TriBeCa MedSpa in New York City is one of 1,800 medical spas in the United States, hybrid facilities that offer treatments like laser hair removal and liposuction alongside traditional spa fare. In recent years, the business has become a growth industry: from July 2007 to December 2008, the number of medical spas increased 85%, according to the International Spa Association, far outpacing the growth of day, destination, and resort spas. The kinds of procedures performed in medical spas has also increased. but despite the many well-regarded facilities like TriBeCa MedSpa, the rapidly growing industry is coming under increased scrutiny, the New York Times reports.
Providers who believe their RAC denials will be limited to 200 every 45 days (corresponding with the medical record request limits) may be in for a surprise. Those limits apply only to complex audits, but no such limits exist for the number of automatic reviews RACs can perform.
"RACs can do as many [automated reviews] as they want. I think it is in people's heads that they can look at only 200 at any one time, but that's really not true,” says Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc.
In fact, recent changes to the RAC process for handling mass quantities of recoupments from automatic reviews may even make it easier for RACs to increase their auditing capabilities—meaning the potential for even more denials for providers.
In the past few weeks, CMS released three transmittals (R561OTN, R571OTN, and R573OTN) detailing several technical changes to "enhance” the RAC mass adjustment process. Essentially, the changes improve the process for the RACs by automating what used to be much more labor-intensive process of initiating mass adjustments of similar claim and/or service types.
"CMS is going to allow RACs to now upload entire files to the intermediary to make mass adjustments, and this is going to make automated denials much quicker for RACs," Hoy says. "And whenever you go from manual to automated, you're going to have a huge increase in efficiency. The changes mean a hospital could get literally thousands of claims denied in one day."
CMS first came out with a RAC-oriented mass adjustment process in 2007, but the changes should make it easier for the RACs. "Basically they can just run reports now," Hoy explains.
And if the back-end work involved in processing mass quantities of automatic denials decreases for the RACs, does it mean an increase in their ability to further audit healthcare providers?
We may have to wait until April 5, 2010, when the changes take effect, to find out.
PeaceHealth Siuslaw Region, a 21-bed critical access hospital in Florence, OR, focused its mission on community commitment and support. But after reviewing the results of its 2005 community image survey, an alarm sounded for the organization's leadership. The report showed that perceived quality, advancement, access, communication, and physician competence were dropping fast.
So PeaceHealth launched an image-boosting community relations campaign, which won the hospital the small hospital best in show award in this year's HealthLeaders Media Marketing Awards.
"As a rural healthcare system, improving our community image while remaining within our restricted marketing budget loomed as a formidable challenge fraught with visions of defeat," marketers wrote in the award entry narrative. "But with clear goals and defined outcomes, we were able to strategically achieve significant community image enhancement utilizing in-house resources and multiple media channels to reinforce overarching messaging of caregiver competence and compassion."
Marketers focused on telling PeaceHealth's story and their emphasis on connecting with patients. The campaign utilized radio, newspaper, direct mail newsletters, and cable TV. They also stretched the small amount of marketing dollars available by negotiating special deals with local newspapers and by using TV-spot audio files as radio spots.
The 2008 community image survey confirmed the campaign's success: Nearly 80% of indicators showed significant improvement.
"The ROI was well-defined and I liked the fact that they had established metrics based on a previous image survey," one judge wrote of the campaign.
The judges also praised the simple yet effective creative and the focus on community, saying the campaign succeed in educating the community and drawing in patients.
When it comes to social media, healthcare leaders are often concered about the potential loss of control, including over brand image. But they should not be, writes John Haydon on his self-titled blog. For example, potential donors still have complete control over whether or not they choose to donate money to your non-profit and what they say to their friends about your organization, he says.
In this blog posting from "Hospital Impact," Nancy Cawley Jean offers answers to common concerns surrounding hospital communications, from getting sued to violations of corporate behavior standards to potential security breaches. The rise of social media makes people even more nervous, she says, but hospitals should "see the obstacles and work your way through them to be part of this new mode of communication."
Kellogg's, the nation's largest cereal maker, is being criticized by those who object to the swine flu-conscious claim now featured in bold lettering on the front of Cocoa Krispies cereal boxes: "Now helps support your child's IMMUNITY." The city of San Francisco has sent a letter to Kellogg and to the Food and Drug Administration asking Kellogg to prove its claim. "I am concerned the prominent use of the immunity claims to advertise a sugar-laden chocolate cereal like Cocoa Krispies may mislead and deceive parents of young children," said Dennis Herrera, the city attorney.
Numerous proposals in the various reform bills under discussion in Congress are designed to improve healthcare for rural communities. But one issue that seems critical in the eyes of some advocates is that of insurance coverage, whether it is public or private.
It must be affordable, available, and allow choice.
Sure there are issues with comparative effectiveness, medical home models, pay for performance, and preventing infections and acute care readmissions. There’s too much health care fraud, waste and abuse, providers don’t talk with each other about their patients enough, and there is a whole range of other problems.
And there are big time workforce issues—problems occurring in rural as well as urban areas too.
