Physician Practice & Rural Health Clinic Support
Healthcare providers continue to face pressure to deliver cost-effective, high-quality healthcare, while maintaining a positive margin. While facing continued uncertainty around payments, insurance and delivery-system reform, many rural providers struggle to develop and implement long-term strategies that deliver maximum financial performance.
Since a hospital and practice designation type can substantively impact reimbursements received, the alignment and designation of practices is of increasing importance.
To combat this, our team partners with rural & community hospitals and health systems to develop strategies that address the evolving market.
Our Team Assists Leadership Teams in Addressing the Following Areas:
Practice designations to be leveraged for enhanced reimbursements and revenue streams
Eligibility in the 340B program
Integration of services into a rural health clinic
Aligning practices through the system
Wyoming County Community Health System (WCCHS), a county-owned health system in northwestern New York comprising a 47-bed acute care hospital with a 138-bed skilled nursing facility and multiple successful physician practices, was transitioning the designation of several of these practices from stand-alone entities to hospital-based practices with the CMS Rural Health Clinic designation.
Methodology & Approach
Our team will prepare an overview of the key eligibility requirements, including benefits of participation, for the provider-based rural health clinic program and articulate how each of these requirements impact the organization and provider-based programs.
Next, Stroudwater will prepare a financial assessment on the inclusion of the listed practices as departments of each of the identified hospitals with provider-based rural health clinic designation.
Achieving rural health clinic (RHC) status may require a change of ownership structure in certain instances. Any changes related to ownership will be identified and an approach recommended for enabling rural health clinic designation.
The Assessment Includes:
- A Review of Historic Utilization by Procedure Code & Payer
- Calculation of average charge per face-to-face encounter
- Estimation of average payment per face-to-face encounter
- Delineation of Provider-Based Assumptions
- Changes in payer mix
- Estimated Change in Net Patient Revenue by Payer
- Potential 340B Revenue
