Clinical Co-Management: A Bridge to Clinical Integration and Pathway to Bundled Payments, 1st Edition (Hardback) book cover

Clinical Co-Management

A Bridge to Clinical Integration and Pathway to Bundled Payments, 1st Edition

By Cherilyn G. Murer, JD, CRA

Productivity Press

131 pages | 23 B/W Illus.

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pub: 2015-08-27
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Description

A decade ago, UK HealthCare recognized the need to reposition itself as a regional referral center, focusing on advanced subspecialty care for the entire state of Kentucky. The goal was to become a "medical destination" for patients from that region who needed access to specialized care.

To support that goal, UK HealthCare established a virtual network of partnering provider organizations throughout Kentucky. By working together, UK HealthCare and its partners provide all Kentuckians access to the appropriate levels of care as close to home as possible.

Clinical Co-Management: A Bridge to Clinical Integration and Pathway to Bundled Payments supplies a detailed view of the Clinical Co-Management Agreement (CCMA) framework. It describes how the successful implementation of CCMAs can pave the way to coordinated efforts by hospital administration and physicians to reduce cost, increase quality, and improve patient satisfaction.

Detailing why CCMAs present a viable alternative to conventional hospital-physician alignment models, such as medical directorships, committee chairs, and physician employment, the book presents an insider's view of the working models for clinical co-management programs.

Complete with a detailed explanation of the self-referral statute (Stark Law) and the Anti-Kickback Statute, this book provides physicians, hospital executives, healthcare attorneys, and industry experts with a trustworthy reference they can refer to prior to and during CCMA negotiations, implementation, and oversight.

Includes a Foreword by Mark D. Birdwhistell, Vice-President for Administration and External Affairs, UK HealthCare

Reviews

"Cherilyn Murer and her team of experts introduced UK HealthCare to the Clinical Co-Management Agreement (CCMA), a tool that has been an excellent way for UK HealthCare to engage with its partnering organizations. A CCMA gives physicians and administrators a voice and process for aligning their respective interests and expertise through a system of protocols, outcome targets, and quality metrics."

—Mark D. Birdwhistell, Vice-President for Administration and External Affairs, UK HealthCare, Lexington, Kentucky; Former Secretary of the Kentucky Cabinet for Health and Family Services

"One of the assets of a CCMA is as a mechanism to validate data. The CCMA process provides a vehicle through which an organization is able to generate verifiable and vetted data that will enable the hospital to improve services, and with Cherilyn Murer and the Murer group guiding this process, my organization has seen significant benefit."

—Rick Wagers, Senior Executive Vice President and Chief Financial Officer, Regional One Health

"When it comes to navigating clients in today’s healthcare environment through the compliance, legal, and financial complexities of implementing clinical co-management agreements, you’re talking about only a handful of people who can accomplish that so successfully as Cherilyn G. Murer."

—Dr. Michael Karpf, Executive Vice President for Health Affairs, UK HealthCare

"Cherilyn has forgotten more about clinical co-management than most health care lawyers will ever know."

—William E. Thro, General Counsel, University of Kentucky

Table of Contents

Defining Clinical Co-Management and Its Impact on Effective and Efficient Healthcare Delivery

Why Clinical Co-Management?

Clinical Co-Management Is the Strategic and Regulatory Mechanism That Can Serve as the Catalyst in Truly Integrating a Healthcare System

The Problem, Again, Is Alignment

What Is Clinical Co-Management?

Failure Lies in a Silo Perspective

Benefits of Clinical Co-Management

CCMA Development Process

Barriers to Successful Implementation

What to Expect?

References

Clinical Co-Management in Historical Perspective

Introduction

Medicare’s Inception and the Prospective Payment System

Watershed Year One: 1965

Watershed Year Two: 1983

On the Road to Managed Care

Watershed Year Three: 1997

Going Forward: Opportunities and Barriers

Watershed Year Four: 2010

References

Clinical Co-Management as the Bridge Toward

Bundled Care

Push from Fee-for-Service toward Bundling

Difficulties of Bundled Care: Lessons from Previous Bundling Attempts

Clinical Co-Management as the Precursor to Bundling

References

CCMA: A Physician’s Perspective

Sasha M. Demos

Preface

Physician’s Introduction

Preoperative Care

Intraoperative Care

Postoperative Care

Clinical Co-Management as the Solution to Implementation

References

Regulatory Compliance

Legal Considerations

Stark Law

Anti-Kickback Statute

CMP Law

Policy Concerns Underlying Fraud and Abuse Laws

Implementation

Determine the Scope

Legal Structure of the CCMA

Administrative Structure

Compensation Structure

Base Compensation

Incentive Compensation

Metrics and Data

Third-Party Valuation

Ongoing Performance Measure Development

Conclusions

Clinical Co-Management Case Study

Introduction

Case Study: Urban-Based Tertiary Medical System

Conclusion and Next Steps

The Conclusion Is That There Is No Conclusion

The Value Is in the Process

The Perils of Clinical Co-Management Valuation

Index

About the Author

Author

Cherilyn G. Murer, JD, CRA, founder, president, and CEO of Murer Consultants, Mokena, Illinois, has long been an active voice in the advancement of quality, cost-effective healthcare. Ms. Murer received a Juris Doctor degree with honors from Northern Illinois University and has coupled her background in law with her previous operational experience as the director of Rehabilitation Medicine at Northwestern Memorial Hospital, Chicago, Illinois. Ms. Murer is a sought-after lecturer and educator whose focus is on assisting her clients in navigating through the complex regulatory, strategic, and financial issues facing healthcare today. With a national client base, Murer Consultants represents large multi-hospital healthcare systems, academic medical centers, and large physician group practices focusing on strategic positioning, consolidation and acquisition, regulatory compliance, and financial management.

In her role as president and CEO of Murer Consultants, Ms. Murer has been instrumental in the development and implementation of Clinical Co-Management as a tool to align stakeholders’ interests in the healthcare field. She has shown time and again the value of Clinical Co-Management nationwide in settings ranging from academic medical centers to large hospital systems. As a recognized innovator in payment delivery mechanisms, Ms. Murer has demonstrated the viability of Clinical Co-Management as a delivery system moving forward with health reform.

Subject Categories

BISAC Subject Codes/Headings:
BUS041000
BUSINESS & ECONOMICS / Management
BUS070080
BUSINESS & ECONOMICS / Industries / Service Industries
MED002000
MEDICAL / Administration