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Poll: Healthcare Providers Delay Collections

Forty-three percent of healthcare providers surveyed by the Medical Group Management Association are waiting between 91 and 120 days before sending a patient’s account to a collection agency, Becker’s Hospital Review reports. Thirty-two percent of respondents said they wait more than 120 days.

Report Shows Benefits of Medicaid

According to a report from The Commonwealth Fund, more than 70 million people have Medicaid, and about 12 million enrolled when states expanded eligibility for the program under the Affordable Care Act.  The report “finds that the large majority of people who have Medicaid for the full year are able to get the healthcare they need.”

Healthcare Job Growth Slows

There were 13,500 new healthcare jobs in March 2017, making the first quarter of this year the slowest in job growth since the second quarter of 2014, according to the Altarum Institute and its Health Sector Economic Indicator report. First quarter growth this year, an average of 20,000 new jobs per month, is also “significantly” lower than 2015 and 2016.




How to Respond to Patient Demands in the Changing Healthcare Market

Patient Demands in the Changing Healthcare Market

The U.S. healthcare market continues to change based on patient demand for price transparency, the shift in patient responsibility for medical bills, data security among healthcare providers and more, according to a report from InstaMed, “Trends in Healthcare Payments Sixth Annual Report: 2015.”

The annual report includes data from more than “$165 billion in healthcare payments volume on the InstaMed Network, which connects over two-thirds of the healthcare market. The data represented was processed between 2012 and 2015.”  According to the report, consumers are influencing change in healthcare payments through sensitivity to how much they are spending on medical costs and how they receive information on what they owe.

The market is also influenced by the greater number of consumers with health insurance and how they are accessing it.  Open enrollment through the Affordable Care Act could reach 40 million consumers through the public and private exchanges by 2018, and many of those consumers will have health insurance for the first time, according to the report.  “This influx of consumers to the healthcare market, coupled with new [Affordable Care Act] plan requirements, has changed how payers do business,” it states.

Consumers are interacting more with payers directly instead of a third-party to manage payments. As a result, payers need to evaluate services to collect payments and issue bills to consumers. “Payers have to build the technical and operational infrastructure to receive individual premium payments and ensure accurate posting and reconciliation.  Consumers are faced with the addition of a new, monthly household bill with premium payments.”

Findings from InstaMed’s data analysis show consumer payments to providers included in the InstaMed Network grew 94 percent from 2012 to 2015 and by an average of 25 percent each year.  Patients also want to know their expected healthcare costs more from providers at the time of service.  In 2015, nine out of 10 consumers said it was important to know their expected costs before a visit to their healthcare provider, according to the report.

“The need is for consumers to understand an estimate of what they will actually pay based on their benefit information which can include variables like their deductible, copayments and coinsurance,” it states.  In 2015, the majority of consumers (77 percent) said they were confused by the Explanation of Benefits they receive from their health plan provider, according to the report.

“The confusion continues when the consumer receives a bill from their healthcare provider for their payment responsibility, which is often printed and mailed weeks or months after a visit and does not clearly indicate what is due or how to pay.”  Consumers also report they will switch healthcare providers based on the cost and bill information they have; 47 percent said they “will switch providers for the ability to understand cost upon scheduling and to easily understand and pay a bill using a preferred method,” according to InstaMed’s report.

Additional findings in the report show consumers prefer to pay their household bills through digital formats. “The digital experience offers consumers the freedom of choice to make payments whenever it is convenient for them,” according to the report. “Seventy-five percent of consumers opt to pay their household bills through an online channel, such as a bank bill pay portal, website or mobile app.”

InstaMed concludes in the report that consumers are a critical stakeholder in the healthcare market as their payment responsibility changes and payers and providers should focus on working together to simplify the payment process.  Healthcare providers should leverage best practices from other industries as a model for their patient payment systems. “Make it simple for consumers to understand what a service will cost and then offer multiple payment options including automatic payments. 

