"In some cases, we have partnered in certain service lines with the specific objective of improving care and reducing costs. For example, we have recently developed protocols for treating some diagnoses on an outpatient basis, thereby reducing emergency department admissions," he adds.
Tim Nguyen, corporate controller at Palomar Health, a 690-bed system based in San Diego, says the health insurance exchanges being established under the PPACA are a major obstacle for providers because of the uncertainty surrounding how they will operate once they are up and running.
"California is going to have a state-run exchange program. It is going to be a nightmare. We will have to decipher what plan the patient belongs to, which tier they belong to, their deducible, and co-pay. The state has no clue—they are just learning as they go along," Nguyen says.
2.Funding Woes /Lack of Automation
Palomar is trying to meet the HIX challenges with increased revenue cycle automation, which will make it easier to determine if patients are eligible for insurance through the exchanges; get authorizations before procedures are performed to make sure the health plan will consider it medically necessary, and estimate patient deductibles and co-pays, Nguyen says.
However, funding this technology initiative comes with its own set of hurdles, he adds.