Healthcare reform is driving the resurgence of hospitals acquiring practices and employing physicians. The trend is indicative of hospitals desiring to gain strategic value and improve margins. The challenge arises when practice operational loss overshadows the goals that triggered the alignment. Through its scientific approach, which uses proprietary data-driven methodologies, Equation provides the tools that enable empirically based business decisions and services that drive quantifiable results.
In the absence of full-time managers, hospital practices may witness increasing operational inefficiencies. Equation provides seasoned professionals in all aspects of physician practices. Armed with analytic tools and systematic approaches to practice management, Equation offers practices leadership and direction to support effective ongoing operations.
Productivity uses Equation’s scientific approach and data-driven models to analyze the relationship between production and compensation. Measuring physician Work RVUs, visits and revenue, this tool applies the metrics into the context of compensation.
Seasoned operational consultants lead this program and leverage analytics to pinpoint areas where gaps exist. They examine workflow, patient flow, medical record documentation and billing/collection methodologies to ensure operational efficiencies within the physician practice.
Equation gathers deep sets of data to assess the one-time value of the merger/acquisition. The process allows healthcare executives to determine whether the alignment is ideal.
Collecting various data sets, our tool leverages proprietary data-driven methodologies to do “on-the-fly” analysis of proposed rates, and how those rates financially impact the practice. This powerful tool helps determine the ideal rate and guides providers through the negotiation process.
This analysis provides the basic 5 (B5) data elements that drive revenue cycle metrics and indicators (gross charges, adjustments, collections, accounts receivables and total RVUs) to identify potential performance gaps and opportunities.
Recognizing charge capture and billing nuances specific to the rural health clinic revenue cycle, Equation incorporates the Center for Medicare and Medicaid Services (CMS) regulatory criteria.
Payer contact compliance analysis provides a detailed view of whether payers are reimbursing hospitals and practice groups according to agreed upon managed care contracts. It conducts analysis at the CPT level to understand the expected and actual reimbursement, and the causes of any disparity.
Practice revenue cycle improvement assesses the complete revenue cycle beginning with data capture for patient demographics, all the way through denial management and dealing with bad debt. The assessment is designed to provide managers with a clear view of uses for available reports and the use of that information in properly managing billing and collecting activities.
Equation will provide interim management of the revenue cycle in the absence of a full time staff and/or will provide implementation of improvement and corrective actions identified during the assessment period.
The tool uses industry benchmarks and a proprietary data-driven methodology to provide an all encompassing view of what a physician can be paid. It provides hospital executives and legal counsel with the information that they need to make informed compensation decisions, and also allows them to calculate the fair market value based on their own risk threshold.
Although careful consideration goes into a hospital’s decision to treat a hospital-owned physician practice as provider based, there is often a rush to initiate the billing process without consideration for the operational criteria that must be implemented. Equation provides a comprehensive overall assessment of provider-based clinic and provider-based rural health clinic operations that is designed to ensure compliance with current regulations, local and federal guidance and best business practices.
Equation provides detailed review of employment contracts, non-employed contracts and service agreement payments to ensure compliance and equitability.
Equation analyzes for accuracy and fairness payments made by the hospital to the physician for being on call and payments for travel to provide coverage service.
Using the current national ratio of physicians to population in comparative markets, Equation’s plan provides hospital management with intelligence on the following:
– What and how many physician specialties are needed
– Which physicians are aligned with the hospital
– Where there are Primary care practice gaps in the market by location
This tool allows hospitals to quantify the investment impact of:
– Non-employed physicians in terms of medical directorships, subsidy payments and income guarantees.
– The loss on employed physicians.
– The benchmark as a percent of hospital revenue.
This deep analytics program determines how to pay physicians for uncompensated care. It helps strengthen the working relationships between hospitals and physicians while ensuring fair and equitable distribution of funds.
This is a unique tool designed to help decision makers understand the production value of newly employed physicians and their practices. Our tool helps healthcare executives to accurately forecast new physician production as it relates to cost.