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Uncertain Reimbursement Environment Means Providers Must be Nimble

Rene Letourneau, for HealthLeaders Media, August 19, 2013

In response to the uncertain, yet inevitable, changes that are coming thanks to healthcare reform, Michigan-based CHE Trinity Health has made some modifications to its conventional business model.

As providers brace themselves for the impact of healthcare reform on reimbursements, finance leaders are trying to make sense of new government payment models and the chaos that is surrounding the rollout of Medicaid expansion programs and the health insurance exchanges.

Hospital executives know what they are up against. In the report 2013 HealthLeaders Media Industry Survey: Strategic Imperatives for an Evolving Industry, reduced reimbursements and healthcare reform were cited as threats by 92% and 40% of respondents, respectively.

To keep pace with the unpredictable nature of healthcare reform implementation, organizations need to be "nimble," says Benjamin Carter, executive vice president, finance at Livonia, MI-based CHE Trinity Health, an 82-hospital system that spans 21 states.

"We are seeing ambiguity, slow starts, and delays related to the transition right now, particularly related to health insurance exchange implementation and which states will—and won't—expand. In the meantime, reduced Medicare reimbursements now are the cause of organizational stress," Carter said.

CHE Trinity Health is keeping a watchful eye on the evolving healthcare reform landscape in order to be prepared to make changes to its business plans when necessary.

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1 comments on "Uncertain Reimbursement Environment Means Providers Must be Nimble"


David Morledge (8/19/2013 at 3:54 PM)
The greatest concern I have for all these shared risk models is that in addition to morbidity, there needs to be a cost for mortality. There is very little actual cost to healthcare systems for morality, and in a purely financially driven model, it would often be the best outcome. For instance, if a hospital has a statistically significant worse mortality rate for out-of-hospital cardiac arrest, there needs be a clear fiscal consequence.