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  • New Model to Fund Connections to Community Services
    More information on the model and a Jan 21 webinar are available through the CMS website Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Tuesday January 05 2016 BACK TO PAGINATION Among the challenges the initiative aims to overcome is a historical lack of interest among hospitals to pay for community services that don t provide direct value for their patients Jan 5 Hospitals and health systems are urged to apply for 157 million in funding that the U S Department of Health and Human Services HHS is offering to test the first federal pay model linking patients to community services The Accountable Health Communities model aims to provide a five year test of various approaches by 44 bridge organizations to connect Medicare and Medicaid patients to available community based services Those services should aim to address patients struggles in the areas of housing instability food insecurity utility needs interpersonal violence and transportation limitations according to a release from the Centers for Medicare Medicaid Services CMS We recognize that keeping people healthy is about more than what happens inside a doctor s office and that s why for the first time we are testing whether screening patients for health related social needs and connecting them to local community resources like housing and transportation to the doctor will ultimately improve their health and reduce the cost to taxpayers HHS Secretary Sylvia M Burwell said in the release The bridge organizations were expected to include hospitals and health systems colleges local governments tribal organizations and for profit and not for profit local and national entities with the capacity to develop and maintain a referral network with clinical delivery sites and community service providers Examples of the kinds of patients that the initiative is expected to target include those who aren t taking needed medication because they lack transportation to the pharmacy Social and economic factors such as income education access to food and housing and employment status account for as much as 40 percent of health outcomes according to 2010 research As health systems are increasingly being held accountable for health outcomes and reducing the cost of care they need tools and interventions that address patient and community factors contributing to excess utilization Patrick Conway MD chief medical officer at CMS and other leaders wrote in a Jan 5 letter in the New England Journal of Medicine Challenges to Success Although partnerships among healthcare social services public health and community based organizations could improve population health outcomes the CMS leaders wrote developing sustainable payment models to support such partnerships has proved challenging For instance previous population health initiatives have had limited success when health systems and insurers do not see them producing value for their own patients or customers researchers noted in a 2014 JAMA letter Among the primary challenges faced by participants in the new model from the CMS Innovation Center is the lack of an evidence base on how best to screen and collect patient data on social needs The data collection point is significant because the foundation of the entire model is universal comprehensive screening for health related social needs Organizations receiving the grants also are expected to face challenges maintaining a motivated and skilled stable of community navigators according to Conway and the other officials Another challenge for a national level test is that community needs and the quality of local resources vary significantly To address that issue the pilot will use three incremental levels of care delivery integration each of which can be deployed in multiple settings community referral community service navigation and community service alignment The approach will include an inventory of local community agencies that provide needed services data sharing to inform a gap analysis and a quality improvement plan The pilot will measure the effectiveness of the model based on whether there are reductions in total healthcare costs emergency department ED visits and impatient hospital readmissions Previous Efforts The new model was inspired by previous initiatives to connect patients to social services For instance Hennepin Health a county based Medicaid managed care organization in Minnesota claimed that its use of housing and community service specialists as part of an integrated medical and social service system helped reduce ED visits by 9 percent The Michigan Public Health Institute s Pathways to Better Health Community Hub model in which community health workers perform a structured assessment of clients health and social service needs and use standardized pathways to link beneficiaries to community resources and to track outcomes previously was funded by a CMS grant Among hospitals that have hesitated to fund social interventions community benefit spending could be a source of funding for such interventions according to a 2014 Commonwealth Fund analysis of the economic case for provider investments in social interventions That paper argued that as uninsured rates fall not for profit hospitals could shift some of the estimated 13 billion they receive in annual community benefit funding from underinsured and uninsured patients to target social needs The Commonwealth report cited the example of Kaiser Permanente which recognized that ameliorating patients social needs can take time and instituted a community benefit strategy to budget those funds across several years CMS is accepting applications until March 31 More information on the model and a Jan 21 webinar are available through the CMS website Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Tuesday January 05 2016 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