By adopting electronic and automated payment channels, payers and providers can set the expectation upfront at the same time enabling faster time to payment. As the industry continues to grow rapidly, paper in the healthcare payments process will be unsustainable to any business model,” InstaMed concludes. “There’s never been more of a need for payers and providers to work collaboratively.” 

More information:



Lyft & Blue Cross Blue Shield Team Up to Provide Patients Free Rides to Doctor Appointments

Free Rides to Doctor Appointments

A strategic alliance between Lyft and Blue Cross Blue Shield (BCBS) has become a reality to help ensure that patients are able to arrive to appointments with their doctors; a service that is free to the patient.  BCBS is made up of 36 independent and locally operated companies with a total of more than 100 million members with the potential for service needs.  Lyft, a ride-sharing company based in San Francisco, is one of the fastest growing ride-sharing companies in the country, currently serving more than 300 cities.

Lyft has created similar alliances with other healthcare organizations in the last few months such as MedStar Mobile Healthcare, Logisticare, Executive Care, National Federation of the Blind and SafeRide Health to name a few.  The president and Chief Medical Officer of the BCBS Institute, Trent Haywood, MD, pointed out that eighty percent of all healthcare outcomes are shaped by “social determinants” including transportation.

Mr. Hayword further pointed out that transportation assistance is available for patients receiving Medicaid, but further stated that access to healthcare due to a lack of reliable transportation has put millions of Americans at risk.  This mindset clearly influenced the decision-making leading up to the partnership between BCBS and Lyft.  “A strategic alliance with Lyft will allow us to positively impact and improve Americans’ health nationwide” said Haywood.  He further stated that BCBS companies “have always been committed to local communities-and solving the most pressing healthcare challenges facing our country.”


Healthcare Cost Affordability Challenges Continue

Healthcare Affordability

Some affordability challenges continue among the population with health insurance as the debate about the future of the Affordable Care Act continues. Data from The Henry J. Kaiser Family Foundation’s recent Health Tracking Poll show that more people with health insurance report dif culty paying for healthcare costs since 2015. For example, when asked how easy or dif cult it is to pay the cost of health insurance each month, 27 percent of poll respondents said it was dif cult in 2015 compared to 37 percent in 2017. Additionally, 29 percent of adults in the poll reported a member of their household had troubles paying medical bills in the past year and had to cut back on other necessities (food, clothing or basic household items) to help.


Healthcare Affordability and Access in the Four Largest U.S. States

Uninsured rates, medical bill problems and healthcare affordability varied in the four largest U.S. states—California, New York, Florida and Texas—in the second half of 2016, according to a report from The Commonwealth Fund. 

The report, based on results from The Commonwealth Fund Biennial Health Insurance Survey conducted from July 12, 2016, to Nov. 20, 2016, was released just before the American Health Care Act was pulled from consideration due to a lack of support in late March.

The report focuses on comparing health insurance coverage, access to care and medical debt among residents of California, New York, Florida and Texas after coverage expansions under the Affordable Care Act. 

“The striking differences among our biggest states demonstrates how much state health policy decisions affect residents,” said Sara Collins, vice president for healthcare coverage and access at The Commonwealth Fund and coauthor of the report, “Insurance Coverage, Access to Care, and Medical Debt Since the ACA: A Look at California, Florida, New York, and Texas,” in a news release.

California and New York expanded Medicaid under the Affordable Care Act and created their own health insurance marketplaces and residents there “were less likely than people in Florida and Texas to have medical bill problems, more likely to be insured, and better able to afford the health care they needed,” according to The Commonwealth Fund. Florida and Texas did not expand Medicaid eligibility and residents in those states use the federal marketplace to enroll in health insurance plans.

Uninsured rates for adults ages 19 to 64 in the four largest states were 7 percent in New York, 10 percent in California, 16 percent in Florida and 25 percent in Texas, according to the report.

