GeBBS Healthcare Blog

Balancing the competitive landscape that comes with physician practice consolidation combined with population health and the shift to value-based care is a lot to consider for busy hospital physician practices.  Add in the constant changes in regulatory guidelines, enhancing the patient experience and most importantly – a continued focus on quality and safety and most hospital administrators have little resources left to focus on improving the revenue cycle.

Lots of questions and headlines began swirling earlier this month after the Centers for Medicare and Medicaid Services (CMS) released its hospital star ratings – a “seemingly” simple system designed to help consumers make informed decisions about hospitals and the care they deliver.  While consumers are used to 5-star ratings for hotels and restaurants, the healthcare industry is clearly far more complex.  As such, a cloud of mystery and skepticism surrounds this incredibly powerful rating system – especially for the thousands of hospitals who participate in Medicare and are therefore automatically subject to stardom whether they like it or not.

After much ballyhoo and for years of promising a major overhaul to the cost-prohibitive Obama-era managed care rules, the CMS has issued a proposed regulation that makes smaller changes – not the drastic “gutting” that had been promised -- to the standards states meet when running their Medicaid plans.

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.

Facing lower reimbursements and shrinking margins, hospitals are exploring ways to capture more revenue. This has led an increasing number of hospitals across the nation to outsource their revenue cycle management to professional outsourcing companies. This trend was identified in a recent Black Book™ survey, which included responses from 1,309 hospital CFOs and business office leaders. The surveyed revealed that 39.8 percent of U.S. hospitals outsourced their complex claims and revenue cycle management to specialized vendors. That is up from 20.4 percent of hospitals in 2013.

By Nitin Thakor, GeBBS President & CEO

Cigna ended its merger agreement with Anthem on Valentine’s Day and said it will seek $13 billion in damages from Anthem on top of the $1.85 billion break-up fee outlined in the deal. The planned $54 billion merger was blocked by a federal district court last week on anti-competitive grounds. Cigna said the reason for the break-up was that the potential alliance cannot and will not achieve regulatory approval and was calling off the deal in the best interest of its shareholders. Industry analysts are projecting that Anthem will not pay the break-up fee without a fight.

A recent article on the Radiology Business Management Association (RBMA) web site discussed consumer’s frustration with the cost of medical care as being at an all-time high as many purchasers of narrow-network, high-deductible and high-co-pay health plans are finding out that the benefits they get from their monthly insurance premiums are much more limited than they thought. One target of their frustration is “surprise” medical bills for services such as radiology, as well as other medical specialty services that a patient may receive from an out-of-network (OON) physician, while either receiving emergency care or a planned treatment at an in-network facility. It is an issue that has been covered by the likes of Consumer Reports and numerous other publications in recent years.  In response, state legislators in nearly two dozen states are either considering or have already passed laws to protect patients from such unexpected/surprise bills.

According to data from the latest quarterly Crowe RCA Benchmarking Analysis: "Patient Financial Responsibility on the Rise,” healthcare providers could be facing a major threat to their revenue cycles. The analysis found that in the past year, insured 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.

By Nitin Thakor, GeBBS President & CEO

A Healthcare Finance News article last year quoted a New Jersey hospital executive as saying: “Big is going to be better; small is not going to survive.” Time will tell if he is right, but most industry analysts agree that the coming year will be full of acquisitions and mergers as hospitals, health systems, information technology companies, software firms, medical practices and other healthcare service providers seek to discover whether or not bigger is indeed better in the new world of the Affordable Care Act (ACA) -- and whatever evolves from its planned repeal and replacement.

Administration of vaccines is an important part of healthcare delivery, and a critical contribution to preventive public healthcare. However, risings costs are making it difficult to align vaccine administration expenses with revenues.

There may be some relief to these rising costs and it comes from something that was once seen as a burden for medical practices. That relief comes in the form of ICD-10 coding.