Mnet Health News delivers the latest news and information articles for the world of healthcare.

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3 Best Practices to Improve Value-Based Care Reimbursement

The transition to a value-based reimbursement system from the more familiar fee-for-service (FFS) model has created an environment where providers are rewarded based on the quality of their service or the level of care delivered to patients. Practices will thus have to evolve in their strategies to be well positioned to bear greater financial risk while at the same time having to pursue improvements in quality. Here are 3 best practices that can help your practice improve reimbursements in a value-based care setting: 

1. Have a Clear Understanding of the Value-Based Reimbursement System

The first step towards a smooth transition to a value-based care payment model is to understand what value means; not just to your practice but to patients and payers. It’s important to understand that in a value-based world, payments are tied to outcomes, effectiveness, and efficiency. The aim is better care for individuals, improving population health management strategies, and reducing healthcare costs. How do you perceive improvement in service delivery? Is your perception of quality care aligned with that of patients and payers? Considerable effort should be made to align the measures of quality you adopt with that of patients and payers. Any form of misalignment should be identified and addressed.  

2. Make Actionable Data Available

A way to increase transparency in service delivery and gain the trust of patients and payers, which is vital to success in value-based care settings, is to make actionable data available on a regular basis. According to a report by the Alliance of Community Health Plans, data is “valuable only if actionable.” Publish data that captures improvements in service delivery by highlighting areas where value has been added and where significant reductions in cost have been achieved. This would build trust in patients and payers because they can easily evaluate the performance of a practice though the data provided.  

3. Educate Your Staff

The education of staff on how to engage with patients should be a top priority.  Operating in a value-based care setting demands that patient’s satisfaction should be pursued as payments are tied to it. According to Dr. Rita Numerof: “The satisfaction of the patient is going to be really important in outcomes. We’re going to have to look at quality outcomes.” Employees at all levels must therefore be adequately trained to understand patient’s needs and be well suited to meet them in the best way possible. 

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News & Notes

News-and-a-Cup-of-Joe

How to Mitigate Risks from Mobile Devices

The use of mobile devices for communication is only growing, and in the healthcare space that means providers and their business partners must have airtight policies and procedures when it comes to processing consumers’ electronic protected health information (ePHI.) Mobile devices should be a part of a company’s risk analysis processes. More information: http://bit.ly/2uJAcjr


Bankruptcy Filings on the Rise

Bankruptcy filings in the healthcare industry more than tripled in 2017, according to Bloomberg.  “Regulatory changes, technological advances and the rise of urgent-care centers have created a ‘perfect storm’ for healthcare companies,” David Neier, a partner in the New York office of law firm Winston & Strawn LLC, told Bloomberg.  Hospitals, including privately-owned facilities in rural areas, may be the most likely to file for bankruptcy after they were subject to reduced payments under The Affordable Care Act in the 2017 fiscal year. https://bloom.bg/2hWyfI0


We Want to Hear from You

Pulse is published for ACA healthcare collection agencies to provide current industry information for healthcare providers. ACA International welcomes article ideas and submissions for consideration in Pulse. Ideas may be submitted to ACA’s Communications Department at comm@acainternational.org.

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4 Top Tips to Lower Your Claims Denial Rate

4 Top Tips to Lower Your Claims Denial Rate

In recent times, the claims denial rate of many practices has risen to unsustainable levels, soaring well above the industry standard of about 3-5%. The implications of high claims denial rates for a practice is far reaching as it hits at the core of revenue cycle performance; negatively affecting cash flow and dragging revenue growth. However, this does not have to be your center’s experience. Your practice can significantly reduce claims denial rates and witness a revitalization in revenue and cash flow growth. Here are 4 tips to help lower your denial rate: 

1. Analyze the Causes of Your Denials

The first step to take in reducing denials is to conduct an analysis of your present denial rate and identify the primary reasons for the denials experienced by your practice. While reasons for denials vary in each circumstance, it’s important that you discover the root causes of denials. You might want to look at your current processes, your staff, or your technology stack to get to the root cause. This is very crucial because adopting strategies of high performing practices might not result in any significant improvement in your denials rate if the root causes of denials are not identified and addressed.  

