Healthcare financial and operational sustainability
In today’s healthcare landscape, margins are squeezed, costs are escalating and regulations continue to multiply. While many organizations are experiencing negative operating margins, some are achieving double-digit performance. Why? Factors such as managed care contract terms, economies of scale, technology utilization, physician recruitment and clinical practices all play a role.
At RSM, we empower healthcare organizations to understand and harness these factors, helping them shift from merely surviving to financially thriving. By effectively navigating and controlling margin complexities, your organization can achieve sustainable success and growth.
We can help in the following key areas:
Net revenue potential: Discover opportunities to enhance your overall revenue performance and reduce risks throughout your revenue cycle, clinical documentation, patient throughput and technology challenges. Understand untapped and unprofitable services, potential investment and divestment, and market alignment strategies.
Cost reduction: Achieve cost reduction via optimized clinical practices, labor and supply chain management, and technology integration. Enhance outcomes and patient experience while substantially reducing costs and improving quality.
Data, technology and innovation: Embrace innovation through the strategic use of technology (e.g., analytics, generative artificial intelligence, electronic health records, enterprise resource planning) and data-driven insights. Empower your organization to make informed decisions and facilitate sustainable margin transformation.
Change management: Collaborate with us to identify, understand, communicate, teach and support the behavioral changes necessary to achieve your overall objectives.
Helping you achieve financial sustainability through:
Empower your revenue streams with streamlined processes and optimized workflows.
From grappling with avoidable denials and documentation challenges to addressing system and staffing challenges and operational inefficiencies, effective revenue cycle operations are critical to driving your overall financial performance. Add in the pressure of maintaining full regulatory compliance and dealing with elevated margin pressures and your healthcare organization may need an expanded commitment to your revenue cycle. At RSM, we help you focus on addressing leadership and governance complexities, streamlining workflows and using advanced technology to address existing core system capabilities and supplementing limitations with artificial intelligence, automation and insightful analytics.
We’re here to empower your team by helping to ensure:
- Quality registration data
- Timely scheduling throughput
- Accurate authorizations
- Consolidated charge master
- Seamless charge capture
- Efficient HIM/coding practices
- Comprehensive clinical documentation
- Effective coding review and education program
- Payment variance resolution
- Denial reduction and emphasis on prevention
- Effective reporting and analytics
- Maximum leverage of technical capabilities
- Succession planning and leadership development
- Leading practice operations and staffing models
- Transparency in vendor performance
Drive overall margin improvement while delivering excellence in patient care.
Clinical operations serve as the heartbeat of every successful institution, yet this vital part of an organization is frequently caught in the crossfire of numerous challenges. Healthcare organizations face a constant struggle to balance efficiency with quality patient care. Labor resource management becomes a juggling act, while service line strategies vie for attention amid ever-changing patient needs.
Our approach to margin transformation through clinical operations blends strategic insight with tactical precision to:
- Optimize patient throughput
- Leverage insights from data to improve the continuum of care
- Achieve quality while reducing costs
- Implement best practices
- Enhance surgical efficiency
- Drive more patient volume through your organization
- Improve workflows and resource allocation
- Enhance the physician and provider alignment
- Deliver a patient-centered care experience
- Assess service line profitability, investment and divestment opportunities
Enhance cost-effectiveness across your supply chain and reduce nonlabor expenses.
From strategic procurement to streamlined logistics, changes to your supply chain can drive margin improvements across your entire organization. Our focus on supply chain optimization is designed to maximize financial sustainability.
Our healthcare supply chain team is versed in:
- Reducing nonlabor expenses and maximizing cost savings
- Addressing clinical device, physician preference and standardization challenges
- Managing group purchasing organization assessments
- Optimizing inventory management and distribution processes
- Creating strategic vendor partnerships and alliances
- Streamlining procurement processes
- Facilitating contract negotiations facilitation for purchased services
- Implementing enterprise resource planning and process integration
Maximize reimbursements and navigate complex payment landscapes.
Whether you’re facing challenges in managed care negotiations, struggling with underpayment recovery or seeking to adopt value-based payment models, we’re here to help you thrive. Our approach involves innovative methodologies to optimize reimbursement rates, mitigate risk, streamline processes, reduce revenue leakage and drive sustainable financial growth.
Our offerings span:
- Managed care strategy
- Managed care negotiation
- Preauthorization automation
- Rational and strategic pricing
- Price transparency and No Surprises Act compliance
- Net revenue modeling
- Underpayment recovery
- Value-based care and alternative payment models
- Risk management
- Contract management system deployment
Secure and optimize vital governmental funding streams.
Navigating the intricate landscape of governmental funding requires understanding the Medicare, Medicaid, and Health Resources and Services Administration regulatory landscape (e.g., statutory, federal register rulemaking process, manual instructions and other guidance) as well as the strategic planning to secure vital funding streams necessary to drive sustained financial performance.
We are here to help you develop a governmental funding strategy that considers:
- Reimbursement department effectiveness
- Medicare/Medicaid cost report out/co-sourcing (all provider types)
- Uncompensated care funding strategy (e.g., disproportionate share hospital eligibility, pharmacy 340B eligibility, Medicare bad debts and Worksheet S-10 reporting completeness)
- Transplant, nursing and allied health education cost finding
- Wage index and occupational mix reporting
- Hospital special designations (e.g., RRC, SCH, MDH, CAH, REH)
- Direct (GME) and indirect (IME) medical education funding strategy
- Provider based clinic analysis
- Medicaid supplemental payments
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Ready to transform your organization's margins and achieve financial sustainability?
Contact us today to schedule a consultation. Let's work together to drive measurable outcomes and position your organization for long-term success.
RSM audit, risk and healthcare consulting
We help healthcare executives thrive by offering solutions focused on your goals and based on a deep understanding of the industry.
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