HealthLeadersMedia.com - Finance News & Analysis

HFMA: Revenue Cycle, Reimbursements Share the Spotlight

Mon, 17 Jun 2013 15:26:00 GMT

Executives attending the Healthcare Financial Management Association's annual ANI conference know that maximizing revenue cycle efficiencies and forming new reimbursement relationships with payers may well be the keys to success in the decades ahead.

HFMA: Patient Financial Interaction Guidelines Sharpened

Mon, 17 Jun 2013 12:18:00 GMT

Stakeholders, including representatives from the Healthcare Financial Management Association and the American Hospital Association, have drafted new best practices for providers to communicate with patients who are becoming increasingly responsible for a greater proportion of their healthcare costs.

CMS Issues Health Insurance Exchange Proposed Rules

Mon, 17 Jun 2013 12:07:00 GMT

Most of the proposal focuses on program integrity for state marketplaces and insurance companies offering coverage in the federally facilitated exchanges. The rule intends to safeguard federal money and consumers.

Healthcare Leaders Seek Strategic Sweet Spot

Mon, 17 Jun 2013 11:57:00 GMT

Hospitals and health systems are getting squeezed at both ends of the revenue spectrum. To survive they must effectively integrate a number of healthcare services and add value. But how?

IRS scandals threaten funding for healthcare law

Mon, 17 Jun 2013 11:18:00 GMT

WASHINGTON -- Mounting scandals at the Internal Revenue Service are jeopardizing critical funding for the agency as it gears up to play a big role in President Barack Obama's health care law. Mr. Obama sought a significant budget increase for the IRS for next year, when the agency will start doling out subsidies to help people buy health insurance on state-based exchanges. Congressional Republicans, however, see management problems at the IRS as an opportunity to limit the agency's funding just as it is trying to put in place the massive new law. Republicans have been fighting the health care law ever since Democrats enacted it in 2010 without a single GOP vote.

Hospital CEO bonuses reward volume and growth

Mon, 17 Jun 2013 11:15:00 GMT

Like hospital leaders everywhere, the people running Valley Medical Center in Renton, Wash., talk frequently about the need to control soaring medical costs. "We are working to reduce the overall cost of health care and to transform health care delivery," Lisa Jensen, chairwoman of the hospital's board of trustees, said last year. Experts believe that's a good prescription for the entire U.S. health industry, which costs the economy far more than systems in other developed countries, delivers mediocre results and is widely seen as unsustainable at its current growth rate.

Choice of health plans to vary sharply from state to state

Mon, 17 Jun 2013 11:12:00 GMT

When a typical 40-year-old uninsured woman in Maine goes to the new state exchange to buy health insurance this fall, she may have just two companies to choose from: the one that already sells most individual policies in the state, and a complete unknown — a nonprofit start-up. Her counterpart in California, however, will have a much wider variety of choices: 13 insurers are likely to offer plans, including the state's largest and best-known carriers. With only a few months remaining before Americans will start buying coverage through the new state insurance exchanges under President Obama's health care law, it is becoming clear that the millions of people purchasing policies in the exchanges will find that their choices vary sharply, depending on where they live.

FBI: Chicago hospital kept patients too sedated to breathe on their own

Mon, 17 Jun 2013 11:08:00 GMT

WASHINGTON – A surgeon at Chicago's Sacred Heart Hospital cut a hole in Earl Nattee's throat on Jan. 3, the day before he died. It's not clear why. The medical file contained no explanation of the need for the procedure, called a tracheotomy, according to a state and federal inspection report that quotes Sacred Heart's chief nursing officer as saying it happened "out of the blue." Tracheotomies are typically used to open an air passage directly to the windpipe for patients who can't breathe otherwise. Now, amid a federal investigation into allegations of unneeded tracheotomies at the hospital, Nattee's daughter, Antoinette Hayes, wonders whether her father was a pawn in what an FBI agent called a scheme to defraud Medicare and Medicaid.

States running out of time on health insurance exchanges

Mon, 17 Jun 2013 11:03:00 GMT

With the deadline for states to implement Affordable Care Act-mandated health insurance exchanges less than four months away, state governments will need to move fast. States are having to reevaluate their existing health insurance infrastructures to meet the act's requirements. They have already received nearly $4 billion in funding for the effort thus far — and can access more dollars through 2014. Some states are still applying for additional federal funding for exchange-related projects. New Mexico, for instance, recently requested $20 million for outreach, education and marketing activities.

MGMA: Physician Compensation Increasingly Based on Quality Measures

Fri, 14 Jun 2013 12:13:00 GMT

Primary care physicians have 3% of their total compensation based on quality measures, but doctors will increasingly be tied to these metrics as reimbursement aligns more closely with quality and cost measures, Medical Group Management Association data suggests.

Healthcare law's employer requirements

Fri, 14 Jun 2013 11:11:00 GMT

WASHINGTON (AP) — Requirements that medium-sized and large employers offer insurance coverage or face fines are one of the most complicated parts of President Barack Obama's health care law. While most of the estimated 160 million Americans with job-based coverage will not see not see major changes when the law takes full effect next year, the so-called employer mandate will be important to millions of workers, particularly in low-wage industries. The Affordable Care Act, as the law is known, actually has two mandates on employers, part of ''shared responsibility'' provisions to ensure that companies keep offering coverage. Think of them as the big stick and the smaller stick.