    Original URL path: http://www.hfma.org/Content.aspx?id=45530 (2016-02-10)
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  • Congress Eases Meaningful Use Hardship Exemption
    infrastructure wrote Steve Posnack and Chris Muir directors at ONC in an accompanying blog post Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Wednesday December 23 2015 BACK TO PAGINATION The measure indicates an increased congressional focus on the meaningful use program which providers are trying to slow down for a variety of reasons Dec 23 Providers could soon have expanded access to hardship exemptions from 2015 Stage 2 meaningful use requirements under the federal electronic health record EHR incentive program due to one of the final legislative acts Congress took before adjourning for the year At the urging of many physician advocacy groups Congress cleared the Patient Access and Medicare Protection Act which gives the Centers for Medicare Medicaid Services CMS additional authority to process physician and hospital hardship exemption applications Eligible hospitals EHs and eligible physicians EPs can seek exemptions if they are unable to meet the modified Stage 2 rule which required 90 days of reporting for 2015 but it was issued on Oct 6 less than 90 days before the end of the year The legislation which is pending President Barack Obama s signature would expand hardships beyond a case by case basis to also include entire categories of applicants Exceptions for eligible providers would be due March 15 2016 and exceptions for eligible hospitals would need to be submitted by April 1 2016 Subsequently CMS could continue to offer case by case approvals of hardship applications through July 1 2016 CMS had acknowledged that the late rule and requirement for providers to report 90 consecutive days of data could be impossible for some to meet so it included a labor intensive case by case hardship exemption process This means that hardship exemptions that would otherwise be approved may never be processed or will be significantly delayed burdening thousands of physicians through no fault of their own wrote Republican physician legislators in a letter to Speaker Paul Ryan The legislation which also includes payment incentives for Medicare administrative contractors to reduce improper error rates in their jurisdictions was based on a bill that Rep Tom Price R Ga a physician previously introduced Due to the tardiness of the final CMS rule it is virtually impossible for doctors to meet the requirement deadlines Price said in a written statement This much needed relief will make the hardship application process much easier for doctors to avoid penalties stemming from the administration s mistake and thereby provide more time to care for patients Limited Success Only 12 percent of physicians and 40 percent of hospitals have met Stage 2 reporting requirements according to a letter from the GOP Doctors Caucus which urged action on the issue Failure to meet the 2015 reporting requirements or to obtain an exemption would cut Medicare payments by 3 percent for these practices in 2017 according to the American Academy of Family Physicians AAFP The tight reporting timeframe along with the assessment of penalties for the first time this year is likely to create a chilling effect on EMR adoption as physicians conclude that the cost of implementation is simply not worth the bureaucratic hassle the representatives wrote Physician advocates echoed those concerns and they praised the legislation s passage This legislative solution will more easily allow CMS to make physicians whole said Wanda Filer MD president of the AAFP in a statement It prevents penalties from being assessed against physicians who cannot meet impossible requirements within an inadequate time frame Potential Significance Voice vote passage of the narrowly focused legislation indicated to some congressional observers a growing bipartisan interest in the meaningful use issue in Congress In mid December the American Medical Association AMA issued a set of recommendations to overhaul the meaningful use program to accommodate physician and patient needs while focusing on promoting interoperability of electronic health records EHR The recommendations which were included in comments the AMA submitted to CMS on Stage 3 of the meaningful use program included elimination of the pass fail design of the program The American Hospital Association AHA also has urged CMS to revise the EHR incentive program s framework to allow more flexibility AHA also has sought a delay in new requirements until at least 2019 to allow for development of health information exchange standards and infrastructure Specifically the AHA recommends that providers not be required to begin Stage 3 until at least 75 percent of EHs 75 percent of critical access hospitals and 75 percent of EPs have met Stage 2 wrote Tom Nickels executive vice president of AHA Similarly the College of Healthcare Information Management Executives CHIME urged federal officials to delay Stage 3 to 2019 and instead undertake a laser like focus on interoperability We are also concerned that key issues not addressed by meaningful use will continue to hamper interoperability such as the lack of ways to uniquely identify patients a problem that will only continue to grow as more health information is digitalized CHIME officials wrote in a letter to CMS In a related development the Office of the National Coordinator ONC for Health Information Technology on Dec 22 released its final interoperability standards advisory for 2016 The document which is a guide for the private sector was the agency s assessment of the best available interoperability standards and specifications It is part of our near term strategy laid out in the Interoperability Roadmap to build on our health IT success to date in order to drive more user friendly technology and connect the current infrastructure wrote Steve Posnack and Chris Muir directors at ONC in an accompanying blog post Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Wednesday December 23 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

