Cooperating for better care.

healthcare providers

Tag Archives

4 ways Trump could affect hospital revenue cycle

November 9, 2016by Robert Whitcomb in Uncategorized tagged , , , , , ,

bucks

Becker’s Hospital Review presents four ways  in which President-elect Donald Trump’s proposed healthcare reforms could affect hospitals’ revenue cycle:

“1. Tax-free, inheritable health savings accounts. Mr. Trump said he would sign legislation to promote tax-advantaged HSAs to encourage consumers with high-deductible health plans to set aside money for out-of-pocket healthcare costs.

“Mr. Trump would also tie HSAs to a person’s estate, meaning an account could pass on to next of kin without facing federal taxes.”

“2. Federal mandate for provider price transparency. Mr. Trump said he would require ‘all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals,’ to disclose service prices to consumers prior to treatment. This could speed the rate of price transparency adoption at hospitals across the nation.”

“3. New Medicaid funding method. Mr. Trump proposed dismantling financing for Medicaid expansion under the ACA and converting the program to a block grant to contain healthcare costs. Block grants would give states more authority over their Medicaid programs in exchange for accepting a fixed amount of funding from the federal government. This means states would not be required to cover certain groups of people, such as children, pregnant women and the elderly, to receive federal money. ”

“4. Repeal of the ACA. Mr. Trump vowed to repeal the ACA as one of his first presidential acts. Bill HR 3762, introduced into Congress October 2015, would: repeal ACA tax credits, end Medicaid expansion, repeal major taxes used to fund insurance expansion and create a two year transition period to dismantle ACA infrastructure. The Congressional Budget Office estimated 22 million people would lose insurance if HR 3762 is signed into law without a Republican replacement plan. The rise in uninsured Americans could negatively affect healthcare providers by increasing their uncompensated care and bad debt rates to pre-ACA levels.”

To read the full article, please hit this link.

Anthem CEO sees merger with Cigna proceeding

May 27, 2016by Robert Whitcomb in Uncategorized tagged , ,

 

Despite what Anthem Inc. Chief Executive Joseph R. Swedish called “dynamic tension” with Cigna Corp. over their proposed $48 billion  merger, he said the health insurers  are on track to receive regulatory approval and proceed with the merger. Many healthcare providers oppose the merger, fearing the huge new entity will be able to cut tougher deals. See this link.

Warning to labs: Shift to value-based payments faster than expected

May 23, 2016by Robert Whitcomb in Uncategorized tagged , , , , , ,

fastcar

 Bundles News reports on the faster than expected move from fee for service  to fee for value. The publication says that nearly a third of  Medicare payments involve value-based reimbursement and other alternative payment values.
The publication reports:

“Clinical laboratory executives should take note of a key financial fact. The transition from fee-for-service healthcare to value-based reimbursement is occurring at a faster clip than theDepartment of Health and Human Services (HHS) anticipated last year when federal officials announced a plan to tie 30 percent of traditional Medicare spending to alternative payments models by the end of 2016.

“That means the transition away from fee-for-service payment for medical laboratory tests and other healthcare services is moving ahead of schedule. As evidence, HHS recently announced it reached the 30 percent target at the start of 2016, nearly a year ahead of the schedule laid out when the Obama administration outlined a plan to reward healthcare providers based on quality of care rather than the volume of services they provide.”

“The 30 percent milestone represents an estimated 10 million Medicare patients receiving value-based care.”

Bundles News says that “the faster-than-expected shift to alternative payment models and value-based reimbursement should serve as a wake-up call to pathologists and clinical laboratory executives who soon may find that fee-for-service reimbursement is no longer the primary payment method for anatomic pathology services and medical laboratory tests.”

Tug of war between HIPAA and interoperability

April 13, 2016by Robert Whitcomb in Uncategorized tagged

tugofwar

Shelly K. Schwartz, writing in Medical Economics, discusses whether HIPAA and EHR interoperability are at odds.

She notes:

“The adoption of electronic health records (EHRs) presents doctors with a dilemma when it comes to protecting patient health data.

