GeBBS Healthcare Blog

Finally, we are thinking out of the box..

Posted on Tue, Mar 06, 2018 @ 10:36 AM

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.

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One of the major social determinants in population health management is how to get patients to their care delivery sites. Uber in a big grab for the medical transit market announced the launch of a new digital tool meant to book rides for patients who need assistance getting to and from their appointments. A healthcare provider can book a ride for patients and caregivers immediately, within a few hours, or with 30 days’ notice. The company is positioning itself as a cheaper and more reliable option than most non-emergency medical transportation. Their announcement included over 100 healthcare providers all across the US.

Amazon is also trying to disrupt healthcare. They made big news last month after announcing it would seek ways to address soaring healthcare costs for its own employees. The online shopping titan is focusing its industry-disrupting power on the broader healthcare sector.

The retailer has rolled out a line of private label over-the-counter medicines and is building a business selling a wide array of medical supplies to doctors, dentists and hospitals. Amazon says the efforts are part of its strategy to enhance the shopping experience for businesses and consumers. The company’s efforts in the healthcare field are being closely watched, especially after it announced last month that it is working with Berkshire Hathaway and JPMorgan Chase to better control costs and reduce spending on the health insurance they offer for the 840,000 people who work for them.

Some industry watchers also speculate that the firm may try its hand at selling prescription drugs in the near future, though they warn this would be a big lift since the drug industry is so highly regulated.

Apple has also joined the fray by launching medical clinics to deliver the “world's best healthcare experience” to its employees. The company is launching a group of health clinics called AC Wellness for its employees and their families this spring, according to healthcare industry sources familiar with the company's plans.

The company quietly published a website, acwellness.com, with more details about its initiative and a careers page listing jobs including primary care doctor, exercise coach and care navigator, as well as a phlebotomist to administer lab tests on-site. Apple’s new primary care group — a group of clinical staff that is run independently from Apple but is dedicated to Apple employees — will initially only serve Apple's employees in Santa Clara County, where its headquarters are located. Initially, it has two clinics in the county.

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The Importance of Capturing Charges and Posting Payments Correctly and Efficiently

Posted on Thu, Feb 15, 2018 @ 07:20 AM

With patient volumes on the rise, these increased number of transactions, in the face of limited resources, mean backlogs, data entry errors, and increased days in A/R. Now is the time to get expert help for your overworked staff.

GeBBS offers comprehensive extended business office (data entry) solutions that take the worry out of the process by improving your efficiency and collections while reducing costs. With improved first-pass rate, a 97% accuracy level, and guaranteed turnaround times, you can focus on growing your business and keeping your patients healthy. This is accomplished with a combination of advanced technology resources along with qualified and knowledgeable billing professionals.

Patient collections are on the rise with many newly insured participants in Affordable Care coverage. High-deductible plans are putting added pressure on revenue cycle operations and the drive to collect patient payments. Having access to a large pool of qualified resources to process payments timely, correctly and provide full-service bank-to-book reconciliation, which are critical to your operations.

GeBBS has experience in working with all the leading EHR systems, including but not limited to Cerner, Epic, McKesson, NextGen, Allscripts, MEDITECH GE Healthcare, eClinicalWorks, and athenahealth.

Our expert data capture services are driven by iP2P (Intelligent Paper to Payment), our proprietary workflow application engine. This solution automates the receipt, processing and posting of all RCM paper documents including charges, demographics, insurance payments, patient payments and correspondence. The iP2P® comprehensive Business Process Management tool can handle all your charge entry and payment posting outsourcing.

The iP2P workflow engine streamlines the outsourcing process by automating the receipt and processing of all paper documents. The client portal provides real-time visibility into production, exception management, and auditing. The index module gives you access to all charges and explanation of benefits (EOBs) from the web portal.

The iP2P Client Portal provides full visibility into real-time production status, exception management and auditing, along with an image repository for easy retrieval and viewing of the scanned documents.

When charge capture and payment posting are done well, the benefits to your practice are obvious —improved cash flow is probably the most important. You can also expect better overall collections when billing problems are spotted early and addressed promptly, secondary payers are billed accurately, and patients receive prompt and accurate statements. Efficient charge capture and payment posting are a win-win for your practice.