    Original URL path: http://www.hfma.org/Content.aspx?id=45150 (2016-02-10)
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  • One-Quarter of New ACA Sign-Ups Auto-Enrolled
    project that 9 1 million enrollees would have ACA marketplace coverage through the end of 2015 Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Tuesday December 22 2015 BACK TO PAGINATION Total 2015 enrollments declined 6 percent to 9 3 million in the latest quarterly report Dec 22 The federally operated health insurance marketplaces are well on their way to meeting their 2016 enrollment goal but many of those enrollees may pay more than necessary Of the 8 3 million sign ups that the federal government run marketplaces garnered in 38 states by Dec 19 over 2 million were automatically re enrolled a senior official from the U S Department of Health and Human Services HHS told reporters Automatically re enrolling for 2016 coverage and not shopping around for lower cost options could cost enrollees 4 5 billion in potential savings according to an HHS report issued shortly before the start of open enrollment That report was part of a nationwide push to get more enrollees to shop around for 2016 coverage instead of auto enrolling in the same or similar coverage The latest HHS enrollment report did not provide the exact number of auto enrollments but indicated the latest total included most of the auto enrollments that are expected to occur during the current open enrollment period which lasts through January The extent of the financial hit that auto enrollees could take was further detailed in a recently released Robert Wood Johnson Foundation RWJF national data set on all plans offered in the health insurance marketplaces in 2015 and 2016 The average lowest cost premium for the popular Silver level plans in each Affordable Care Act marketplace will increase by 12 percent to 253 while the average overall Silver level premium will increase by 11 percent to 296 Meanwhile average family plan Silver level deductibles will increase by 11 percent to 8 003 and average individual coverage Silver plan deductibles will increase by 18 percent to 4 219 The impact of those increased costs was illustrated in a new RWJF analysis that found 10 percent of individual market enrollees with incomes from 200 to 500 percent of the federal poverty level will spend more than 21 percent of their income on healthcare costs in 2016 In addition to the rising premium and out of pocket costs that non shoppers could face customer advocates have warned that a lack of shopping could leave them in plans that don t meet their medical needs or that have dropped their preferred providers Another potential financial risk for automatic re enrollers could arise if their incomes have changed and they don t provide the insurance marketplace with updated information In that scenario consumers may receive too large a premium tax credit and have to repay the Internal Revenue Service for the excess subsidy The latest totals do not include the millions more who were enrolled for coverage in the 12 state based marketplaces Kevin Counihan CEO of Healthcare gov said in a call with reporters Some Improvements Federal officials emphasized their success bringing in some new consumers to the federal marketplace Through Dec 19 29 percent of plan selections were by new customers with 71 percent made by returning or auto re enrolling customers Officials also reported comparatively improved performance this year among the so called young invincibles or enrollees ages 18 to 34 The average age of marketplace shoppers qualifying for coverage to begin Jan 1 was younger than the average age of those beginning coverage Jan 1 2015 There were nearly twice as many consumers under age 35 or about 2 1 million more compared with last year Those younger individuals comprised 35 percent of the federal marketplace plan enrollment compared with 33 percent before the deadline for 2015 coverage And that s good because a younger risk pool is a healthier risk pool and that s good for everyone s premiums Counihan said Although federal officials emphasized the increasing tax penalty faced by most Americans who lack ACA compliant health insurance coverage they downplayed the role of the penalty in the latest enrollment results There are probably many reasons behind the increase in enrollment and the enthusiasm that we are seeing Meena Seshamani MD director of the Office of Health Reform at HHS said during the call The penalty going up may be one but also there are many more people who are in the marketplace and so there are people who may have a family member a work colleague a neighbor who may be getting marketplace coverage and so it becomes more familiar to them Current Enrollments HHS officials also announced that current enrollments in all federal and state marketplaces declined 6 percent to 9 3 million in the third quarter of 2015 HHS attributed much of the decrease to reductions in federal financial assistance for enrollees who failed to adequately document their income when applying for subsidies In the second quarter of 2015 HHS cut subsidies to about 734 000 households because of a lack of required documentation Such cuts dropped to 186 000 households in the third quarter so the administration expected a smaller enrollment drop off in the final quarter of the year HHS continued to project that 9 1 million enrollees would have ACA marketplace coverage through the end of 2015 Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Tuesday December 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