“On the one hand, Medicare provides incentive payments for meaningful use of EHRs, which requires doctors to capture, store and securely share protected health information with their patients and other providers. On the other, HIPAA makes healthcare providers accountable for keeping protected health information (PHI) confidential, delivering hefty fines for those who fail to comply.”

Of retail strategies and narrow networks

February 25, 2016by Robert Whitcomb in Uncategorized tagged , , , , ,

 

Herewith some provocative questions for hospital executive, trustees and directors at a Society for Healthcare Governance symposium and reported in Hospitals & Health Networks:

Jamie Orlikoff, a healthcare-governance expert, asks  “How many of you  can say you have a retail strategy in place?”  Clearly, some hospitals and health systems are, as Orlikoff put it, “going to be blindsided by consumerism.”

Orlikoff noted that the first question a patient will ask if likely to be  “’How much will this cost me?’”

”The traditional reply from healthcare providers? ‘Don’t worry about it. Your insurance will cover it.”’

But, Orlikoff pointed out, today’s consumers would say: “Well, no, I have a $5,000 deductible. If you can’t give me that answer, I’ll go to someone who will.”

“And once they know how much a procedure is going to cost them, consumers have an immediate follow-up question: How good is the quality of what I’m paying for? If a hospital can’t provide proof of value, Orlikoff said, the individual again will either go elsewhere, or decide he might not need that procedure after all.”

Rich Umbdenstock, who recently retired as head of the American Hospital Association, discussed narrow networks and asked:  “If you were forming a narrow network, would you choose your hospital to be in it?”

Among the factors to consider, he said,  paraphrased here by H&HN:

• “How do we do less … with less … and get better outcomes for the customer/provider/partner’s return on investment?

• “Can we fund our strategic plan on the 10 to 30 percent less revenue we will be getting from Medicare and other payers?

• “Can we manage payment risk?

• “How are we solving the consumer/patient hassle map? In other words, how are hospitals improving customer service and making the health care experience less complex and onerous?

• “As a board, how are we adjusting our mission/plan/metrics/agenda/structure/composition/management incentives?

“How do we do less … with less … and get better outcomes for the customer/provider/partner’s return on investment?

• Can we fund our strategic plan on the 10 to 30 percent less revenue we will be getting from Medicare and other payers?

• “Can we manage payment risk?

• “How are we solving the consumer/patient hassle map? In other words, how are hospitals improving customer service and making the health care experience less complex and onerous?

• “As a board, how are we adjusting our mission/plan/metrics/agenda/structure/composition/management incentives?”

 

 

 

CMS orders physicians to hunt down overpayments

February 12, 2016by Robert Whitcomb in Uncategorized tagged , , , , , , , , ,

foxhunt

Medscape reports that new rules from CMS say that “physicians must not only return Medicare overpayments within 60 days of identifying them but also actively look for overpayment through self-audits and other forms of research….”

“If a physician fails to hand back overpayments within 60 days, he or she risks getting sued by the government under the False Claims Act (FCA).”

Many physicians, already drowning in paperwork, will not be pleased by this latest CMS mandate.

“This requirement would be extremely burdensome for physicians as it would impose a boundless duty to troll medical records in search of innumerable vulnerabilities,” the American Medical Association and dozens of other medical societies wrote CMS in 2012.

“CMS did not cut organized medicine any slack in its final regulations, but instead said what physicians did not want to hear. The agency also warned that some healthcare providers might avoid self-scrutiny for the sake of not discovering money they would have to return,” the publication reported.

“We disagree that this rule creates a requirement for any formal compliance plan or audit strategy,” CMS said. “Rather, it requires that providers and suppliers maintain responsible business practices and conduct a reasonably diligent inquiry when information indicates that an overpayment may exist.”

Wanda Filer, M.D., president of the American Academy of Family Physicians, one of the signatories to the 2012 letter to CMS, told Medscape that she hopes the agency will “interpret ‘clear duty’ very gently,” lest, as the publications put it, “physicians find themselves with more administrative work that reduces face time with patients”

“Patients have one clear duty, and that’s taking care of patients,” Dr Filer told Medscape.  “CMS has a clear duty to protect the Medicare trust fund. How we strike the balance…will be the art of this.”

Contact Info

info@cmg625.com

(617) 230-4965

Wellesley, Mass