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Hospital Merger Activity Continues to Increase

Hospital merger and acquisitions continue to increase, including a notable rise in transactions among large healthcare providers, according to an analysis of industry activity by Kaufman, Hall & Associates LLC.  In the first quarter of 2017, hospital and health system transactions increased 8 percent from 25 to 27 compared to the first quarter of last year, according to a news release from the firm.

“The increase follows another year of continued growth, with transactions climbing from 66 announced deals in 2010 to 102 in 2016. The overall trend illustrates that healthcare organizations across the country continue to seek new efficiencies and capabilities for a transforming industry,” it states. “The first quarter was particularly notable for an uptick in transactions among large organizations, with three announced deals targeting organizations with nearly $1 billion or more in revenues. 2016 saw four such deals announced in 12 months.”  Additional transactions among the larger organizations are expected.  

“Hospitals and health system executives are looking for strategic opportunities to ensure the continued growth and success of their organizations amongst disruptive forces, including innovative competitors, declining payments, flat or decreasing inpatient volumes, and increasing price sensitivities among consumers,” said Anu Singh, managing director at Kaufman Hall, in the news release. “As the number of independent hospitals declines, organizations are seeking to build new capabilities and economies of scale through partnerships.”

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National Poll Shows Healthcare Costs Top Financial Concerns


While Americans always seem to have something to be concerned about; a new national poll from Gallup shows that Americans are most concerned today with healthcare costs when considering ALL financial concerns for those living in the United States.  The poll further went on to show that a majority of those living in America believe that the Federal government should also make it possible for all Americans to have healthcare coverage.

Two other polls that were recently published also point out that most citizens of the United States are concerned about healthcare coverage for themselves and their families.  In fact, a growing number of poll respondents now appear to be favoring a single-payer healthcare system.

Gallup points out that some of the anxiety around the topic of healthcare could be due to all of the uncertainty regarding the current healthcare policy and the effort to repeal and replace the law.  In 2010, healthcare concerns spiked as the ACA was being signed into law and many Americans made clear that the costs of healthcare were their top concern.

While healthcare costs were the top anxiety for Americans at 19 percent, other financial concerns cited by those who responded to the poll included high debt at 11 percent, college expenses at 10 percent and lack of money at 10 percent.

One bright spot worth noting is that some financial anxieties have lessened in recent years.  While 10% of respondents say low wages are their families biggest financial problem; this percentage is the lowest number seen since before the financial crisis of 2008 began.



CMS Proposes Rule to Update Medicare Admissions Policies

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would update 2018 Medicare payment and policies when patients are admitted into hospitals.  “The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care,” according to a news release from CMS.

CMS also released a Request for Information (RFI) on ideas for regulatory, policy, practice and procedural changes to guide the discussion on future regulatory decisions for inpatient and long-term hospitals.  CMS is accepting comments on the proposed rule and RFI until June 13, 2017.

“Through this proposed rule we want to reduce burdens for hospitals so they can focus on providing high quality care for patients,” said CMS Administrator Seema Verma in the news release.  “Medicare is better able to support the work of dedicated hospitals and clinicians who provide the care that people need with these more flexible and simplified approaches.”

The news release also states, “CMS is committed to transforming the health care delivery system—and the Medicare program—by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improve outcomes.”  CMS is also proposing a one-year moratorium on “the payment policy threshold for patient admissions in long-term care hospitals while CMS continues to evaluate long-term care hospital policies” and a reduction in reporting requirements for hospitals using electronic health records.

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Americans Worry Over Healthcare Uncertainty

Anxious Woman Worries About Healthcare

As the debate continues on Capitol Hill about the future of healthcare in the United States, the issue is also on the minds of many Americans as well.  Whether Obamacare continues to move forward in one form or another or is replaced by something completely different, a majority of Americans are now concerned about their ability to afford health insurance in the future.

A new study from shows that in the last year, one out of four families have chosen not to make use of medical professionals because they felt they couldn’t afford the expense even though they believed they needed it.  The fact that Americans are choosing not to get medical advice due to the cost is of great concern. also pointed out that 13 percent of those responding to their survey didn’t have any healthcare insurance at all; which is quite a risk when considering that medical bills have the capability of leading to large debt that could take many years to pay off.

The survey showed that a full 56% of Americans say that they are concerned that they might not have the option of affordable healthcare in the years to come.  This anxiety has led some to worry that they might be faced with the painful choice to not care for medical issues of a serious nature due to an inability to pay for their services.  In the meantime, as the healthcare debate continues; American anxiety continues to grow.


News & Notes


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.” 

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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:

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