    Original URL path: http://www.hfma.org/Content.aspx?id=45135 (2016-02-10)
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  • GAO Urges Site-Neutral Payments
    had proposed reducing OPPS payments for services performed in off campus hospital outpatient departments Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Monday December 21 2015 BACK TO PAGINATION More vertical consolidation is associated with larger shares of evaluation and management services being performed in hospitals the agency notes Dec 21 Congress s investigative agency is urging expanded use of Medicare site neutral payments to combat what it sees as a trend toward increasing costs after hospitals acquire physician practices The Government Accountability Office GAO found hospital acquisition of physician practices has accelerated in recent years as has physician employment The analysis found that from 2007 through 2013 the number of such vertically consolidated hospitals increased by 21 percent to 1 707 organizations During the same period the number of vertically integrated physicians nearly doubled to almost 182 000 Some of the industry sources questioned by GAO credited the trend in part to the higher Medicare payment rates rendered for services performed in hospital outpatient departments HOPDs compared with those performed in physician offices GAO subsequently concluded that counties with more vertical integration had much higher numbers and shares of evaluation and management E M visits performed in HOPDs rather than in physician offices The median percentage of E M office visits performed in HOPDs in counties with the lowest levels of vertical consolidation was 4 1 percent in 2013 compared with 14 1 percent in counties with the highest levels of consolidation GAO s findings suggest that Medicare will likely pay more than necessary for E M office visits the report stated The GAO report urged Congress to provide the Centers for Medicare Medicaid Services with authority to equalize payment rates between HOPDs and physician offices Hospitals Push Back Among the many reasons why the same services should receive higher payments when performed in HOPDs than in settings such as physician offices the American Hospital Association stated in response to GAO is that services in hospital settings are based on audited cost reports and not on physician payment rates GAO acknowledged that it might be inappropriate to equalize the total Medicare payment rate for all services However Medicare aims to be a prudent purchaser of healthcare services and that goal is not achieved if Medicare s total payment rate for certain services such as E M office visits is substantially higher simply because hospitals have acquired physician practices wrote James Cosgrove director of health care for GAO Such vertical integration is an essential ingredient for successful implementation of Affordable Care Act ACA hospital advocates noted GAO acknowledged that its analysis did not examine whether patients in HOPDs were sicker than those obtaining similar services at physicians offices However counties with higher levels of vertical consolidation tended to have either similar or slightly lower median risk scores and rates of death end stage renal disease and disability This suggests that areas with higher E M office visit utilization in HOPDs are not composed of sicker than average beneficiaries Cosgrove wrote Another point of hospital advocates that went unaddressed in the GAO analysis was that HOPDs not only have to support the costs of unique operations such as emergency departments but they also provide a range of services for patients that are not available at private practices or fully compensated by Medicare Growing Focus The GAO report which was requested by leaders of the Senate committees with jurisdiction over Medicare was the latest focus on the issue of site neutral payments Recently enacted legislation required site neutral payments after 2017 for practices acquired by hospitals after the law s enactment The site neutral payment provision and a one year extension of a 2 percent sequester cut were expected to cut Medicare spending by 9 3 billion over 10 years The issue recently garnered attention in the first national analysis of such deals which concluded that hospital and physician practice integration was associated with increases in outpatient prices although not inpatient prices The Federal Trade Commission FTC is closely watching hospital acquisitions of physician practices a senior official recently told reporters in a briefing Although the FTC has challenged some outpatient clinic combinations and acquisitions of physician practices by other practices the agency has yet to bring a case against a hospital acquisition of a physician practice Previous proposals from the Medicare Payment Advisory Commission MedPAC have recommended that Congress implement site neutral payments for certain services provided in both hospital outpatient departments and physician offices and for nonchronic critically ill cases cared for in both long term care hospitals and acute care hospitals The MedPAC proposal would reduce Outpatient Prospective Payment System payments for 66 ambulatory payment classifications to a level that either equals or comes closer to amounts given to physicians through the Medicare Physician Fee Schedule Medicare fee for service hospital spending on outpatient services in 2014 increased 11 percent to 54 billion according to recent MedPAC data Outpatient hospital use increased 4 percent for the year Meanwhile the Obama administration had proposed reducing OPPS payments for services performed in off campus hospital outpatient departments Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Monday December 21 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

