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Fitch sees Feds as greatest threat to for-profit hospitals’ earnings

October 2, 2017by Robert Whitcomb in Uncategorized tagged Community Health Systems, HCA Healthcare, high-deductible health plans, hospital revenues, LifePoint Health, Tenet Healthcare and Universal Health Services, Tom Price

Healthcare Dive looked at the future of for-profit hospitals in light of a Fitch Ratings analysis of the sector.

The news service wrote:

“After reviewing the finances of Community Health Systems, HCA Healthcare, LifePoint Health, Tenet Healthcare and Universal Health Services, Fitch Ratings said federal and state government policy decisions — which are often politicized — create an unpredictable environment. Federal regulations and political decisions are the biggest risks to the industry’s operating profile, with 30%-40% of hospital revenues coming from Medicare and Medicaid, according to the report.”

“This is a concern for providers now, as HHS has proposed scaling back or eliminating some mandatory bundled payment models. The agency has pushed for deregulation, which can have a variety of effects but is forcing some hospitals to alter their course for transitioning to value-based payment models. The bundled payment decision and other proposals have angered some providers but also relieved others. With Tom Price out as HHS secretary, however, regulatory changes may slow down.”

“Fitch said hospital revenues are also affected by consumer finances through high-deductible health plans (HDHP) and health savings accounts. Insurers and employers have been able to slow premium increases by using HDHPs, but these plans have also saddled members with more out-of-pocket costs.”

To read more, please hit this link.

2 experts to physicians: Value-based care is her to stay

April 11, 2017by Robert Whitcomb in Uncategorized tagged Health Savings Accounts, high-deductible health plans, MACRA

Ingrid Lund, Ph.D., practice manager for the physician practice roundtable at The Advisory Board Co., and Eric Cragun, senior director for health policy at the Advisory Board, agreed in a Physicians Practice podcast that value-based care is here to stay, as is much of the Affordable Care Act.

Ms. Lund said: “Certainly whatever the GOP does, whatever their next move on healthcare reform is, it will impact providers in some way, but I think we can agree there are some safer bets and ways to move strategy forward even though we’re in this point of uncertainty.”

She also said that the bi-partisan Medicare Access and CHIP Reauthorization Act (MACRA) will stick around and that physicians should continue to adapt to the move toward risk-based contracts.

Another “safe bet,” according to Ms. Lund, is to “double down on your consumerism strategy” thanks to the rise of health savings accounts and high-deductible health plans.

To hear/read more, please this link.

Chargemaster focus needed in transition to value payments

February 4, 2016by Robert Whitcomb in Uncategorized tagged fee for service, high-deductible health plans, Jon Melling, patient populations, payment-for-value, Pivot Point Consulting, quality analytics, revenue cycle

Jon Melling, a partner and IT consultant at Pivot Point Consulting, spoke with Becker’s Hospital Review about how hospitals are transitioning from fee-for-service to value-based billing.

“The two [systems] are so fundamentally different that you can’t just flick a switch and move from one to the other,” noted Mr. Melling, and hospitals and health systems face many challenges in bridging the gap.

The reimbursement that hospitals are getting now has fallen, in part because of the the rise in popularity of high-deductible health plans, Mr. Melling told Becker’s. “And under value-based billing there is likely to be a further decline in the level of revenue accrued.”

Becker’s noted: “The onus is on hospitals to find other avenues of revenue to mitigate loss, and successfully manage the health of their patient populations in a cost-effective way.”

Becker’s paraphrases Mr. Melling as saying: “To successfully manage their patient populations, providers will need to seriously invest in powerful, quality analytics engines as well as market-particular wellness initiatives, such as requiring mammograms and prostate exams for those over a certain age.”

This financial incentive to better identify and manage at-risk populations has sparked new conversations between insurance plans and care providers. “There is and will be a substantially increased amount of crossover between physician groups, payers and hospitals,” Mr. Melling added.

“If you’re a provider in a network, you have to work very closely with the payer to make sure you’re clear about the parameters and the criteria for care, and come to an agreement about the level of reimbursement for specific conditions, or what the overall payment will be if you are taking on a population,” he said.

As hospitals navigate between volume and value, Mr. Melling pointed out core revenue-cycle areas demanding provider attention.

Becker’s summarized his views on this point as: “Hospitals will need to pay increased attention to their chargemaster, potentially managing separate chargemasters where one cannot manage both value-based and fee-for-service charges….{and} Denials management will continue to be a key indicator of revenue cycle performance, with an increased focus to denial prevention.”

He added: “{I}t surprises me sometimes the level of understanding within organizations surrounding revenue cycle processes.” Executives and staff will need lots of education as they move deeper into the payment-for-value world.

Hospital admissions keep falling

January 4, 2015by Robert Whitcomb in Uncategorized tagged high-deductible health plans

Inpatient admissions at many hospital systems kept falling during 2014’s third quarter. Changes tied to healthcare reform were cited, including Medicare’s “two-midnight rule,” which has shifted many patients to ”observations” from admissions. But of course, Medicare is doing other things with financial incentives to control costs by shifting patients away from hospitals.

Further explaining the decline is the increase in high-deductible health plans with hefty co-payments and co-insurance.

high-deductible health plans

Fitch sees Feds as greatest threat to for-profit hospitals’ earnings

2 experts to physicians: Value-based care is her to stay

Chargemaster focus needed in transition to value payments

Hospital admissions keep falling

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