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  • Practices Foresee Little Benefit from CMS’s ICD-10 Help
    to final bill days to payment denial rate and reimbursement rate for RelayHealth customers will be tracked Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Wednesday September 30 2015 BACK TO PAGINATION Post deadline steps physician practices should take include forming teams across the practice that can track the number and type of claim denials to determine what is causing them Sept 30 In the waning weeks before the historic Oct 1 transition to the ICD 10 code sets physician practices reported gaining little benefit from federal initiatives aimed at easing the switch according to recent polling Porter Research polled 318 providers nationwide in August about their organizations readiness for the ICD 10 transition and found few were planning to utilize assistance and flexibility offered by the Centers for Medicare Medicaid Services CMS On Oct 1 the agency is requiring all HIPAA compliant providers to switch to the new codes when billing Medicare or Medicaid and many private payers also will require the switch Few survey respondents most of which were the types of small physician practices that are expected to face the biggest challenges during the transition planned to utilize non specific ICD 10 codes as permitted 3 percent while 74 percent planned to use the most specific codes possible CMS announced in July that for one year after Oct 1 review contractors will not reject any previously paid Part B claim based solely on the use of wrong codes as long as a code from the correct family is submitted The concession negotiated with the American Medical Association has drawn criticism from coding experts for doing little to make the submission of initial claims easier while also sowing confusion because it would not apply to payers outside of Medicare Factors that possibly limited the appeal of the flexibility to survey respondents included the policy s exclusion of medical necessity determinations and lack of clarity around whether secondary Medicare payers such as Medigap plans would follow it Ken Bradley vice president of strategy and regulatory compliance for Navicure said in an interview Additionally half of the survey s respondents said their concerns about the switch were not lessened by CMS plans to authorize advance payments to physicians if a Medicare contractor is unable to process claims due to ICD 10 problems In such circumstances physicians can apply to Medicare administrative contractors for a single advance payment for multiple claims during an eligible period of time according to a CMS FAQ Thirty two percent of respondents said their concerns were mitigated by the CMS offer There was a little bit of a sigh of relief that Medicare in the event that they make a mistake is going to proactively do advanced payments Bradley said Reduced Testing CMS offered three rounds of end to end testing as well as the chance for providers to individually submit claims as part of acknowledgement testing right up to Oct 1 But the share of providers opting out of end to end testing with any payer jumped from 10 percent in a separate survey at the beginning of the year to 38 percent in the recent survey About half of the respondents either planned to engage in end to end testing or had completed it Among those that completed such testing none reported surprising or negative results However varying rates of success in CMS s three rounds of end to end testing over the last nine months raised concerns among some payment consultants that many practices could face significant revenue impacts from ICD 10 related payment denials That concern was echoed by the respondents to the recent survey More than half were only somewhat confident or not confident that they would be ready for ICD 10 and the majority 56 percent named ICD 10 s impact on revenue or cash flow as their biggest concern Seventy one percent of respondents expected their denial rates to increase by at least 11 percent after the transition Specific challenges during the transition as identified by respondents included increased clinical documentation updates and coding issues 31 percent and a lack of preparedness by payers resulting in a lack of payment 27 percent Many commercial payers have said they are prepared for the transition and Bradley was hopeful that was the case although similar promises proved untrue during the 5010 claims transition Provider Responses The leading responses planned by providers were improving their patient collections process 34 percent and denials management process 30 percent On the day before the transition Navicure concluded more than 98 percent of its clients at least had the software in place to send the ICD 10 values However it remained up to the providers to send the accurate values which was why Navicure encouraged providers to take the time to review their coding values to ensure they match the clinical documentation Even after the changeover according to the consultancy providers should form teams from across the practice that can review real time denial and rejection results to identify the types of denials that are increasing and the common causes of those denials It takes a team effort to eliminate some of those types of problems Bradley said Another step providers should take is to closely follow communications from payers and vendors to be able to respond quickly to issues that develop Regardless of the CMS flexibility practices should strive to use the most specific possible ICD 10 codes given that those will be required over the long term That means that they may need to look at some short term hopefully reduced productivity rates so that they are watching and monitoring and measuring things to make sure that they are accurate during those first few weeks and months of implementation Bradley said Meanwhile Navicure plans a follow up survey sometime before the end of the year to see how the transition has gone That polling comes in addition to efforts by CMS