    Original URL path: http://www.hfma.org/Content.aspx?id=45123 (2016-02-10)
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  • Contractors to Provide Two-Midnight Guidance: CMS
    medical necessity criteria that are incorrectly coded or that do not include the necessary documentation Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Thursday December 17 2015 BACK TO PAGINATION CMS is giving hospitals a chance to comment on a recently issued notice regarding justification for a 0 2 percent hospital cut related to the two midnight policy Dec 17 Hospitals confused about a new physician exception to the Medicare short stay rule should seek clarification from contractors until regulators issue further details according to the Centers for Medicare Medicaid Services CMS Uncertainty has swirled around a change in the Medicare short stay policy known as the two midnight rule since it was finalized in the fall According to the payment policy inpatient admissions and payment under Part A require physician documentation that the patient will need care spanning two midnights The new change would allow shorter admissions if a physician identified rare and unusual circumstances where such an admission was necessary The agency has promised to issue sub regulatory guidance to clarify such exceptional circumstances but has not yet done so even as the Jan 1 start of the modified policy looms After Jan 1 quality improvement organizations QIOs and recovery audit contractors RACs will conduct patient status reviews although RAC reviews will be limited to providers that have been referred by a QIO as exhibiting persistent noncompliance with Medicare payment policies During a regular call this week CMS officials told hospitals that until sub regulatory guidance is issued they should seek guidance on the subject from their Medicare contractors How that new rule will work they should be working with their contractors and asking those questions in the meantime but CMS will be releasing additional guidance Tiffany Swygert an acting deputy director for CMS said in a Dec 15 call with providers But contractors have not clarified the exemption in their communications with hospitals said Day Egusquiza who advises hospitals on payment issues in her role as president of AR Systems Egusquiza had urged hospitals to not use the exemption It s very subjective Egusquiza said about the exemption If physicians are given the opportunity to say My patient is so rare and unusual that he doesn t need two midnights he doesn t meet the benchmark of a second midnight after the outpatient first midnight but I m going to make him an inpatient anyway now how do you set guidelines for what that means She views the exemption as a throwback to the admission policy standard used before Medicare added the two midnight short stay policy in 2013 The vagueness of the pre two midnight policy along with the inability of physicians to provide consistently detailed justifications for such admissions cost hospitals billions of dollars in challenges from Medicare auditors Egusquiza said We can all pretend that our doctors are going to write a beautiful story as to why this is so rare and unusual that they don t meet two midnights or a one and one midnight Egusquiza said in an interview They don t write it guys CMS noted in its final rule implementing the new admissions policy that such exemption cases would be prioritized for medical review An alternate approach for hospitals would be to use the two midnight benchmark under which a patient is placed in observation and then converted to inpatient status if needed It s massive flexibility we have right now Egusquiza said Use the two midnight presumption and two midnight benchmark and steer away from rare and unusual which will be next to impossible to prove in the record Fee Rule A hospital fee related to the two midnight policy also is under renewed discussion CMS issued a November notice with comment period in which it reiterated its justification for cutting hospital inpatient payments by 0 2 percent to offset an expected increase in inpatient admissions under the two midnight policy Specifically CMS expected inpatient prospective payment system IPPS expenditures to increase by 220 million in FY14 because of the short stay policy Medicare Payment Advisory Commission MedPAC data released in December reported that Medicare fee for service inpatient spending per beneficiary actually decreased by 7 percent in 2014 That analysis included both hospitals paid through IPPS and critical access hospitals Additionally MedPAC reported that Medicare inpatient hospital use declined by 4 percent in 2014 The latest CMS justification for the two midnight cut came in response to a court directive in the case of a legal challenge by hospitals to the pay cut The court ordered CMS to provide further justification and additional opportunity for hospitals to comment on the cut Comments are due Feb 2 The ongoing annual cut has been in effect since Oct 1 2013 Improper Pay Improved Meanwhile the two midnight rule and corresponding educational efforts were credited by CMS s annual Agency Financial Report with reducing improper inpatient hospitals claims from 9 2 percent in 2014 to 6 2 percent in 2015 Such payments are usually those provided for products or services that do not meet Medicare or Medicaid coverage and medical necessity criteria that are incorrectly coded or that do not include the necessary documentation Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Thursday December 17 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

