them for value-based purchasing, bundled payments, more complex cost accounting systems and new reporting requirements

 

Value-based purchasing, a payment system that focuses on value as opposed to volume, utilizes intricate measuring systems, including report cards and data collection, to determine quality. The overall goal is to improve patient care and safety and reduce healthcare costs by holding doctors and hospitals accountable for quality and patient satisfaction, and rewarding the ones who provide those things. Fromberg says that every hospital needs to invest in improving clinical outcomes and developing a value-based approach. “In the end, everything will be driven by clinical outcomes and patient satisfaction,” he says. “It will demand that everyone on the provider side collaborate to improve clinical processes. Reimbursement systems will reward those who improve quality of care and lower costs, to incentivize everyone to work towards that goal.”

 

To improve quality of care, doctors will need to shift their emphasis to preventive care, particularly in the care of patients with chronic conditions such as diabetes. “Patient non-compliance is a common and costly problem,” Fromberg explains. “Non-compliance often results in expensive hospital admissions. Doctors that are willing to see patients more frequently, helping them to improve their health through compliance and lifestyle modification, are going to be rewarded. Insurance companies plan to increase reimbursement for primary care doctors who develop such a pro-active approach.”

 

Patient satisfaction assessment is another integral aspect of value-based care, as it reveals an organization’s strengths, weaknesses and areas for improvement. According to Fromberg, “Even if the medical care is excellent, a patient who has a negative experience will not return. This is a challenge for hospitals – how do you measure satisfaction?” The value-based purchasing system will measure value by collecting data about clinical outcomes, satisfaction and cost, but the exact nature of this measuring is as yet unknown. “The Centers for Medicare and Medicaid Services (CMS) will expect greatly detailed cost accounting, and this will force hospitals to significantly upgrade their accounting systems. Many hospitals have implemented new, expensive EMR systems – but will they be adequate for the data reporting that the new system will require?”

 

CMS is also planning to implement “bundled payments” which means that compensation will no longer be paid individually to the multiple providers who deliver services to a patient during a single episode of care. Instead, payments will be bundled and paid to the entire group in a single claim. This is intended to provide incentive to providers to work as a team and provide care more efficiently.

 

“Soon, the healthcare system will be inundated with the newly insured,” says Fromberg. “Changing the way we serve patients is imperative. But hospitals have to be ready for this and it’s going to be tough, for healthcare organizations of all sizes. How are they going to cope, survive, and afford the infrastructure that they will need? How are they going to meet all the clinical and cost data reporting requirements? At Marcum, we have the resources and expertise, on both the provider and payor side, to assist healthcare organizations to meet the challenges of the new era. We can help them implement the processes and infrastructure that they will need as the healthcare industry undergoes transformation, so that they achieve their goals to improve, to be accountable for quality and to deliver the highest level of excellence in patient care.”