“This variation was also apparent in the proportions of residents reporting problems getting needed care because of the cost—significantly lower in California and New York than in Florida and Texas. Lower percentages of Californians and New Yorkers reported having a medical bill problem in the past 12 months or having accrued medical debt compared to Floridians and Texans,” the report states.

The variations between the states may be due to whether they expanded Medicaid eligibility, operated their own health insurance marketplace and the uninsured rate before the Affordable Care Act was in effect, among other factors. 

The Commonwealth Fund found that 41 percent of Florida residents and 44 percent of Texas residents participating in the survey said they had medical bill or debt problems in the past year including that they had trouble or could not pay their bills; were contacted by a collection agency about unpaid bills; had to change their lifestyle to pay the bills; or had medical debt to pay. Twentyeight percent of survey respondents from California and New York said they experienced any of these medical bill or debt problems in the last year.

“This report shows that when states embrace policies that make healthcare and health insurance affordable and accessible, people benefit,” said Commonwealth Fund President David Blumenthal. “As the Affordable Care Act and Medicaid face an uncertain future, states should take whatever steps they can to hold onto the progress they have made under the [Affordable Care Act] and ensure people can get the healthcare they need.”


Ransomware Becomes Healthcare’s Latest Crisis

At this point, more than 200,000 systems have felt the sting of malware known as WannaCry; a ransomware attack that began on Friday May 12th of this year.  This attack has led to doctors being blocked from access to patient files and charts and has even resulted in patients in desperate need of help being sent away from emergency rooms. 

International efforts are now taking place to track down the criminals who are responsible for such an unprecedented global attack.  The United States, Russia and the United Kingdom were among the 150 or more countries that were affected by the virus and investigators are working tirelessly to track down those who are responsible for this latest attack.

In the United Kingdom, authorities are scrambling to upgrade their security software fearing that another attack capitalizing on the same vulnerability could be imminent.  In the meantime, UK’s National Health Service (NHS), the Government of the United Kingdom, and many other governments are faced with answering questions concerning preparedness against further attacks and the viability of systems that are currently set in place.

Meanwhile, cybercrime specialists working for Europol are offering support for countries affected by the virus and have launched their own investigation to try and track down the culprits in this case.  Cyber criminals often believe that they are working completely anonymously, but investigators have assured the public that they have tools to bring these criminals to justice.

 A British cyber-specialist, known as Malware Tech, has been called an “accidental hero” after registering a domain name that stopped the virus from spreading unexpectedly.  The action taken by Malware Tech prevented the spread of the virus to more than 100,000 computers throughout the world. 

In England & Scotland, hospitals were forced to cancel medical procedures after last Friday’s attack brought down dozens of NHS systems.  Medical staff on hand at the time of the attack reported watching as computers went down “one by one,” taking hold of them, locking them down and demanding money to release data.

Recently here in the United States, reports have shown that it can take from several months to several years for a healthcare system to discover and report a breach to the Health and Human Services department.  That same report showed that it took so long to report breaches in patient data because it sometimes took several years to even identify a breach.  Analyzation of the report pointed out that healthcare organizations currently spend only about 10 percent of what other major industries in the U.S. spend on securing their data.  With that in mind, it’s highly likely this story will continue to unfold in the near future.




Healthcare Providers Unprepared for Medicare Quality Payment Program

More than half of healthcare provider surveyed this year say they are “unprepared” or “very unprepared” for administering and executing initiatives required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). According to the fifth annual Health IT Industry Outlook Survey conducted by Stoltenberg Consulting Inc. at the 2017 Health Information and Management Systems Society annual conference, 64 percent of respondents reported they are unprepared or very unprepared for the initiatives.

MACRA was launched on Jan. 1, meaning healthcare providers that bill more than $30,000 to Medicare Part B and care for more than 100 patients a year should start recording their quality data and documenting how they are using technology to support their practice, Collector magazine editor Anne Rosso May reported in the January issue of Pulse.  