Efforts Applauded, But Uphill Battle Unlikely to Produce Results

Posted on Mon, Jan 22, 2018 @ 09:30 AM

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.

Modern Healthcare magazine reported last week that Intermountain Healthcare, Ascension, SSM Health and Trinity Health are working with the U.S. Department of Veterans Affairs to pool their capital and 450 total hospitals to fight back against drug companies that unexpectedly hike the prices of decades-old off-patent generic drugs with minimal competition. They also look to create a more reliable supply of generic drugs like saline and sodium bicarbonate that are vulnerable to shortages.

While the health systems didn't specify what drugs their new venture will make, they want to provide both sterile injectables and oral medication either through their own FDA-approved manufacturing facility or by contracting with existing manufacturers. Most hospitals have some compounding pharmacy capacity, but the initiative will not use hospital compounding facilities to produce products, Harrison said.

Industry experts have commented that while they applaud the effort and think it might be a step in the right direction, this endeavor is going to be a labor-intensive and costly to set up manufacturing efforts.

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Players across the health industry have discussed how to cope with dramatic price hikes of widely used drugs coupled with enduring drug shortages, but solutions have been harder to come by. Retail prescription drug expenses accounted for about 12% of total U.S. healthcare spending in 2015, up from about 7% through the 1990s, according to a recent report from the U.S. Government Accountability Office. Branded drugs with no generic alternatives, or single-source drugs, are the main culprit. A study from Blue Cross and Blue Shield Association found that patent-protected drugs make up 63% of total drug spending. This new endeavor cannot combat 63 % of total drug spending.

But even off-patent drugs are part of the drug price dilemma. Valeant Pharmaceuticals, for example, acquired the rights to the off-patent heart drugs nitroprusside and isoproterenol and increased their respective prices 30-fold and 70-fold over a three-year span. The Cleveland Clinic found that utilization across 47 hospitals it studied decreased utilization by 53% and 35% for nitroprusside and isoproterenol respectively, which took a toll on patient safety and outcomes.

The health systems are making a valiant effort, but it is very unlikely that their work will significantly affect the cost of drugs or any drug shortages.

Medicare Advantage Growth Could Spell Problems for Providers

Posted on Thu, Jan 18, 2018 @ 07:41 AM

Medicare Advantage (MA) business continues to experience significant growth, increasing demand for MA plans. Despite the uncertainty surrounding health care and proposed budget cuts to the program, Medicare Advantage enrollment continues to climb and this trend is expected to continue throughout 2017 and beyond. As of February 1, 2017, total Medicare Advantage membership stood at 19,593,341, with a net gain of 1,389,665 members, year-over-year.

According to data from the Centers for Medicare and Medicaid Services (CMS), 34% of the 58 million people eligible for Medicare are enrolled in MA plans across the United States and U.S. territories. The top ten carriers covered over 68% of all Medicare Advantage enrollees as of February 1, 2017. UnitedHealth Group and Humana lead the segment with more than 4.6 and 3.3 million MA members, respectively. Aetna and Kaiser Family Foundation also command significant market share with each enrolling over 1.4 million.

This continued MA growth has the potential to exacerbate the problem of how to manage members within these high-deductible health plans. Research has found that offerings in high-deductible health plans (HDHPs) and related products are projected to grow by 11 percent per year. HDHPs have several pros and cons. They offer flexible spending options for healthier beneficiaries with a low-premium, high deductible financing design. However, HDHPs can be problematic for older and sicker beneficiaries.

These high-deductible plans are forcing healthcare providers to adopt new and unique revenue cycle management strategies. This trend of increasing high-deductible plans is expected to grow over the next several years. As a result, both patient liability and bad debt are on the rise and healthcare providers are experiencing unprecedented revenue and margin pressures. Hospitals and clinics have become like retail organizations, which need to provide their consumers with access to payment capabilities at point of service, via the web, through payment plans, and more. The answer for healthcare providers is to take advantage of professional outsourcing companies who have expertise in patient access management solutions that can improve patient satisfaction, while lowering their collection costs and increasing revenue. These necessary outsourcing services include:

  • Scheduling, Eligibility Verification, and Pre-Authorization
  • Patient Call Center
  • Self-pay Collections

Self-pay collection is the most critical of these services. A recent McKinsey study found that 74 percent of insured consumers indicated that they are both able and willing to pay their out-of-pocket medical expenses. An experienced outsourced self-pay collections team leverages analytics to arrive at the best time to contact patients and their propensity to pay scores to create outbound campaigns that are patient experience-oriented, non-obtrusive, and drive higher patient connect ratios.