But in rural communities, much of the issue boils down to a problem of inadequate coverage.
That's part of the thrust of a 12-page report released last week by the Rural Policy Research Institute, a joint program of Iowa State University, the University of Missouri, and the University of Nebraska.
Senate and House proposals under discussion as of Oct. 26 (just before H.R. 3962 was introduced) would, when fully implemented, reduce the number of uninsured by 6.2 million in non-metropolitan areas, leaving 1.9 million persons uninsured, it says. That would lead to a coverage rate of 96% in rural areas, largely through tax credits, subsidies, and public program expansions to rural people who seek insurance.
A greater percentage of people in rural areas are uninsured, compared to people living in urban areas, so programs like the proposed health insurance exchanges would go a long way to fill the gap.
I asked one of the report’s authors, Keith Mueller, chairman of Department of Health Services Research and Administration at the University of Nebraska Medical Center, to list three of the most important policy measures required in any health reform package.
He listed four.
1. It should have meaningful health insurance reform, including a guarantee that no one could be turned down for a health insurance policy because of age or a pre-existing condition. Health insurance exchanges are an effective way to accomplish this. And everyone would have to buy an insurance policy.
2. It should make sure that competition in the insurance market is there to keep quality up and premiums affordable. "We need to make sure there are competing plans, or if there are places where the market can’t work because the population is too dispersed, you need to have something else that guarantees that the plans are affordable," Mueller says.
"If there’s only one choice and it’s not affordable, then perhaps open up Medicaid to a different population, or offer a public plan."
For large portions of rural areas today, Mueller says, there is only one health insurance company actively selling health insurance packages.
3. It should guarantee that patients should have access to a healthcare delivery system that is local and offers choice. "A health plan that is based on use of provider networks must contract with local providers," he says.
The latest health reform proposal, H.R. 3962, addresses "standards for network adequacy," but is not specific and leaves the details up to a "Health Choices Commissioner," he says.
4. It remedies the declining health practitioner workforce in rural communities through subsidies, loan forgiveness programs, and incentives to encourage younger providers into rural areas.
The report, funded in part by the Robert Wood Johnson Foundation, says that without health reform policy change, "rates of employer sponsored health insurance coverage in rural areas will continue to decline."
It recommends, "because a greater percentage of rural residents are self-employed, some form of subsidy (e.g., tax credits for individual insurance purchase) should be part of an effective solution."
How will healthcare reform affect marketers? Well, it won't if your organization views marketing as the department that creates ads and writes press releases. But if your hospital or health system leaders understand the value of a strategic marketer—or if you'd like to convince them they should—La Grange, IL-based SPM Marketing and Communications has some advice for you.
The firm's most recent "red paper" explains how to prepare for the "new normal," the product of what is likely to be a slow and protracted economic recovery and the lower reimbursements that will inevitably come about with or without passage of healthcare reform. (Just in case you were wondering, the company's term for white paper comes from their nickname, "the tomato people.")
Healthcare marketers who don't want to see their budgets slashed—or their departments eliminated altogether—must prove their strategic value and shed once and for all the perception that they're just creative types and communicators.
To do so, they must deliver two important messages to senior leaders, SPM says. First, that cutting marketing won't accomplish the dramatic cost-reductions that the new normal will require. Second, that cutting marketing "means crippling the only function whose primary purpose is to build volume, drive revenue, and kindle patient retention."
SPM suggests marketers and senior leaders adapt the advice of Harvard Business School marketing professor John Quelch, offered earlier this year in his blog post, "How Marketers Should Plan For Recovery".
SPM has expanded on Quelch's seven steps to prepare for the new normal, tailoring it to the healthcare field. A sampling:
Don't assume a return to the old normal: With or without healthcare reform, marketers need to dig deeper into consumer's changing attitudes and behaviors.
Assess your target customer's trust in your brand: Messaging that is honest, meaningful, and educational will be more effective than "brag and boast" efforts.
Stay focused on growth: Prioritize marketing efforts that will add to revenue and are tied to measurable results.
Focus on high-potential customers: re-engage patients who have delayed care using seminars and other tactics.
Know your lead indicators: Monitor points of contact such as call center calls and report trends to your leadership team.
Develop scenarios: Good planning and quick reaction will spur revenue growth.
Don't wait: Get ahead of your competitors and craft your recovery strategy now.
If you'd like a copy of the red paper, contact Kate Harken, vice president of client development at SPM, at harken@spmadvertising.com.
Note: You can sign up to receiveHealthLeaders Media Marketing, a free weekly e-newsletter that will guide you through the complex and constantly-changing field of healthcare marketing.
When H1N1 outbreaks were first encountered in April, the Maryland Department of Health was one of the first to notice a trend in flu-like illnesses.
The state had been on a mission to achieve 100% hospital compliance by June 30, 2009, within the state-run Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE). In December 2008, 17 hospitals were on board, and by June 1, all 46 had joined, making Maryland the first state with 100% compliance.
So when alerts began showing up in the spring for outbreaks of flu-like illnesses, some employees at the state department thought the system was broken, says Fran Phillips, deputy secretary for public health at the Maryland Department of Health and Mental Hygiene in Baltimore.