    Original URL path: http://www.hfma.org/Content.aspx?id=42345 (2016-02-10)
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  • Hospital-Physician Practice Mergers Drive Some Price Increases: Study
    or diagnostic tests de Brantes said The study was funded by the Robert Wood Johnson Foundation Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Thursday October 22 2015 BACK TO PAGINATION The findings could spawn additional Medicare site neutral payment cuts according to one payment expert Oct 22 Hospital and physician practice integration was associated with increases in outpatient prices but not inpatient prices according to the first national analysis of the effect of such deals over several years The analysis of prices charged by practices in 240 metropolitan statistical areas to 7 million enrollees in preferred provider organizations or point of service plans from 2008 through 2012 found that markets with greater increases in physician hospital integration had greater increases in outpatient spending And almost the entire difference in spending stemmed from price increases and not increased utilization according to the study published this week in JAMA Internal Medicine In contrast physician hospital integration was not associated with higher inpatient prices These findings are consistent on average with hospitals conferring their existing market power to newly employed physicians or acquired practices as the integrated organization negotiates prices for outpatient physician services but not with physician hospital integration strengthening the organization s bargaining power in negotiating prices for inpatient hospital services the authors wrote During the study period the share of hospital employed physicians increased in the studied areas by 3 3 percentage points to 21 3 percent the researchers concluded The merger trend was credited with at least a 75 increase in average annual outpatient spending raising the mean to 2 407 The study also found that price differences between office visits at independent physician offices and physicians integrated with hospitals were larger and more varied among commercially insured patients than among the Medicare population These pricing patterns provide suggestive evidence that price increases associated with physician hospital integration did not result solely from transmission of setting related price differentials in the Medicare payment system but likely also resulted from the enhanced market power of the provider organizations the authors wrote The absence of reductions in utilization after hospitals purchased practices suggested to the authors that such provider integration has not produced efficiency gains through improved care coordination or management Such efficiencies may not come from consolidation until alternative payment models emerge with incentives to limit utilization Limitations Identified Among the factors limiting the study s conclusions was that it did not assess whether any improvements occurred in the quality of care delivered by the integrated physicians Improved quality would enhance value in the absence of changes in utilization the authors wrote Hospital advocates underscored additional limitations The study relies on data as much as seven years old and is not reflective of the changes happening in today s healthcare market Tom Nickels executive vice president of the American Hospital Association said in an emailed statement Alternative payment arrangements facilitated by hospital physician integration have led to quality improvement and slower cost growth Additionally the study does not reflect recent drops in provider prices For instance physician prices fell by 1 2 percent for the 12 month period ending September 2015 according to the Bureau of Labor Statistics while hospital price growth is at a historic low Prices at hospitals increased by 1 4 percent in 2014 the slowest rate since 1998 and down from 2 2 percent in 2013 Study Effects The authors concluded that the changes in the structure of healthcare provider markets and in spending should be monitored and may require additional regulatory measures to control Alternatively if the Centers for Medicare Medicaid Services forces hospitals into initiatives such as a new pilot program that requires hospitals in some areas to accept episode based payment they will not be able to continue raising rates or diverting patients to costly hospital outpatient department services James Reschovsky PhD and Eugene Rich MD wrote in an accompanying commentary Instead hospitals will need to work with their acquired physicians to reduce utilization and lower prices while improving quality This skill is one that hospitals might postpone developing only at their own peril the commentators wrote Francois de Brantes executive director for the Health Care Incentives Improvement Institute wrote in an email that clinical integration is simply not occurring at the pace that it should and that clinical integration for care quality purposes does not require formal integration at the organizational level The new research is likely to fuel a further push to cut Medicare payment rates to hospitals de Brantes said He noted that states already have begun to enact laws that bar providers from charging different prices for the same service based on site of service or a change in ownership The data across the country are very consistent that the first effect of the purchase of an independent practice by a hospital is to increase prices for certain common procedures or diagnostic tests de Brantes said The study was funded by the Robert Wood Johnson Foundation Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Thursday October 22 2015 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide

    Original URL path: http://www.hfma.org/Content.aspx?id=43053 (2016-02-10)