Don’t let high-deductible, self-pay insurance amounts wreck your revenue cycle. Work with an experienced outsourcing team that will provide your patients with flexible payment options and easy access to payment capabilities for web, phone, credit card, and e-check payments.

Improve Your Revenue Cycle Management

Posted on Tue, Jan 09, 2018 @ 05:00 AM

The new value-based care reimbursement environment is changing healthcare revenue cycle management (RCM) and forcing healthcare providers to adopt new and unique RCM strategies. New value-based care models, whatever The Affordable Care Act (ACA) ends up being, and the transition to ICD-10 have added complex challenges to an already burdened reimbursement system. Patient volumes are rising and the newly insured’s high-deductible plans are putting added pressure on revenue cycle managers to bill and collect for the monies they are owed.

To overcome these challenges, a deep understanding of the revenue cycle is required, in conjunction with solutions that cut through RCM complexity and are tailored to individual provider’s revenue cycle management needs. RCM solutions should work with a provider’s legacy systems to build efficient workflow processes that provide higher output through the use of a hybrid model of in-house staff knowledge, outsourced expertise, automated technology and manual solutions.

“Right Sourcing” includes a combination of outsourced expertise and in-house knowledge. “Right sourcing” allows healthcare providers to take advantage of outsourced industry expertise, while leveraging their in-house staff’s knowledge base. These outsourced experts will be well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. By leveraging their in-house staff and skilled outsourced people, in conjunction with the appropriate technologies, providers can reduce operating and capital costs, recover revenue, improve patient satisfaction, and increase productivity.

What is needed to survive and thrive in this new reimbursement environment is a suite of end-to-end, comprehensive revenue cycle management solutions, including:

Extended Business Office -- Using a combination of advanced technology resources, along with qualified and knowledgeable outsourced billing professionals, this type of solution can improve first-pass rates, and provide an accuracy level of up to 97 percent with significantly improved turnaround times.

Charge Capture and Payment Posting – This solution can automate the receipt, processing and posting of all RCM paper documents, including charges, demographics, insurance payments, patient payments and correspondence.

Claims Management -- Understanding the components of how the different aspects of claims management affect reimbursement are critical to ensuring that claims are paid promptly.

Denial Management -- Experienced analysts adept at trending denials and looking for patterns of deficiency will increase cash flow and reduce aging A/R. Most healthcare organizations do not have enough of this expertise on staff.

Accounts Receivable (A/R) Management -- It is critical to any provider’s success to have access to qualified resources that understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover and close out A/R.

Credit Balance Resolution – This aspect of RCM carries with it real and serious financial and compliance risks. It is a provider’s fiduciary responsibility to manage these real risks. Industry data shows that over 55 percent of credit balances are a result of incorrect posting of allowances.

Health Information Technology (IT) -- IT automation tools can increase providers’ visibility into their data, automate their processes, streamline workflow, and provide business intelligence to enhance the decision-making process.

This kind of RCM will not only help healthcare provider’s survive in today’s reimbursement environment, but will also help them cope with the new value-based care delivery world.

It Didn’t Take Long!

Posted on Tue, Dec 12, 2017 @ 11:52 AM

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.

The $69 billion merger between CVS Health and Aetna, announced by CVS on Sunday, has spurred industry analysts to talk about a possible deal between Walmart and Humana, as the retailer feels the increased competition from an integrated pharmacy business and is currently in an arms race against on-line giant Amazon who is reportedly poised to enter the pharmacy business.

Humana has not responded to the merger rumors.

So far, the American Hospital Association has offered no comment on what an Aetna-CVS deal, and its analytically-boosted pharmacy health hubs, would mean as competition to providers, but their totally integrated business would be a juggernaut with which other pharmacy and health plans will have to compete.