"For a while, we honestly thought we had some kind of data interference or it was some sort of programming error, but then we linked that to some of the other data sources we had and we realized we were seeing people who were at the leading edge of what later came to be positive lab tests of H1N1," Phillips says.
By June, ESSENCE tracked the virus in all 46 hospitals throughout the state and has continued to track the H1N1 virus as flu season hit this fall.
"We're watching now for the first time how this virus is going to behave in a large population in a flu season," Phillips says. "That's why everyone is looking at how the emergency room volume rates relate to the severity of the individuals admitted to the hospital, either in regular medical beds or ICU beds. It's a really important way to determine how moderate or severe this illness will be."
ESSENCE delivers a very simple and very broad set of data to the state department of health because it only sorts cases based on the patient's chief complaint. Data from every hospital is collected every day and batched at midnight, which staff members at the health department receive each morning. Two dedicated epidemiologists comb through the data and look for correlations or irregularities.
There are also algorithms built into the system that initiate alerts if a particular hospital is seeing an increased compliant above the expected level. Yellow or red alerts are issued depending on the number of complaints.
"The idea is this is a way to get a very early indicator during a biological event, an outbreak, or a chemical event, before they get the confirmatory lab data," Phillips says.
One of the primary advantages to the system is the ability to effectively communicate with the public and spread awareness to prevent a surge on hospitals and protect the public from transmitting the disease.
"Right now, what we are seeing is this tremendous increase in emergency room visits in Baltimore city and we know that is because the flu is here," Phillips says. "So we are working with hospitals to advise the public about what does and does not warrant a trip to the emergency room. You don't want to overload that really important part of the healthcare system. On the other hand, people who need to go absolutely need to go. So it's an important message, but to be able to have the data to know when to put the message out is part of what's very helpful for us."
The other phase that Maryland has integrated into the system includes data from more than 200 chain pharmacies in the state to track over-the-counter medicine sales. ESSENCE organizes the sales according to the symptoms each medicine is designed to treat including, fever, diarrhea, headache, and cough.
Maryland's next phase is to incorporate school systems to track absenteeism among students as an indication of possible flu disease outbreaks. Paired with the other data, it could form a concrete prediction of where the infection is spreading.
"It's a little bit more challenging because school health programs don't have the IT savvy and capability that hospitals and pharmacies do, but we are getting there," Phillips says.
If your health insurance company is not paying claims promptly, the state may soon come calling.
Georgia Insurance Commissioner John W. Oxendine this week fined UnitedHealthcare and three sister companies—UnitedHealthcare of Georgia, Inc., American Medical Security Life Insurance Company, and Golden Rule Insurance Company—a combined $750,000 for allegedly not paying thousands of health claims promptly. Oxendine made it clear that he's not done with his investigation and may soon levy more fines against other insurers in the near future.
Oxendine made his decision after UnitedHealth submitted claims data through March 31, 2009, which reportedly showed that the company and its subsidiaries did not pay claims promptly.
UnitedHealth sent a statement to me on Monday that said the fine involved a "small percentage of claims not processed within 15 days." The health insurance giant said the company processes 97% of its claims within 15 days and 99% of claims within 30 days in Georgia.
I find it humorous that states are going after health insurers for the promptness of claims payments when these same states are some of the worst payers in healthcare. State Medicaid programs pay much lower than private health plans and are far from prompt.
For instance, athenahealth's fourth annual PayerView Rankings that were released in May found that state Medicaid programs lagged far behind private insurers and Medicare. In fact, Medicaid had double the number of days in accounts receivable than other insurers and denied more than one in every five claims.
Athenahealth, an Internet-based provider of business services to physician practices, evaluated 172 national, regional, and government payers in 40 states, and provided three trouble spots that often lead to delayed physician payments:
Health insurers' varied policies and procedures for claims submissions and payment that can cause confusion in physician offices.
Real-time claim adjudication that don't help practices integrate the technology into their workflow, but is really a euphemism for additional work for practices, such as needing to rekey information onto the payer's Web site.
Insufficient resources for providers, including inadequate call center staff, which makes it difficult for offices to research and/or follow claims, leading to misinformation and additional phone calls to resolve the issues; outdated and difficult to find provider manuals and other documentation; and incomplete information that doesn't provide enough insight to help offices learn where they may have made mistakes in the process.
Health insurance companies should take athenahealth's comments to heart. Payers need to prepare for more states to come knocking on their doors if they are not paying claims promptly. That means streamlining policies and procedures, creating real-time claim adjudication that removes barriers for physicians' offices, and providing the proper outreach and communication so that physician offices don't need to spend hours on the phone each week with insurers' call centers.
Health insurers are the bad guys in healthcare, whether you like it or not. This means they are easy prey for state officials. Though Medicaid reimbursements are often slow and lacking, health insurers can't use that as an excuse when the state fines or questions their promptness.
They need to instead understand that removing barriers for physicians and working with doctors are more than a way to make physicians happy. It's also a way to avoid becoming the next headline when a state decides to make you an example.