2. Minimize Coding Errors 

Errors in coding represent one of the greatest cause of claim denials for practices. Previous and newly developed codes must therefore be verified to ensure they are free from errors. To achieve this, a practice might have to employ the services of expert coders and billers if it lacks expertise to handle it in-house. Expert coders and billers will be a great addition to your staff as they will help fix coding and billing errors that cause loss of revenue.

3. Educate Your Staff

Education and training of your staff on effectively managing claims collection and denial processes should be given top priority by your practice. Many claims denials can be avoided if employees are trained on the best practices. Significant training should be given to employees to ensure accuracy of data collected from patients as this forms the foundation of a best-in-class claims management. 

4. Create a Claims Denial Unit 

Creating a unit specifically dedicated to claims denial management will help your practice reduce its denials rate significantly. Operational efficiency is easily achieved when a unit in your practice is saddled with the responsibility of identifying, resolving, and proffering solutions to the causes of claims denials unique to your organization. This team should comprise physicians, coders, billers, software development experts, medical researchers, and members of the top management.

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News & Notes

Consumers’ Medical Debt Ranks Low Over Other Forms of Debt

GoBankingRates’ latest survey on debt in the U.S. shows what most of us already know – consumers have various debts of various sizes, the lowest being medical debt. Sixty-five percent of the 2,500 consumers surveyed have mortgage debt while 21 percent have medical debt. Among the respondents with medical debt, their balances are less than $500. http://bit.ly/2gMeLsy

Family Premiums Under Employer Plans Continue Modest Increase

Yearly family premiums under employer-sponsored health insurance plans increased by $18,764 or an average of 3 percent in 2017, according to the 2017 Employer Health Benefits Survey from the Kaiser Family Foundation and Health Research & Educational Trust. And, employees’ average payment toward family premiums has increased at a faster rate than the employer’s portion since 2012. http://kaiserf.am/2hiVoHP

Cybersecurity Plans are Difficult to Achieve

Complete protection against cybersecurity attacks for hospitals is a challenge, FierceHealthcare reports, based on research from Harvard University, Case Western Reserve University and Brown University in the Annals of Internal Medicine.  Hospitals are developing best practices in the aftermath of several significant cybersecurity attacks, but contingency plans are lagging in the U.S. http://bit.ly/2xLm33l

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CMS: Medicare Premiums Will Decrease in 2018

Medicare coverage for beneficiaries of the program will improve in 2018, according to the Centers for Medicare and Medicaid Services (CMS.) This will result in more choices and options for Medicare coverage in 2018.  “As CMS releases the benefit and premium information for Medicare health and drug plans for the 2018 calendar year, the average monthly premium for a Medicare Advantage plan will decrease while enrollment in Medicare Advantage is projected to reach a new all-time high,” according to a news release.

CMS estimates that the Medicare Advantage average monthly premium will decrease by $1.91 (about 6 percent) in 2018, from an average of $31.91 in 2017 to $30. Seventy-seven percent of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium for 2018, it states.  “More affordable choices lead to greater health security for those who need it most,” Health and Human Services Secretary Tom Price said in the news release. “Both Medicare Advantage and Medicare Part D are providing a higher level of health security for so many of America’s seniors precisely because they are built to be more responsive to their needs.”

Medicare Advantage enrollment is estimated to increase to 20.4 million in 2018, a increase compared to 2017.  Thirty-four percent of consumers enrolled in Medicare are projected to be in a Medicare Advantage plan in 2018, according to the CMS news release.  “The success of Medicare Advantage and the prescription drug program demonstrates what a strong and transparent health market can do—increase quality while lowering costs,” CMS Administrator Seema Verma said.

“When Americans are empowered to choose the plans that fit their needs and the needs of their families, they demand more from their insurance plans and in turn plans, like any business, provide customers better service at a lower cost.  CMS also reports access to the Medicare Advantage program continues to be strong as 99 percent of consumers with Medicare also have access to a Medicare Advantage plan.  

“The number of Medicare Advantage plans available to individuals to choose from across the country is increasing from about 2,700 to more than 3,100–and more than 85 percent of people with Medicare will have access to 10 or more Medicare Advantage plans,” it reports.  “In addition, more Medicare Advantage enrollees are projected to have access to important supplemental benefits such as dental, vision, and hearing benefits.”

More information: http://go.cms.gov/2hurRIj

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Healthcare Mergers & Acquisitions Strong in First Half of 2017

Revenue cycle management and healthcare IT mergers and acquisitions exceeded $14.7 billion in the first half of this year across 66 deals, according to the latest M&A Update from ACA International member company Greenberg Advisors, LLC.  “Transactions were completed in every corner of the market, large and small, and among technology and service companies alike. 