“Many felt MACRA would be delayed due to its size and enormous financial impact on physician reimbursement in the transition to value-based care,” said Joncé Smith, vice president of revenue cycle management at Stoltenberg Consulting in a news release on the survey results.  “MACRA’s quality payment program (QPP) now streamlines and increases provider accountability for quality outcomes and cost reduction, but success under the program will take far more than just passive submission of claim data.”

Sixty-eight percent of survey participants reported that “preparation and compliance with MACRA should be a combined effort across clinical, financial and IT departments,” according to the consulting firm.  Thirty-one percent of survey participants said the top challenge with the quality payment program is “revising data management/reporting mechanisms to meet new reporting requirements” followed by “motivating the entire organization to collectively work together to achieve program alignment goals” reported by 29 percent of participants.

“Success with MACRA requires a joint effort of IT and departmental resources to successfully combine clinical, financial and operational data,” Smith said. “This effort commands not only a deep technical knowledge of how and where to extract and transform the right data, but also a solid understanding of how to integrate it in such a way that the resulting data demonstrates that an organization meets objective criteria for its chosen reporting path.”

Visit the Stoltenberg Consulting website to download the report:  

ACA members can read more on the Quality Payment Program in the January issue of Pulse at:


Nearly ¾ of Malware Attacks on Healthcare Industry in 2016 Were Ransomware

Healthcare Industry Malware & Ransomware

A recent Verizon Data Breach Investigations Report pointed out that nearly ¾ or 72 percent of the malware attacks on the healthcare industry came in the form of ransomware in 2016.  But the results might not be too difficult to believe since the healthcare industry currently remains one of the largest targets in the U.S.  Because hackers understand that data is such an integral piece of the healthcare experience, ransomware has become one of their biggest threats.

Attacks using ransomware have doubled and are currently the fifth most common malware in use according to the report by Verizon.  The second most targeted enterprise was the financial sector with 24 percent of all issues in 2016.  The Verizon report considered the more than 2,000 attacks in 2016 and found that the healthcare industry was breached 458 times, with 286 of the breaches including improper data disclosure.

The authors of the Verizon report pointed out that “healthcare has the unenviable task of balancing protection of large amounts of personal and medical data with the need for quick access to practitioners.”  

The ransomware virus first reared its ugly head last year in February with an attack on the Hollywood Presbyterian Medical Center.  This attack caused the center to sound an internal emergency and eventually led to the payment of $17,000 to hackers; just so that they could ultimately regain controls of their own systems.

A report from Symantec also had similar findings showing that ransomware numbers had increased by 36 percent during 2016.  According to this report the number had increased from 340,000 in 2015 to 463,000 in 2016.  While detections of ransomware through antivirus software was still a smaller percent of overall attacks; it’s clear that there was a rise in ransomware detections during 2016.  That same report also pointed out that one in 131 emails received contained a link or an attachment that was malicious; which was the highest rate in five years.

The rise in ransomware during 2016 may have been affected by the release of Ransomware-as-a-Service.  Developers with criminal intent created ransomware kits that are customizable and can be tailored to a specific industry.  These “kits” are provided to hackers free-of-charge by the developers in exchange for a percent of the ransom paid.

“Cybercriminals concentrate on four key drivers of human behavior to encourage individuals to disclose information: eagerness, distraction, curiosity and uncertainty.  As our report shows, it is working with a significant increase in both phishing and pretexting this year” said Bryan Sartin from Verizon.  The fact that bad actors seem to understand human psychology and human behavior appears to imply that the problem won’t be going away soon.


How Price Transparency Shapes Consumers’ Opinions of Healthcare Providers

More and more consumers prefer, when they can, having price estimates for healthcare before receiving a medical service. This is especially the case as health costs and the prevalence of high-deductible health plans, resulting in consumers paying out-of-pocket, increase.

Findings from a recent TransUnion Healthcare survey reflect these trends, showing how price transparency from healthcare providers influences consumers’ opinion of their services.  For example, three in four patients (74.7 percent) reported that having cost estimates in advance would positively impact their opinion of a healthcare provider, according to TransUnion Healthcare.