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  • Hospital, Physician EHR Attestation Slows
    are implemented quickly our results suggest that many HIE efforts will continue to struggle Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Friday September 18 2015 BACK TO PAGINATION Despite slowing participation in the EHR incentive program the number of providers with some type of EHR continued to rise in 2014 a report finds Sept 18 Fewer hospitals and physicians successfully attested to meaningful use of electronic health records EHRs in 2014 as part of the massive federal incentive program aimed at spurring their widespread adoption More than 4 300 hospitals attested to Stage 1 of meaningful use at least once in the five years since the start of the incentive payment program In 2014 the first year of Stage 2 of meaningful use only 1 826 hospitals or 38 percent of hospitals registered for the program successfully attested to meeting its criteria This reduction in the number of attestations suggests that even those hospitals that have met Stage 1 criteria may be facing significant challenges in achieving Stage 2 stated an annual report on the state of health IT by the Robert Wood Johnson Foundation RWJF and other organizations Among eligible healthcare professionals more than 305 000 had successfully attested to Stage 1 by July 2015 But less than 60 000 or 20 percent had successfully attested to Stage 2 The report authors noted that similar to U S hospitals health professionals appear to be having difficulty achieving the more stringent Stage 2 criteria Similarly total meaningful use payments to eligible health professionals in both Medicare and Medicaid fell from 2013 to 2014 the report found The provider attestation findings came as a growing number of provider organizations and members of Congress urged an extended delay in the release of the rules for the third stage of meaningful use For instance the American Medical Association this week backed the recent call of Sen Lamar Alexander R Tenn for delaying the final rules for Stage 3 to 2017 The Stage 3 rules are currently undergoing review and finalization by the Office of Management and Budget Rising Adoption Despite the slowdown in the incentive program EHR adoption has increased among both hospitals and physicians For instance almost three quarter of physicians had adopted a certified EHR in 2014 according to data released this week by the National Coordinator for Health Information Technology However only 51 percent of physicians were using all defined Basic EHR functionalities such as for recording demographic information and computerized prescription order entry Only 62 percent of physicians either participated or planned to participate in the EHR incentive program However even among the physicians who might not or will not apply to the incentive program nearly half had adopted a certified EHR Basic EHR adoption among hospitals increased to 75 percent in 2014 from 61 percent in 2013 However comprehensive EHR adoption has increased much more slowly to 34 percent in 2014 from 27 percent in 2013 Data Exchange In 2014 76 percent of hospitals reported exchanging data including laboratory results radiology reports clinical care summaries and medications with outside health professionals according to the RWJF report The rate of data exchange with ambulatory health professionals and other hospitals was an increase from 62 percent in 2013 and 41 percent in 2008 At the state level the rate of data exchange by hospitals ranged from 100 percent in Rhode Island and Delaware to 42 percent in Nevada Amid pervasive barriers to better EHR data sharing the RWJF researchers asked health information exchange HIE organizations to identify the factors that most obstructed such information transmission The most common answers were the difficulty of hiring or retaining staff a lack of agreement on what HIE includes and stakeholder concerns about privacy and confidentiality Developing legislation that simultaneously tackles technical financial governance human resource privacy and security and patient consent domains is daunting and far more difficult than if there were a single substantial barrier inhibiting HIE progress the RWJF authors wrote The authors concluded that without comprehensive policy efforts that are implemented quickly our results suggest that many HIE efforts will continue to struggle Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Friday September 18 2015 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you

    Original URL path: http://www.hfma.org/Content.aspx?id=41430 (2016-02-10)
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  • Quality, Cost Initiatives Draw Physician Concern | HFMA
    of 1 624 primary care physicians was conducted from Jan 5 to March 30 2015 Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Wednesday August 05 2015 BACK TO PAGINATION Medical homes and health information technology were more likely to be seen by physicians as having a positive impact on care Aug 5 Many primary care physicians see negative effects from a range of high profile quality and cost control initiatives according to a new poll The increased use of quality metrics used to assess physician performance drew some of the strongest objections in a nationally representative primary care physician poll released Aug 5 by the Commonwealth Fund and the Kaiser Family Foundation Half of physicians including half of those receiving incentive payments based on the quality of care they provide said the use of physician quality metrics was having a negative impact on primary care providers ability to provide quality care to their patients Only 28 percent of physicians enrolled in such initiatives and 17 percent not enrolled saw positive effects from physician quality assessments The results showed primary care clinicians views are decidedly negative when it comes to financial penalties and the increased use of quality metrics in judging their performance wrote the