    Original URL path: http://www.hfma.org/Content.aspx?id=44861 (2016-02-10)
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  • Big Insurer Wins in Omnibus, Tax Packages
    and financial compensation to rescue workers who responded to the Sept 11 2001 terrorist attacks Rich Daly is a senior writer editor in HFMA s Washington D C office Follow Rich on Twitter rdalyhealthcare Publication Date Wednesday December 16 2015 BACK TO PAGINATION Provider focused provisions include additional funding for hospitals in Puerto Rico Dec 16 An end of the year federal spending bill known as the omnibus and a huge tax package included 32 billion in tax cuts for insurers among other provisions The 1 1 trillion omnibus bill to fund federal agencies through FY16 and a 650 billion tax package were publicly revealed Dec 16 and expected to clear Congress by the end of the week Among the healthcare provisions was a two year delay in the start of an Affordable Care Act ACA tax on high cost employer sponsored plans Delaying the so called Cadillac tax which was scheduled to begin in 2018 will cost 19 8 billion according to estimates by the Joint Committee on Taxation A related 4 billion provision would make the Cadillac tax penalties deductible against the corporate income tax Due to the tax most employers were expected to shift workers to lower premium plans with some combination of greater cost sharing more stringent benefit management or coverage of fewer services according to the Congressional Budget Office CBO For providers I don t think the temporary delay in the Cadillac Tax will substantially slow the trend to higher cost sharing for beneficiaries Chad Mulvany director of healthcare finance policy strategy and development for HFMA He urged hospitals to continue to focus on communicating with patients about their responsibility and providing up front price estimates at or as close to the time of service as practical Our Dollars and Sense work offers practical guidance on how to do that Another major provision is a 12 2 billion pause in the ACA s health insurance tax for 2017 The health insurance tax drives up the cost of coverage for millions of Americans Clare Krusing a spokeswoman for America s Health Insurance Plans said in a written statement Repealing or suspending this tax would be a victory for seniors small business owners and middle class consumers A CBO report that the insurance tax would probably be passed through as a roughly corresponding increase in premiums Delaying the insurance tax also could carry benefits for the more than 9 million enrollees in ACA marketplace plans A one year tax holiday for the health insurer tax should take some pressure off of ACA marketplace plan premium increases for 2017 Larry Levitt a senior vice president at the Kaiser Family Foundation wrote in a tweet Average Silver level premiums the most popular plan type in the ACA marketplaces increased 11 percent to 296 in 2016 according to a Robert Wood Johnson Foundation RWJF and Manatt Health Solutions data set released Dec 16 Similarly the average premium for the lowest cost Silver level plans increased 12 percent to 253 A potential downside of delaying the two insurer taxes is that the move could build a case for permanently overturning them and eliminate major funding sources for the ACA according to some budget hawks Loren Adler research director for the Committee for a Responsible Federal Budget wrote in a blog post that unwinding the ACA s cost controls undermines the case for future expansions to the law such as fixing the family glitch or increasing cost sharing assistance or for any expansions to the social safety net Health insurers took a potential hit through another provision that extended a ban on the federal government s authority to shift funds to pay for the ACA s risk corridors program The Centers for Medicare Medicaid Services gave out 2 5 billion less in 2014 risk corridor payments than ACA marketplace plans had been anticipating because it relied on funding from profitable ACA plans of which there were relatively few Some of the 12 ACA CO OPs that went out of business blamed lower than expected risk corridor funding for contributing to their financial troubles But supporters of the funding limitation that was extended in the pending legislation said the risk corridors program always was supposed to be self funding so any shortfall was due to the poor financial performance of ACA plans overall Provider Provisions The legislation appears not to include an extended delay in the Comprehensive Care for Joint Replacement CJR model which is slated to begin April 1 2016 according to one industry observer Physician legislators had launched an effort to include a CJR delay of a year or more in year end legislation The bill does include increased Medicare payments for Puerto Rico hospitals as well as incentive payments for Puerto Rico hospitals to implement electronic medical records Medicare radiology provisions included reduced payments for non digital X rays starting with 20 percent cuts in 2017 for film X rays and a 7 percent cut for images using computed radiography technology in 2018 Additionally the legislation would reduce from 25 percent to 5 percent the multiple procedure discount in the professional component for imaging services furnished after January 2017 The provision is expected to increase Medicare payments to physicians when multiple imaging services are provided Another provision would direct CMS to explain why insurers can refuse to accept third party payments for health insurance premiums from not for profit organizations CMS has repeatedly rejected hospital efforts to help their patients pay their insurance premiums unless the funds are provided through unconnected foundations Other Healthcare Details The pending legislation also would pause the ACA medical device tax which already has gone into effect The 4 billion delay would apply to 2016 and 2017 The package also would increase FY16 funding for the National Institutes of Health by 2 billion the largest increase for the agency in 12 years Another provision would provide a five year renewal for a program that provides health care and financial compensation to rescue workers who responded