“The findings also demonstrate that patient interest in up-front costs has risen over the last 18 months,” it reports in a news release. “A similar TransUnion survey in 2015 found that 57 percent of patients would be more willing to return to a healthcare provider if they were given billing estimates at the point of service.”

TransUnion Healthcare’s survey, conducted in November 2016, included 2,058 consumers with health insurance who managed their own healthcare decisions and received medical services in the last 12 months.

The findings also show that 43 percent of respondents reported it was “somewhat or very difficult” to obtain information on costs, while another 21 percent of respondents never attempted to find price information on medical procedures.

“Patients are increasingly evaluating their care experience on whether they received estimates or billing information,” said Gerry McCarthy, president of TransUnion Healthcare. “Hospitals and healthcare providers have an opportunity to improve patient satisfaction and increase transparency by delivering out-of-pocket cost information before a procedure. Patients may be more apt to pay their bill in full, leading to increased point-of-service collections and less payment challenges for healthcare providers. Healthcare providers can also screen patients’ eligibility for charity care, financial aid or payment plans to provide a better patient payment experience.”

TransUnion also asked consumers about their outlook on healthcare if the status of the Affordable Care Act were to change under President Donald Trump’s administration.  “Six in 10 patients said they were fearful that health insurance plans offered through the Affordable Care Act would be disrupted in 2017 or 2018,” according to TransUnion.

“Approximately one in four (27 percent) patients believe the new administration will help to simplify healthcare, while another 43 percent said the new administration will make healthcare more expensive and complex.” McCarthy added, “Regardless of impacts from changes to the Affordable Care Act, healthcare providers need to be diligent about screening patients at or before care, to verify insurance coverage, estimate payment and determine financial assistance eligibility. It’s clear that this process benefits both the patient and the healthcare provider.”

More information:




Top Trends Expected to Influence the Healthcare Industry in 2017

Healthcare leaders are optimistic about trends in the industry this year, such as demand for services, job opportunities and containing costs, according to the results of a survey by B.E. Smith.  The company, which provides executive leadership solutions to healthcare providers, surveyed nearly 1,000 healthcare executives to determine their outlook for the industry this year.

Overall, “two-third of healthcare leaders are optimistic regarding the 2017 outlook for the healthcare industry,” according to the survey, which was conducted after the 2016 election.  “Long-range drivers of demand for healthcare services, such as the aging of the U.S. population, will continue to expand the industry, even in the current era of changing healthcare policy, healthcare executives say. Only a small percentage of those healthcare leaders surveyed said they were not optimistic,” it reports.

Healthcare leaders participating in the survey also said they are optimistic because of “growth and change in the industry and opportunities for organizations and careers. The changing nature of healthcare puts a premium on leadership; the survey examined the significant opportunities related to healthcare leadership due to the vibrancy of the industry.”  Other trends identified in the survey include:

Keeping Costs in Line

Containing costs remains a top focus for healthcare executives.  “While spending growth rates have been declining over the past decade, 2017 may reverse course. One leading forecaster predicts a 6.5 percent rise in 2017,” according to the report.  In January, the Centers for Medicare and Medicaid Services predicted national health expenditure growth will average 5.6 percent each year from 2016 to 2025. 

In 2016, national health spending growth is estimated at 4.8 percent, slower than the rate of 5.8 percent reached in 2015 “as a result of slower Medicaid and prescription drug spending growth,” according to CMS. This year, health spending is predicted to increase by 5.4 percent, influenced by growth in private health insurance spending. According to the B.E. Smith survey, spending growth this year could present challenges for healthcare providers.

Competition and Strength in Leadership

“Agility, innovation and creative leadership” are critical for healthcare managers this year. Part of that leadership model includes focusing on more, not less, competition.  “Facing market challenges from growth in telemedicine and over 2,000 retail clinics, successful hospital leaders will embrace strategies that are proactive competitive catalysts,” according to the report.