The activity mirrored the blistering pace set in the first half of 2016,” according to the report.  The latest data show that a majority of transactions in revenue cycle management and healthcare IT were under $25 million in enterprise value, but 30 percent of all transactions did exceed $50 million. This is a notable increase from the second half of 2016, when 18 percent of all transactions exceeded $50 million, according to the report.

Twenty-eight companies have made multiple acquisitions in revenue cycle management and healthcare IT since the beginning of 2016, it states.  “It is good to see the level of deal activity and interest in [accounts receivable management] rising again, creating more opportunities for owners and investors,” Brian Greenberg, CEO of Greenberg Advisors LLC, said in a news release. 

“A wide variety of buyers—from inside and outside of the ARM industry, from Europe and elsewhere—tell us that they are interested in making strategic acquisitions.” The findings for the first half of 2017 also show that 48 percent of sellers in accounts receivables management include firms focused on healthcare receivables or financial institutions.  Greenberg will be part of a panel of speakers at ACA International’s 2017 Fall Forum & Expo Nov. 1-3 at the Loews Chicago Hotel.

In “Dissecting the Deal,” scheduled for Nov. 3, Greenberg will join Harry Strausser III, Corporate Vanguard at Eastern Revenue Inc.; Michael Lamm, president/CEO of Corporate Advisory Solutions LLC; Michael Ginsberg, president/CEO of Kauklin Ginsberg Company; and Thomas Edens, president of Marion Financial Corp., will discuss how companies approach potential M&A transactions for buyers and sellers.

More information: http://bit.ly/2wHvKy4 and https://www.acainternational.org/events/fallforum2017

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Uninsured Rate on the Rise for Some Consumer Demographics

The uninsured rate for certain groups of consumers divided by their age, income and access to Medicaid, is on the rise, according to The Commonwealth Fund’s fifth annual survey tracking the Affordable Care Act.  There was a significant increase in the uninsured rate for consumers ages 35 to 49; adults earning more than 400 percent of the federal poverty level ($47,520 for one person and $97,200 for a family of four); and those residing in states that have not expanded Medicaid, according to a news release on the survey.

The Commonwealth Fund’s survey included a nationally representative sample of 4,813 adults ages 19 to 64 living in the U.S.  The uninsured rate for respondents ages 35 to 49 increased from 11 percent in 2016 to 15 percent in 2017, according to the survey.  The uninsured rate for adults with incomes at or above 400 percent of the federal poverty level increased from 2 percent in 2016 to 5 percent in 2017.  Consumers in this income group are responsible for the full insurance premium and are subject to annual premium increases, according to the survey.

Lastly, the uninsured rate for consumers living in states that did not expand Medicaid increased from 16 percent in 2016 to 19 percent in 2017.  However, “despite the uptick in uninsured rates for some groups, the overall rate remained statistically unchanged from 2016 at 14 percent, representing an estimated 27 million working-age adults nationwide,” The Commonwealth Fund reports.  “In the years since the Affordable Care Act was passed, more than 20 million Americans have gained health insurance,” said Sara Collins, vice president for Health Care Coverage and Access at The Commonwealth Fund and the report’s lead author, in the news release.

Expanding Medicaid in all states, making premium subsidies accessible to more consumers, and assisting them with finding coverage on the Affordable Care Act marketplaces could remediate limits on access to coverage for the uninsured, according to the survey.  Other findings in the survey include:

Subsidies help consumers with low incomes afford premiums. While about 64 percent of consumers with incomes below 250 percent of the federal poverty level reported their premiums “were very or somewhat easy to afford,” only 34 percent of consumers with incomes above those levels provided the same response.

Cost was the primary reason consumers did not enroll in a plan.  Seventy-four percent of uninsured adults who shopped the marketplaces and didn’t enroll in a plan or obtain other coverage reported they could not find a plan they could afford.  However, 66 percent of consumers who reported they didn’t enroll in a plan because they couldn’t afford it had incomes that meet the qualifications for premium subsidies or Medicaid.

In 2017, 57 percent of consumers enrolled in plans through the marketplaces are estimated to have coverage with cost-sharing reductions that lower their deductible, copayments and coinsurance.