poll s authors It may be some time before they can become comfortable with these new payment models More than half 55 percent of physicians said their practice receives incentives or payments based on measures of quality of care patients experiences or the efficiency of the care they provide Clinicians may need to increase quickly their comfort with quality metrics Earlier this year Medicare embarked on a mission to tie 85 percent of its fee for service payments to quality or value by 2016 and to tie 50 percent of all Medicare payments to quality or value through specific alternative payment models like accountable care organizations ACOs and bundled payments by the end of 2018 Similarly 52 percent of physicians said that programs that include financial penalties for unnecessary hospital admissions or readmissions positively affect quality of care Only 12 percent of physicians reported positive effect ACO Support Other findings that may not bode well for the payment shift was unenthusiastic physician support for ACOs Among all primary care physicians only 14 percent reported that ACOs had a positive impact on the quality of care delivered Among physicians in ACOs positive impacts were seen by 30 percent and negative effects were seen by 24 percent of physicians The dim view of primary care providers toward ACOs may stem from their lack of involvement with day to day management of organizational change the survey authors wrote Twenty nine percent of all primary care physicians said they participate in an ACO arrangement with Medicare or private insurers the share in ACOs rose to 34 percent of physicians who accept Medicare Twenty eight percent of physicians were unsure whether their practices participate in ACO arrangements Another concern flagged by the survey s authors was the cumulative effect of poorly received health care delivery and payment trends on physicians Nearly half of primary care physicians said that recent trends in health care are causing them to consider retiring earlier than planned As primary care transformation efforts mature and spread it will remain important to judge their effects on patients in terms of access quality and costs of care the survey authors wrote However it is also important to assess their effect on primary care clinicians Positive views Other payment reforms drawing large physician participation were 30 percent receiving incentives or payments through a primary care medical home or through the Affordable Care Act s ACA s Advanced Primary Care Practice APCP medical home pilot Medical homes drew more positive reviews in the survey One third 33 percent of physicians said medical homes are having a positive impact on quality of care while roughly one of 10 said the impact was negative About a quarter of the group said there has been no impact or they are not sure About two thirds of primary care physicians 64 percent reported they were paid either through capitation or salary or through a combination of capitation salary and fee for service About a third of primary care physicians 34 percent are still paid exclusively on a fee for service basis Among the initiatives that primary care providers view as most helpful to providing high quality care to patient was health information technology HIT which half view as having a positive impact Only 28 percent reported a negative HIT impact on care delivery The survey s authors wrote that the more positive views of HIT and medical homes may reflect clinicians earlier exposure to them Physicians have been adopting electronic health records with the help of federal subsidies since 2009 and medical homes pre date the recent ACO push The survey of 1 624 primary care physicians was conducted from Jan 5 to March 30 2015 Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Wednesday August 05 2015 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives

    Original URL path: http://www.hfma.org/Content.aspx?id=35419 (2016-02-10)
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  • CMS Offers Physicians ICD-10 Flexibility
    person training through its Road to 10 ICD 10 education initiative for small physician practices Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Wednesday July 08 2015 BACK TO PAGINATION The AMA has dropped its support for legislation to delay the transition following the CMS policy change July 8 Physicians and other providers reimbursed under Part B will have another year before their bills are rejected for incorrect ICD 10 coding the Centers for Medicare Medicaid Services CMS announced this week The change in CMS policy was urged by the American Medical Association AMA over concerns that many small practice physicians lack the resources to accurately use the new billing codes On Oct 1 the agency is requiring all HIPAA compliant providers to switch to the new codes when billing Medicare or Medicaid and many private payers also will require the switch We appreciate that CMS is adopting policies to ease the transition to ICD 10 in response to physicians concerns that inadvertent coding errors or system glitches during the transition to ICD 10 may result in audits claims denials and penalties under various Medicare reporting programs Steven J Stack MD president of AMA said in a written statement An important caveat is that Part B providers will need to submit claims with codes from the right family of ICD 10 codes to receive payment Other changes announced this week include the creation of a CMS communication and collaboration center to monitor ICD 10 implementation quickly identify issues related to the transition and initiate fixes The center will include an ICD 10 ombudsman who will receive and address concerns of physicians and other providers with forthcoming rules specifying the process of submitting such concerns With easy to use tools a new ICD 10 ombudsman and added flexibility in our claims audit and quality reporting process CMS is committed to working with the physician community