Market position is a moving target, and COVID-19 made that target even more unpredictable. The patients who walked through the doors at hospitals, doctor’s offices and surgery centers pre-pandemic are different from the ones coming through them now. “The rising acuity of patients coming back is just much more complex, much more fragile,” notes a recent Sg2 forecast of service line trends. “Fluctuating volumes and inconsistent surges have made planning really difficult.” In this environment, hospital leaders must ask three key questions, which are listed below, with answers related to four service lines: cardiovascular, neurology, cancer and orthopedics. 1. What does the market look like today? Hospitals and ambulatory surgery centers in New York state have a tremendous advantage when it comes to understanding their market position. They have access to the Statewide Planning and Research Cooperative System , a core data set that allows facilities to compare their clinical, discharge an...

The Hospital Inpatient Prospective Payment System proposed rule for federal fiscal year 2024 includes a change to the rural wage index calculation that has the industry buzzing because it would affect all hospitals – rural and non-rural alike. If finalized, CMS will calculate each state’s RWI with data from rural hospitals and reclassified hospitals, even if those facilities are not rural geographically. As HealthLeaders notes , CMS’ approach since FFY 2020 has been to exclude reclassified hospitals from the rural floor calculation if they were not physically rural. Why the change? Who stands to lose or gain? And what other changes should hospitals watch for? What is the rural wage index? With the FFY 2024 rule, CMS proposes to reverse its exclusion of hospitals redesignated as rural from the RWI calculation. DataGen Senior Healthcare Data and Policy Analyst Jacob Orsini notes that hospitals can reclassify if they are either near a rural area or have a patient population with enough...

CMS’ Bundled Payments for Care Improvement Advanced program will soon kick off a two-year program extension through 2025. Model Year 7 (Jan. 1 - Dec. 31, 2024) will be the first time that current participants (acute care hospitals and physician groups) can update their episode of care selections since 2020. MY7 is also only the second time since BPCIA launched (2018) that CMS will allow new providers to join. Applications were due May 31, 2023. Whether you’re a new applicant or a current participant looking to update your episode selections to improve results, it’s never too early to prepare. BPCIA participants take on immediate full risk. This makes it critical to choose episodes that present the greatest savings, incentive and quality improvement opportunities. Episode selection — An art and a science For optimal BPCIA episode selection, providers must analyze their performance from the historic baseline period and design their clinical effectiveness strategies accordingly. It’s impo...

Strategic growth requires knowledge of how key healthcare industry drivers impact your market. Understanding factors such as population demographics, economics and competitors in the marketplace enables you to make sound decisions about how and where to provide care. With so many global pressures on healthcare, it’s important to remember a crucial industry principle: healthcare is local. Better data ensures your local lens is as clear as possible. Assess your data capabilities How you assess your strategic planning data mirrors how you should assess your market: start from the inside out, maximize the resources you have, and identify and fill the gaps. A few key questions include: Which data sets already deliver strong service line insights? How can we leverage this data to identify more savings, growth and care redesign opportunities? What data is needed to make expansion decisions related to patients, services, settings and provider partners? For New York hospitals and ambulatory sur...