More information:  http://bit.ly/2wKef0d

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New Report Shows Growth in Healthcare Prices Near All-Time Low

In the past year, from September of 2016 to September of 2017, healthcare prices have risen a scant 1.1%, which is the slowest rate of growth in the past two years according to a new report from Altarum.  That rate of growth is just barely higher than the all-time low of .9% which happened in 2015.  Since that point in time, that number has fluctuated between 1.2% and 2.3%.

The report points out that such a small increase in healthcare prices was likely due to a drop in prescription drug prices recently.  Growth in prescription drug prices has dropped to 1.4% in September from 2.7% in August.  

The report also found that total healthcare spending was 4.3% higher in September in comparison with the same month the previous year.  The expected growth of the healthcare industry for 2017 is forecast at 4.5%.  This rise in healthcare spending is viewed as modest in an industry known for heavy spending.

At the beginning of the century, in the early 2000’s, growth in healthcare spending was normally about 10%; however, the numbers have been declining significantly in recent years.  One reason for such a dip is likely the move from inpatient care previously to an outpatient setting according to analyzation from the creators of the Altarum report.

Publishers of the report point out that the trend in healthcare is moving away from inpatient healthcare and toward the outpatient care model.  Even employment numbers are demonstrating the same trend.  Hospitals have recently slowed their hiring this year in comparison with recent years.  On average, hospitals are likely to add about 5,000 new jobs per month in 2017.  This is about half the hires in the previous two years based on data from the report.

One report analyst pointed out that the slowdown of hiring at hospitals could simply be a return to previous healthcare industry patterns after several years of strong hiring gains resulting from the implementation of the Affordable Care Act (ACA).  Another analyst pointed out that a slowdown in hiring is most likely the best way to control healthcare spending because that is typically where most of the money is spent; payroll for employees.

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News & Notes

Survey: Physicians Call for Reduction in Medicare ‘Regulatory Complexity’

Physician practices face too many regulatory burdens, according to the Medical Group Management Association Regulatory Burden Survey.  Nearly half of respondents said they spend more than $40,000 per FTE physician, per year, to maintain compliance with federal regulations.  http://bit.ly/2vVB6Ji

 

Mandatory Bundled Payment Models on the Chopping Block

The U.S. Department of Health and Human Services has proposed to end mandatory bundled payment programs, which pay multiple providers with a single amount payment for a complete “episode of care,” Fierce Healthcare reports.  Supporters say the bundled payments are a step toward value-based delivery models while critics say mandating their use goes too far.  http://bit.ly/2wX68Bo

 

Healthcare Providers Slow to Embrace Consumerism

Consumer demands are evolving; however, healthcare providers are not keeping up with their expectations, according to results from the Kaufman Hall’s Healthcare Consumerism Index. In fact, “fewer than one in 10 organizations are treating consumer expectations as a high priority by consistently applying and building consumer-centric capabilities,” a report on the results, “2017 State of Consumerism in Healthcare: Slow Progress in Fast Times,” states. http://bit.ly/2iB5CTO

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Apple & Amazon Quietly Begin Move into Healthcare Sector

Until recently, Amazon’s new lab at its headquarters in Seattle was a secret.  It was set up to identify business prospects within the field of healthcare; prospects such as telemedicine and EHR’s.  But Amazon is not the only company seeking to make moves into healthcare.  Rumors that Apple is in talks with healthcare organizations and hospitals to unify health records onto their iPhone have recently been confirmed.

Reportedly, Apple has been in talks with Crossover Health, a company based in Aliso Viejo, California (also home to Mnet Health).  Crossover is a startup that works with employers who are self-insured to provide them with medical services at clinics that are onsite.  This move has stoked the fires of speculation concerning Apple’s move into the healthcare arena.

While negotiations apparently continued for several months, they did not result in a deal ultimately according to one unnamed source.  Others have mentioned attempts to strike a deal with One Medical, a concierge primary care organization based in San Francisco.  Tim Cook, Apple CEO, has publicly expressed an interest in business opportunities represented within healthcare.  An interview in Fortune magazine in September quoted Mr. Cook as saying “There’s much more in the health area.  There’s a lot of stuff I can’t tell you about that [Apple] is working on…I do think it’s a big area for Apple’s future.”