to work through this transition Andy Slavitt acting administrator of CMS said in a release The agency also will not subject physicians or other eligible professionals to ICD 10 related penalties for 2015 quality reports to the physician quality reporting system the value based modifier or meaningful use programs as long as the correct family of codes is used CMS will not deny informal review requests based on 2015 quality measures if it is found that the only error is related to the specificity of the ICD 10 code Broad Support The AMA s support for the new ICD 10 policy followed previous efforts to block or delay the transition including backing a bill in May to delay the switchover In response to questions about whether the CMS policy change has led AMA to drop its support for legislation delaying ICD 10 an AMA official told Healthcare Financial Management that since all signs indicate that the switchover will occur Oct 1 the association is focusing on steps to ease the transition and mitigate potential disruption The AMA s change in approach was welcomed by hospital finance leaders some of whom had raised concerns about previous efforts to delay or change the switch to ICD 10 codes By working together and allowing flexibility in the claims auditing and quality reporting processes CMS has taken a major step to reassure stakeholders that this implementation will go forward as scheduled on Oct 1 said Sandy Wolfskill director healthcare finance policy revenue cycle MAP for HFMA The Coalition for ICD 10 praised CMS s changes to ICD 10 implementation in a written statement saying they allow for flexibility in the claims auditing and quality reporting process and help to ease physicians transition process Additional Steps CMS plans to send letters this month to all Medicare fee for service providers encouraging ICD 10 readiness and notifying them of the latest policy changes The agency plans to undertake later this month its final round of voluntary ICD 10 end to end testing with Medicare providers The last testing period follows an uptick in the acceptance rates of provider claims reported in June during the second round of end to end testing Physician advocates had cited the lower acceptance rates in the initial round as justification for delaying ICD 10 implementation CMS will offer ongoing Medicare acknowledgement testing for providers through Sept 30 The agency also will provide additional in person training through its Road to 10 ICD 10 education initiative for small physician practices Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Wednesday July 08 2015 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare

    Original URL path: https://www.hfma.org/Content.aspx?id=32096 (2016-02-10)
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  • OIG Targets Physician Compensation
    own terms rather than waiting for a whistleblower or someone to bring it up Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Thursday June 11 2015 BACK TO PAGINATION Hospitals will need to review their existing and renewal agreements to ensure they are staying clear of overcompensation concerns raised in an alert June 11 Physician compensation arrangements that exceed fair market value may violate federal fraud statutes and be subject to prosecution according to the leading federal healthcare law enforcement agency The Office of Inspector General OIG an agency of the U S Department of Health and Human Services issued a fraud alert this week warning that physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for services actually provided Although many compensation arrangements are legitimate a compensation arrangement may violate the anti kickback statute if even one purpose of the arrangement is to compensate a physician for his or her past or future referrals of federal healthcare program business the alert stated The OIG urged physicians to carefully consider the terms and conditions of medical directorships and other compensation arrangements before entering into them The agency recently reached settlements with 12 physicians who entered into questionable medical directorship and office staff arrangements Among the improper remuneration alleged by OIG in those cases were compensation agreements in which an affiliated healthcare entity paid the salaries of the physicians front office staff Because these arrangements relieved the physicians of a financial burden they otherwise would have incurred OIG alleged that the salaries paid under these arrangements constituted improper remuneration to the physicians according to the alert Hospital Effect The letters appear to serve primarily as a warning to physicians said Larry Vernaglia chair of the healthcare practice group at Foley Lardner It s designed to send a message to the physician community to not think that they are immune from liability under the enforcement regimes just because the government has been going after hospitals Vernaglia said in an interview The letter actually could help hospital officials during negotiations of compensation arrangements with physicians who are insisting on more generous packages This letter is a useful tool for CFOs to have in their pockets when they find physicians who are pushing back unreasonably Vernaglia said They can say Look I m not just being cheap you have some exposure here under these laws You should be careful He already has advised hospital clients to save the document for future negotiations with physicians Collaboration Impact The increased scrutiny of physician compensation comes as the industry is undertaking an unprecedented push to align physicians with hospitals Hospitals not only have purchased large numbers of previously independent physician practices but also have sought to integrate the physicians into leadership positions in their organizations I hope the term medical director doesn t become a dirty word as a result of letters like this because it s a really important and good thing