The Healthcare Finance article reported that Moody's Investors Service was bullish about the Aetna-CVS deal, saying its diversified revenue stream, unsurpassed scale and reach in the industry had the potential to reshape the entire health plan market.

The merger does have the potential to reduce the cost of healthcare, due to Aetna's membership data, technology and strong Medicare Advantage growth, combined with CVS's pharmacy operations, including minute clinics and prescription drug programs. However, it remains to be seen whether or not the savings from these mergers will be passed on to consumers or go straight to the bottom lines of the merged giants.

Another thing to consider is what will be the long-term effect on the healthcare industry when almost all of the pharmaceuticals and health plans are controlled by three or four seamlessly integrated giant companies. Will they pass their benefits and cost savings on to consumers or will they exploit their nearly monopolistic advantages for company gains?

“Blurring the Lines” – UnitedHealth Group Buys Davita Medical Group

Posted on Thu, Dec 07, 2017 @ 11:50 AM

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.

DaVita Medical Group serves approximately 1.7 million patients per year through nearly 300 medical clinics featuring primary and specialist care. The Group also operates 35 urgent-care centers and six outpatient surgery centers. UnitedHealth Group provides healthcare insurance

coverage and benefits services, while their Optum subsidiary provides information and technology-enabled health services to 115 million consumers in 35 states.

The agreement, entered into on December 5, 2017, calls for Optum to acquire DaVita Medical Group for approximately $4.9 billion in cash. The transaction is expected to close in 2018. According to their press relea
se, DaVita Medical Group will become part of Optum’s OptumCare division, which works with more than 80 health plans to serve consumers through 30,000 affiliated physicians and hundreds of care facilities.

Here is another example of “blurring the lines” with close integration of healthcare services: insurance provider, healthcare medical services provider, and information and technology-enabled practice management services. This acquisition and vertical integration will certainly strengthen the combined companies’ position in the marketplace, but will any cost saving benefits derived from this vertical integration be passed on to the consumers/patients of these combined companies? Let’s hope that happens.

Join the Fight to Prevent Cuts to 340B Hospitals

Posted on Tue, Nov 21, 2017 @ 11:49 AM

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.

Mr. Wood’s Message:

The 340B program enables hospitals that serve many low-income and uninsured patients to buy prescription drugs from drug manufacturers at discounted costs and use the savings to provide a range of comprehensive health services to their local communities.

This program has played an important role in helping hospitals stretch already scarce federal resources to expand access to care, enhance community outreach programs and offer unique health services like free vaccines, clinical pharmacy benefits and smoking cessation classes.

However, without further action, the Centers for Medicare & Medicaid Services will cut Medicare payments to many of the hospitals that participate in 340B by nearly 30%—even though the program does not cost the federal government a dime.

Cuts that severe would dramatically threaten access to care for many patients in communities across the country, including our most vulnerable patients. That's why the AHA has filed a lawsuit to prevent these cuts, and reengaged with Congress to enlist its help protecting this important resource for our patients and communities.

Right now, it's important that we work together to assure that both the Court and Congress understand that the savings generated through the 340B discount program make a big difference for our communities and help our friends, neighbors and family so they can have access to the level of care they deserve. Please join our efforts now by urging your representative in Congress to cosponsor H.R. 4392, a bill to prevent these significant cuts from taking effect.

Gene Woods, AHA Chairman

Uncertainty Over the ACA Repeal Has Many States Scrambling for Health Insurance Coverage

Posted on Fri, Sep 08, 2017 @ 11:46 AM

The California state exchange, Covered California, is pumping millions of additional dollars into its marketing budget to promote ACA enrollment, and it's giving the federal government an extra month to commit to paying next year's cost-sharing reduction subsidies before it allows insurers to hike 2018 rates.

To keep insurers from exiting the exchanges, Covered California also said it will allow those plans that incur unexpected losses due to federal policies and uncertainty, such as that around the enforcement of the individual mandate, to recoup those losses over the next three years. The ACA gives state regulators the power to limit insurers' profits.

The steps taken by Covered California are just one example of how state-based exchanges could mitigate the problems caused by the uncertain policy environment. Several other states, including Delaware, have announced that next year they will not participate in the exchanges. The insurers blame financial losses and mounting uncertainty over federal funding and rules that govern the exchanges.

