GeBBS Healthcare Blog

Cost containment has become a leading factor in the delivery of healthcare. What are some of the issues that are contributing to these burgeoning costs? One of them is Medicaid. We spent over $576 billion on Medicaid programs in 2017, as reported by the Kaiser Family Foundation.

The RevCycle Intelligence e-newsletter reported recently that 80 percent of hospitals are vetting full revenue cycle management (RCM) outsourcing. The demand to outsource full RCM is up 86 percent from 2015 among hospitals and inpatient organizations. Approximately 80 percent of hospital leaders in a new Black Book survey of 709 C-suite executives, board members, and senior managers at hospitals and other inpatient organizations said they were vetting or considering outsourcing full RCM by 2019.

Here we go again! In my last blog I mentioned how companies like Amazon, Google, Apple, Uber, etc. will be driving innovations in healthcare delivery and costs over the next 10 years. Today, the Wall Street Journal (WSJ) reported that retail giant Walmart is in preliminary talks with health insurer Humana about developing a closer partnership, with one possibility being that Walmart might acquire Humana.

Companies like Amazon, Google, Apple, Uber, etc. will be driving innovations in healthcare delivery and costs over the next 10 years. This will have a significant, positive effect on the industry and it will be good for consumers/patients.

Four not-for-profit health systems recently unveiled plans to create their own generic drug company. Industry experts say they'll face an uphill battle to make a significant dent in one of the fastest-growing industry expenses and persistent problems: rising drug prices and drug shortages.

Right on the heels of the Aetna-CVS merger story, Healthcare Finance News reported earlier this week that Humana is eyeing a deal with Walmart.

In another example of the blurring boundaries in the healthcare industry, UnitedHealth Group, one of the nation’s largest insurers, is buying Davita Medical Group, a large physician group with a roster of 30,000 doctors. It seems that every day we are reading about more healthcare companies seeking to tighten their vertical integration by “blurring service lines” in the healthcare marketplace. Aetna/CVS, Humana/Walmart (rumored) and now UnitedHealthcare Group through their Optum subsidiary is buying DaVita Medical Group.

Following is a plea from AHA Chairman Gene Woods, and I would urge everyone in the healthcare industry to respond to his plea by contacting their congressional representatives. Our hospitals are already hurting from lower inpatient volumes and the movement to value-based care. This unnecessary cut will hurt them even further. As Mr. Woods points out, the 304B program does not cost the federal government a dime, and this is not the time to “pile on” further cuts to our already cash-strapped hospitals.

Although employee negligence and lost/stolen devices continue to be major causes of data breaches, criminal attacks are now the leading cause of breaches in healthcare.

What are these cyber criminals doing to get access to the data, and what is causing the breaches in our healthcare organizations? Ponemon’s report says that 88 percent of these breaches came from phishing to get a foothold into a network. The attackers try to compromise employees who have elevated privileges that will give them access to sensitive systems and critical data.

Stronger technical controls like encryption and bio-access security devices will prevent damages from most of these attacks. These criminal are not looking for gall bladder surgery data; they are looking for financial information they can use to rob unsuspecting patients.

In today’s healthcare environment of shrinking reimbursements, due to governmental mandates and Medicare policy changes, the importance of maintaining a healthy revenue cycle is second only to providing the best patient care possible. Without an adequate margin there can be no medical mission.