Healthcare price growth plummets to 1.1 percent

Fri, 14 Jun 2013 11:08:00 GMT

ANN ARBOR — Health care prices rose nationally just 1.1 percent from April 2012 to April 2013, the lowest annual increase since 1997, and a sharp 0.5 percentage point drop from the rate of increase reported in March from a year earlier. The 12-month moving average price increase, at 1.8 percent, is the lowest since 1.7 percent recorded in September 1998. National health expenditures, which reflect both prices and utilization, grew 4.2 percent, remaining in the vicinity of the record low levels seen annually since 2009.

AZ lawmakers pass Medicaid expansion

Fri, 14 Jun 2013 11:00:00 GMT

(Reuters) - A divided Arizona Senate passed a key piece of President Barack Obama's Medicaid expansion agenda on Thursday, handing Republican Governor Jan Brewer a policy victory over fierce opposition from conservatives in her party. By an 18-11 vote, the Senate approved the bill with the backing of a bipartisan coalition of lawmakers that will add hundreds of thousands of the state's poorest residents to the Medicaid healthcare rolls, but was opposed by conservative Republicans. The state House of Representatives approved the same measure by a 33-27 vote early on Thursday after a marathon debate.

EMHS on budget as other ME hospitals struggle financially

Fri, 14 Jun 2013 10:56:00 GMT

BREWER, Maine — About 60 percent of Maine hospitals are operating at a loss, but Eastern Maine Healthcare Systems isn't among them, according to EMHS President and CEO Michelle Hood. Hood, citing 2012 figures compiled by the Maine Hospital Association, laid out the system's financial picture Wednesday at an annual meeting of EMHS corporators, a group of volunteer community members who provide oversight of the health organization. The tough economic climate has contributed to financial struggles at some hospitals in Maine, and many are likely to respond by downsizing, joining bigger systems and looking for new business models, Hood said.

Small US insurers fill gaps for MS health exchanges

Fri, 14 Jun 2013 10:52:00 GMT

(Reuters) - When the state of Mississippi begins offering subsidized health insurance under President Barack Obama's reform law this year, residents will have only one choice - Magnolia Health Plan - a small insurer little known in most of the country. The Obama administration hoped to attract robust competition in creating the exchanges, and it is counting on millions of Americans without coverage to sign up for these plans in the program's first year. But the nation's biggest insurers have decided against joining the exchanges on a large scale, professing uncertainty about the roll-out and how much the uninsured would participate.

Aggressive End-of-Life Care Easing in Hospitals

Thu, 13 Jun 2013 12:19:00 GMT

Dying patients are more likely to receive less intense medical care than in the recent past. The cost of that healthcare, however, provided by hospitals, physicians, and hospice, continues to rise, says a Dartmouth Atlas report.

Doctor pay rises to $221K for primary care

Thu, 13 Jun 2013 11:22:00 GMT

Physician compensation rose only slightly last year as more of doctors' compensation was based on the quality of care they provide and whether their patients are satisfied, a new salary survey indicates. The 2013 Medical Group Management Physician Compensation and Production Survey Report showed physician pay increases were largely flat, rising about 3 percent for primary care doctors – family doctors, internists and pediatricians — to $220,942 in 2012 compared to $212,840. Meanwhile, compensation for specialists rose 3 percent to $396,233 from $384,467 in 2011. Pay ranged from $532,269 for cardiologists to $301,000 for obstetricians, according to MGMA's list of selected specialties.

Obamacare shows hospital savings as patients make gains

Thu, 13 Jun 2013 11:18:00 GMT

Less than five months before the Affordable Care Act fully kicks in, hospitals are improving care and saving millions of dollars with one of the least touted but potentially most effective provisions of the law. While much of the focus on Obamacare has been on the government rush to open insurance exchanges by Oct. 1, 252 hospitals and physician groups across the U.S. have signed up to join the administration's accountable care program, in which they share the financial risk of keeping patients healthy. Under the program, hospitals and physician practices take responsibility for tracking and maintaining the health of elderly and disabled patients.

OIG: Medicare could have saved $910 million on lab tests in 2011

Thu, 13 Jun 2013 11:15:00 GMT

Medicare could have saved $910 million in 2011 by paying the lowest possible rate for certain clinical lab tests, according to a report from the Department of Health and Human Services Office of Inspector General released June 11. The report, Comparing Lab Test Payment Rates: Medicare Could Achieve Substantial Savings (OEI-07-11-00010), said "Medicare could have saved $910 million, or 38 percent, in 2011 if it had paid the same rate as the lowest paying insurer surveyed for each lab test in each geographic location." OIG looked at payment rates for 20 clinical lab tests in 56 geographic regions and compared Medicare's payment rates against those of Medicaid and three fee-for-service Federal Employees Health Benefits (FEHB) plans.

Obamacare: Is a $2,000 deductible 'affordable?'

Thu, 13 Jun 2013 11:11:00 GMT

Until now, much of the debate swirling around Obamacare has focused on the cost of premiums in the state-based health insurance exchanges. But what will enrollees actually get for that monthly charge? States are starting to roll out details about the exchanges, providing a look at just how affordable coverage under the Affordable Care Act will be. Some potential participants may be surprised at the figures: $2,000 deductibles, $45 primary care visit co-pays, and $250 emergency room tabs. Those are just some of the charges enrollees will incur in a silver-level plan in California, which recently unveiled an overview of the benefits and charges associated with its exchange. That's on top of the $321 average monthly premium.