Thirty percent of respondents to B.E. Smith’s survey said leadership competencies are their “top concern this year. Respondents also identified vision, strategy and integrity as important leadership characteristics. The survey found that “almost 18 percent [of respondents] believe that ‘evolving leadership roles and competencies’ will have the greatest impact on their organizations’ futures.”

Employee Mobility

“Steady growth fuels an already competitive labor market and could portend a rise of employee mobility,

placing organizations at greater risk of turnover,” according to the report.  Job growth is the fastest in clinical positions within the healthcare industry.  In 2016, job growth was also high in outpatient care centers and home health agencies.

Job satisfaction is a key indicator to monitor turnover. B.E. Smith found that there is opportunity for improvement.  “While 75 percent of respondents registered satisfaction with their current positions—a strong showing though down from last year’s 88 percent—only 30 percent say they are ‘highly satisfied.’”

The survey findings also include that 27 percent of respondents said they are not considering a job change, compared to 43 percent from the year prior.

Finding Top Talent

Executive leaders in the industry say one of their top recruitment challenges is finding “high quality talent. Two-thirds feel that finding quality candidates is the biggest challenge in filling executive vacancies. The strong labor market and improving economy add another hurdle.”

Some executives said they look outside their organization to recruit healthcare leaders.  “Over half of organizations anticipate reliance on internal development to strengthen leadership ranks in 2017, a notable one in five cited two externally-oriented alternatives,” according to the report.  Those respondents said they are considering recruitment outside of their organization and from other industries, including finance and hospitality.

“B.E. Smith believes one explanation is a tighter market for experienced executives coupled with a greater willingness to bet on emerging outside leaders and non-industry veterans in an environment that demands adaptability and innovation.”

The survey also evaluated healthcare industry leaders’ outlook on employee engagement, which is driven by work-life balance and job flexibility and leads to employee retention.  “Many analysts have connected strong engagement with such benefits as better financial performance and higher customer satisfaction,” according to the report.

More information:


Colorado Senate Pushes for Collection Reform in Light of 'Medical Debt Malpractice'

Colorful Colorado

In Colorado, some patients are finding that a trip to the mailbox means a letter from a collection agency concerning a medical bill they believed was paid in full months earlier.  Apparently, this phenomenon is becoming a more regular occurrence based on a new report from the Colorado Public Interest Research Foundation.  According to this report, Colorado is now ranked seventh nationally for the most complaints per-capita concerning mistakes being made in medical billing; in fact, there are 7.2 complaints per 100,000 residents.

These complaints are being filed with the Consumer Financial Protection Bureau (CFPB).  The report is being made public courtesy of the Colorado Public Interest Research Foundation and comes to light as Colorado lawmakers, including Senator Bob Gardner of Colorado Springs, are entertaining a bill that would give the Colorado populace added protections from predatory practices from debt collectors.  The bill, known as Colorado Fair Debt Collection Practices Act, would create a situation that would force some debt collection agencies to improve their efforts at verifying that they are actually talking to the person who actually owes the debt.

The report makes it clear that almost two-thirds of complaints that have been filed to the CFPB pertaining to medical debt are regarding money that either wasn’t ever owed in the first place or was ultimately discharged over the course of a bankruptcy.  Another thing the report mentions is that Colorado consumers have filed numerous complaints of “inappropriate and aggressive” tactics by collectors.  Some of these complaints include threats of contacting family members or patient workplaces or the threat of arrest.  Other collection agencies have even been reported for posing as police or even lawyers.

The Director of the group who published the report, Danny Katz, has made his support of the Senate Bill clear and further gone on to state that medical debt collection has the capability of leading to “lawsuits, dinged credit, and garnished wages” and that the Bill could “make a difference” for those living in the state of Colorado.”  With Colorado being ranked seventh for the most complaints per capita for erroneous and aggressive medical debt collection tactics; that leaves six other states with an even worse problem.  These states are Nevada, Florida, Delaware, Georgia, New Jersey and Maryland.

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