Apple has hired several healthcare experts and consultants in the last few years.  The giant tech company has also collaborated with researchers from Stanford to improve its digital health software while also make the iPhone the right place to go for patient health information.  Two software tools have recently been released by Apple; the Apple HealthKit and ResearchKit, which were designed to share patient health information with developers and also to recruit patients for clinical studies.

Meanwhile, Amazon is currently developing an EHR platform, telemedicine options, and health apps for devices such as the Amazon Echo.  Amazon is said to call its covert team “1492,” which, of course, is the year that Christopher Columbus first sailed to the Americas.  Another interesting tidbit is that positions for this team can be searched using the keyword “a1.492.”  They are also working on healthcare apps for devices such as the Echo and the Dash Wand.

In other apparently related news, President Trump recently announces that the CEO of Apple, Tim Cook, has promised that his company will build three large new manufacturing plants in the United States.

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News & Notes

Second Quarter Health Spending Growth Estimates Decline

Health spending growth estimates for the start of the second quarter 2017, show 4.5 percent growth year-over-year, compared to 5.2 percent for the first quarter and 5.2 percent for 2016, according to the “Altarum Institute Center for Sustainable Health Spending Health Sector Trend Report” released in July 2017.

http://ow.ly/pL0c30eec1Z

 

Consumers Report Favorable Interactions with Healthcare Providers

Consumers surveyed by the Pew Research Center report positive experiences with their healthcare providers, including 87 percent with a doctor visit in the last year who said their “concerns or descriptions of symptoms were carefully listened to.” Twenty-three percent said they “felt rushed by their healthcare provider.” 

http://ow.ly/u2ud30eeeaY

 

Report: U.S. Healthcare System Remains Behind Other Countries

The Commonwealth Fund’s latest research on the U.S. healthcare system shows while there has been “significant progress,” the U.S. still lags behind other countries. For example, 33 percent of U.S. adults in the survey reported they did not take a prescription medicine, visit a doctor when sick or receive recommended treatment in the last year because of the cost; compared to 7 percent in Germany and the United Kingdom and 8 percent in Sweden and the Netherlands.

http://ow.ly/RaMd30eefpU

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Younger Generations More Likely to Avoid Healthcare Due to Cost

The impacts of possible changes, including repealing and replacing the Affordable Care Act, to healthcare legislation and services in the U.S. remain uncertain; but consumers are consistent in their concern about the cost of care, according to results from Bankrate’s recent Money Pulse survey.  Thirty-one percent of Millennials said they avoid medical care because of the cost, according to the survey of 1,002 adults in the U.S. conducted in May.

Twenty-five percent of Generation X, 23 percent of Baby Boomers and 8 percent of the Silent Generation in the survey said cost caused them to avoid medical care, Bankrate.com reports.  “It’s very concerning that people are forgoing medical attention because of the expense,” said Robin Saks Frankel, credit card analyst at Bankrate.com, in a news release. “Thirteen percent of respondents don’t have any health insurance at all—a risk that could cost them. 

Unexpected medical bills can lead to a huge financial burden that could take years to pay off should something go wrong.”  “Older millennials (ages 27-36) are most likely to forgo care due to cost … [and] about one in three Americans in that age group say they’ve chosen not to seek needed medical attention because they couldn’t afford it,” according to Bankrate.com.  

When asked how worried they are about access to affordable health insurance in the future, 35 percent of respondents said they are very worried; 21 percent said they are somewhat worried; 17 percent said they are not too worried; and 24 percent said they are not at all worried.  “That’s about the same level of concern we found when we asked the same question in August 2014, nearly a year after the opening of the health insurance exchanges created under former President Barack Obama’s healthcare overhaul,” Bankrate.com reports.

The survey also shows more than half (56 percent) of all respondents are concerned about health insurance coverage. Sixty-four percent of Generation X respondents said they are concerned about coverage; followed by 58 percent of Baby Boomers; and 56 percent of Millennials, according to Bankrate.com.  “That fear of the unknown is understandable, Tevi Troy, CEO of the American Health Policy Institute, told Bankrate.com. 

“But, he says coverage isn’t likely to change much for the estimated 177 million Americans who get health insurance through work. Employers are likely to continue providing affordable healthcare because it helps with recruitment, retention and employee morale—factors unrelated to any changes in government policy.”

More information:  http://ow.ly/9IEh30cOLsd and http://ow.ly/ixnA30dZvFJ

 

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