Top 10 Hospital Contracting Priorities
8. Better reimbursement for carve outs
Carve outs can include services provided in trauma and neonatal intensive care units, as well as transplant and implant procedures. Edwards says this is important, but ranks as a lower priority because not as many hospital provide these services or uses carve outs. "Now they try to cover these items in their overall rates," he explains.
9. Better Medicare Advantage rates
Aging baby boomers are increasing demand for Medicare Advantage and payers such as Cigna are acquiring MA plans in an effort to grab a significant share of the market. Although reimbursement rates are an ongoing battle, Edwards says this priority is less important to hospitals than it was last year. "Did they rate it low because they just don't think there's anything they can do about the rates?"
10. Bundled payments for medical home, ACO
Making this a lower priority item doesn't mean they aren't doing it explains Edwards. "It means they care about it less and it moves the needle less than the other factors. Other priorities can be done quickly but the return on bundled payments and ACOs could take years."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
- Healthcare Leaders Seek Strategic Sweet Spot
- 3 Reasons Wellness Programs Fail
- CMS Issues Health Insurance Exchange Proposed Rules
- Patients Shoulder Nearly 25% of Medical Bills
- ACOs Widespread, Yet Challenged
- MGMA: Physician Compensation Increasingly Based on Quality Measures
- HFMA: Patient Financial Interaction Guidelines Sharpened
- Data Collaborative Taps Predictive Analytics to Coordinate Care
- HFMA: Revenue Cycle, Reimbursements Share the Spotlight
- Physician Pay Will Soon Depend on Outcomes