Blue Cross and Blue Shield of Kansas City says it plans to withdraw from Obamacare next year, citing big losses and uncertainty. The move would leave nearly 19,000 residents in Western Missouri without a coverage option unless another carrier steps in. It said that it's lost more than $100 million on ACA plans in the three years since the exchanges opened.

Anthem said it won't participate in Ohio's ACA exchange next year, citing growing uncertainty over the law's future. The move will leave about 10,500 Ohio residents in at least 18 counties without an insurance option on the exchange unless another carrier steps in.

As one can see the ACA is in turmoil, but even where the ACA exchanges are functioning, healthcare providers must deal with huge out-of-pocket ACA deductibles, which are straining revenue cycles across the country. Patient financial responsibility has grown from 23.3 percent to 26.9 percent for outpatients and 10.2 percent to 12.1 percent for inpatients.

In 2017, the out-of-pocket maximum for ACA can range from $7,150 for an individual plan to $14,300 for a family plan before marketplace subsidies kick in. Healthcare providers are struggling with collection rates as they try to adapt to increasing patient responsibility amounts for insured self-pay co-pays and deductibles.

Compounded with the “shaky” status of the ACA, this high deductible trend is expected to grow over the next few years. As a result, both patient liability and bad debt are on the rise and healthcare providers are experiencing unprecedented revenue and margin pressure. Hospitals and clinics have become like retail organizations, which need to provide their consumers with access to payment capabilities at point of service, via the web, through payment plans, and more.

Payers need to continue to monitor their risk score, health of their members and utilization in order to succeed in the ACA market place.

A professional outsourced, self-pay collections team leverages analytics to arrive at the best time to contact patients and their propensity to pay scores to create outbound campaigns that are patient experience-oriented, non-obtrusive, and drive higher patient connect ratios.

Don’t let the uncertainty of ACA or high self-pay insurance amounts wreck your revenue cycle. Work with an experienced outsourcing team that will provide your patients with flexible payment options and easy access to payment capabilities for web, phone, credit card, and e-check payments.

Staying in Touch Is What’s Behind Kaiser's $1 billion Quarterly Operating Gain

Posted on Tue, Aug 15, 2017 @ 11:43 AM

There was a time when healthcare providers knew their patients and their patients’ healthcare needs. A patient stayed in touch with his or her doctor on a regular basis and the doctor could make care assessments and ongoing recommendations for patients over time.

Kaiser, the nation's largest integrated health system with annual revenue of about $71 billion, has revived that type of care regimen and it is paying off for them and their patients. The health system earned $1 billion of operating income in a quarter—an eye-popping number for any healthcare system let alone a not-for-profit -- because it knows its patients and has regular contact with its 11.7 million health plan enrolls.

Kaiser stresses continuity of membership. It has one of the highest rates of membership retention in the industry. That retention rate falls across all lines of business, including commercial and Medicare managed care, and it allows Kaiser to promote preventative care and head-off avoidable health problems that can cause medical costs to skyrocket.

Said another way – they stay in touch and they know their patients!

Even though 95% of its 11.7 million members are covered on a capitated basis, by staying aware of their patients’ healthcare needs they can still make money as a for-profit healthcare system. Kaiser executives commented that frequent contact with enrollees, many of whom have been with Kaiser for years, allows Kaiser to keep costs in check. For example, Kaiser can track enrollees with chronic conditions to assure they are getting their prescribed check-ups and adhering to medication schedules.

Kaiser knows how enrollees are progressing health-wise because the company constantly hears from them. The company's 11.7 million members had 100 million medical encounters with Kaiser’s clinicians last year, 52% of which were virtual either by email, secure communication portal or telemedicine, their CEO told a Nashville audience last April.

Rather than seeing those medical encounters as costly, Kaiser views them as crucial to keeping enrollees healthy. The proof is in Kaiser's medical cost trends vs. the competition. In each of the past three years, Kaiser's expenses have increased under 2% a year, lower than general inflation and less than half that of overall medical inflation.

Old fashion healthcare and the practice of medicine still works – know your patients and know their medical needs! It’s good for the bottom line and it’s good for patients.