for hospitals and physicians to be collaborating Vernaglia said It s good for patient care it s good for organizational efficiency and if done right it is a good thing Physician compensation also has become more complex amid the ongoing shift from the fee for service payment model to models that pay for value The OIG alert indicated that hospitals and health systems should go back and review existing physician compensation arrangements to ensure compliance with the new federal guidance We have found from experience that hospitals do better if they find problems in this area by self disclosing them than they do when they get an investigation Vernaglia said So there actually is an incentive to finding these problems out and dealing with them on your own terms rather than waiting for a whistleblower or someone to bring it up Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Thursday June 11 2015 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps

    Original URL path: http://www.hfma.org/Content.aspx?id=31382 (2016-02-10)
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  • Physicians in Medicaid Expansion States See Big Impact on Patient Mix
    an analysis of data from a nationally distributed sample of 16 000 providers in the athenahealth network Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Friday May 29 2015 BACK TO PAGINATION The lack of a patient surge to primary care physicians raises some worrying possibilities for authors of new research May 29 Physicians in states that agreed to expand Medicaid eligibility saw their numbers of uninsured patients drop and their volumes of Medicaid cases jump according to a national provider database From 2013 to 2014 the proportion of physician visits by uninsured patients in states that opted to expand Medicaid eligibility as authorized by the Affordable Care Act ACA decreased 39 percent according to a joint data initiative of athenahealth and the Robert Wood Johnson Foundation Meanwhile in non expansion states the proportion of visits by uninsured patients decreased by only 11 percent A sharp increase in Medicaid case mix largely explains the drop in the proportion of uninsured visits in expansion states as the proportion of visits involving major public and private insurers is normally quite stable Josh Gray vice president of athenaResearch wrote in a web post Gray s conclusion was based on the finding that the proportion of physician visits by Medicaid patients in expansion states spiked from 12 2 percent in December 2013 to a peak of 16 7 percent in September 2014 Non Expansion Trend Meanwhile the proportion of physician visits by Medicaid patients in non expansion states actually declined slightly from 6 6 percent of patients to 6 0 percent That drop occurred even as Medicaid enrollments also increased in those states due to previously eligible beneficiaries seeking coverage for the first time a phenomenon known as the woodwork effect The slight decline could be related to physicians in non expansion states becoming more focused on opening their patient panels to those who are newly insured by one of the federally qualified subsidized health plans now available through the healthcare marketplaces Gray wrote The ACA also was credited with changes in primary care physicians private payer mix In non expansion states the proportion of visits from commercially insured patients increased by two percentage points to 74 percent In expansion states the share of privately insured patients fell 0 2 percentage points while the share of Medicaid patients jumped 2 8 percentage points to 15 5 percent Another trend for physicians in expansion states was an increase in the small number of patients who switched from commercial insurance coverage to Medicaid In those states the share of commercially covered patients who switched to Medicaid was 1 8 percent between 2013 and 2014 up from 1 1 percent between 2012 and 2013 The authors of the analysis attributed the increase both to individuals who lost their jobs and to low income workers who chose Medicaid to avoid premium contributions and to reduce their out of pocket costs No Surge Another finding that might raise concerns for hospitals was that physicians did not see a large influx of new patients from 2013 to 2014 despite ACA coverage provisions credited with covering 10 million uninsured people during that time The initiative found that the proportions of visits by new patients in five physician categories changed little For example the share of new patients in primary care practices increased from 22 6 percent of visits in 2013 to 22 9 percent in 2014 Similarly small increases were found for pediatricians and surgeons while the proportion of new patient visits was flat for OB GYNs and declined slightly for other medical specialists Among the possible explanations for the small overall increase the initiative s authors wrote was that many patients might not have needed to visit a physician after getting coverage or might have sought care in an emergency department ED Other research has found a surge in visits by newly covered patients especially Medicaid enrollees to hospital EDs in 2014 as hospitals and insurers continue to struggle to get the newly insured to seek care in more appropriate settings The results of the latest research were based on an analysis of data from a nationally distributed sample of 16 000 providers in the athenahealth network Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Friday May 29 2015 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences

    Original URL path: http://www.hfma.org/Content.aspx?id=31134 (2016-02-10)
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  • Improving Population Health Management Processes at OSF HealthCare