    Original URL path: http://www.hfma.org/Content.aspx?id=44731 (2016-02-10)
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  • Five Steps for Capturing More Revenue For Your Hospital
    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 healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY The Future of Online Patient Billing Portals This white paper written by Apex President Patrick Maurer discusses methods to increase patient adoption of online payments Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections This white paper shows why patient centric approaches to online payment portals are important complements to traditional provider centric approaches HFMA Business Profiles Optum Enabling Transformative Change Elena White vice president of risk quality and network solutions for Optum discusses how healthcare providers can leverage data and technology as they enable risk in their

    Original URL path: http://www.hfma.org/FiveStepstoCapturingMoreRevenue/ (2016-02-10)
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  • Fast Facts for Purchasers: Spinal Implants
    clause for an annual review of pricing given that market standards and pricing can shift Source MD Buyline Please note these numbers have been adjusted to exclude special deals outliers and unique circumstances Publication Date Friday October 31 2014 BACK TO PAGINATION Despite initial concerns that the passing of the Affordable Care would inhibit growth of the spine market the additional 30 million patients receiving coverage along with the aging U S population and rise of obesity have helped the market continue to grow According to Millennium Research Group s most recent report the U S spine market is expected to continue to grow modestly through 2022 reaching nearly 7 1 billion Currently there are over 200 spine product manufacturers although the market is dominated by five main companies One Level Cervical Plate Screw System one plate and four screws Account for 12 of all spine procedures completed in 2013 Low High Average Price 1 482 3 011 2 245 One Level Lumbar Pedicle Screw System two rods four screws set screws or collars caps Account for 33 of all spine procedures in 2013 Low High Average Price 3 874 6 878 5 095 Lumbar T Lumbar Interbody Fusion one cage with four screws or a plate Account for 24 of all spine procedures completed in 201 Low High Average Price 6 045 11 045 8 355 Cervical Interbody Fusion one cage or spacer with three to four screws or a plate Account for 24 of all spine procedures completed in 2013 Low High Average Price 2 764 4 800 3 692 Pricing for spine implants can be negotiated in one of three ways line item pricing category capitated pricing and capitated construct pricing Line item pricing This approach allows purchasers to negotiate spine implants at the line item level An overall discount from the vendor may be the simplest way to review this type of pricing It generally is best to focus these types of negotiations on products that are used most often Category capitated pricing This approach allows purchasers to lump implants into categories e g interbody fusion screws and then to negotiate the lowest price for each category The purchaser should work closely with the vendor to create these categories and the cap pricing for each Construct capitated pricing matrices Hospitals can find this approach very beneficial if implemented and managed properly Prior to entering an agreement with any vendor the purchase should submit the line item details for each of the constructs in order to be able to negotiate to the lowest price available With any pricing matrix it is important to clearly identify all components for each pricing category To prevent lower demand components from being used in higher demand systems the purchaser may want to state that a procedure will be categorized by its lowest priced component For example if a medium demand component is used in a high demand procedure the procedure will be paid at the medium demand price It also is important to stipulate that these prices be all inclusive with no additional fees allowed for delivery freight or loaner arrangements It also is always best for purchasers to seek competing bids from vendors although sole source agreement or market share commitments also can provide savings These agreements can provide access to better deals and lower pricing but they also can limit physicians options When deciding on a commitment agreement the best approach may be to lock in pricing during the term and to include a clause for an annual review of pricing given that market standards and pricing can shift Source MD Buyline Please note these numbers have been adjusted to exclude special deals outliers and unique circumstances Publication Date Friday October 31 2014 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 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    Original URL path: http://www.hfma.org/Content.aspx?id=25935 (2016-02-10)
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