    flow into case management by about 44 percent These staff time reductions translate to a little more than 2 million per year that we can put back into direct patient care Starting with the deployment of a single internally created predictive model focused on just one issue we ve been able to improve patient outcomes while simultaneously identifying opportunities to reallocate a significant amount of staff time Chris Franciskovich is a data scientist healthcare snalytics OSF HealthCare Peoria Ill Stephen Hippler MD FACP is chief clinical officer OSF HealthCare Hoa Cooper MHSA BSN RN NEA BC is vice president OSF Care Management OSF HealthCare Publication Date Monday December 07 2015 BACK TO PAGINATION At OSF HealthCare we re called to serve our patients with the greatest possible care and love To stay true to our mission while simultaneously adjusting to the changing healthcare market we re continually working to create more effective and efficient ways to identify and assist patients with various health risks After all the health of the population is an aggregate of the health of its individual members If we re going to serve those individual members as well as possible we have to become better at identifying and acting on specific needs quickly As a Pioneer accountable care organization we believed it was important to address transitions of care in a meaningful and robust manner We leveraged our electronic medical record EMR improved and spread transition processes throughout our system made significant improvements and learned a lot along the way After a few years of work in this area we realized we need automated approaches that run silently behind the scenes and help clinicians identify at risk patients driving work processes and helping us better assist our patients with our limited resources Here s a quick view of the strategies that set the stage for our success using our 30 day readmission reduction program as an example Learning from Experience Over the past few years our organization has invested in the rapid deployment of Epic a robust EMR throughout our integrated health system During this time we also built out our enterprise data warehouse and transformed our healthcare analytics team to include individuals focused on truly advanced analytics and predictive modeling Simultaneously we ve been working diligently at reducing readmissions through a number of system wide initiatives As part of this effort we implemented a nursing assessment based navigator inside Epic that requires nurses to assess each patient on multiple criteria The idea is to identify a need for follow up actions such as case management referrals However we found the approach required a significant amount of nurse time over the course of an inpatient stay What s more it produced a large volume of inefficient downstream work through false positive generation When implementing the nursing assessment based approach we understood the tool was designed not to predict readmissions with great specificity but to help identify key areas of potential patient need as a way of focusing improvement efforts We quickly recognized the value of an approach that would entail robust inpatient case management and ambulatory complex care management but we needed to better understand which patients were at high risk and could benefit from these interventions Furthermore from a functional standpoint the use of the navigator tool required an average of about 60 minutes of nurse time for each inpatient stay approximately 30 minutes of nurse time for each outpatient with observation stay and a minimum of about 10 minutes of case management review time for nearly 90 percent of inpatient and outpatient with observation visits When multiplied by our nearly 65 000 inpatient stays and approximately 17 000 outpatient with observation visits per year this translated into around 41 nurse or case manager FTEs worth of time each year That s about 3 2 million in salary and benefits in nursing time each year to assess patient risk Building a Model that Works When it came time to build the predictive model we had appropriate data flow a wealth of historical knowledge on the topic leadership alignment staff interest and the skill internally to build and deploy such a model We created an industry leading predictive model composed of about 50 variables then divided the output into four risk levels Approximately a quarter of our readmissions are in each group but the percentage of the population differs significantly Low risk About 55 percent of discharges with a readmission rate of about 4 percent Medium low risk About 22 percent of discharges with a readmission rate of about 11 percent Medium high risk About 16 percent of discharges with a readmission rate of about 18 percent High risk About 7 percent of discharges with a readmission rate of about 30 percent To deploy the model we developed two interconnected reports The first provides clinical staff with a list of the medium high and high risk patients grouped by unit and risk level and then sorted by probability to readmit The second report is an individualized risk profile for each patient If a staff member clicks the patient s name on the first report the second report is generated and provides visibility into the patient s recent risk history as well as customized descriptions of each variable impacting that patient s risk The intent was always to establish a process by which the risk score automatically is transmitted back into our EMR but we needed to start with a faster and more easily managed process before making changes to our EMR When we deployed the predictive model we asked the case managers to focus efforts on the medium high and high risk patients making sure we were aligning these patients with the existing interventions we had developed over the past half decade or more Over the course of the year we began driving additional work flows based on the model s output In conjunction with a functional transformation of our case and care management structures we

    Original URL path: http://www.hfma.org/Content.aspx?id=44393 (2016-02-10)
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