Combined, "bundled" payments are getting close attention during the healthcare debate as a way to encourage hospitals and doctors to work together to hold down costs and improve care. Bundling payments moves medical charges away from the traditional fee-for-service system that pays providers separately for individual services. Critics of the current healthcare system say the arrangement leads to doctors and hospitals delivering more care, but not better care.
Baylor Health Care System is asking for incentives from Terrell, TX, to build a 100-bed hospital in the city. The project is planned to expand to as many as 400 beds. When complete, it would be the largest regional hospital serving Kaufman County, TX.
The $467 million, 14-story Smilow Cancer Hospital is set to open October 26 in New Haven, CT. The facility is the culmination of a multiyear expansion effort at Yale-New Haven Hospital and part of a larger campaign to raise the hospital's profile in the treatment of cancer. The hospital is in the midst of a recruitment drive that could lead to more than 60 additional physicians specializing in cancer, officials said.
Los Angeles County-USC Medical Center has become too overcrowded to handle the expected surge of H1N1 flu patients in coming months, county leaders said as they forced hospital officials to reduce wait times by transferring patients more quickly. The crowd waiting for emergency room beds at County-USC often swells to 100 with some waiting up to 24 hours, Supervisor Gloria Molina said. Recent county reports show that 30% to 40% of the time the hospital is operating at "severely" and "dangerously" overcrowded levels.
Rhode Island health officials are tracking the spread of swine flu through electronic prescription records, developing what they believe is a model that could help doctors more easily identify an outbreak of the illness. Rhode Island is believed to be the first state to use electronic pharmacy prescription data to track swine flu among its entire population, said Rob Cronin, a spokesman for Surescripts, which operates the country's largest electronic prescriptions network. Company representatives say it the state is also believed to be the first to have all of its pharmacies set up to receive electronic prescriptions from doctors.
Massachusetts' healthcare and life sciences companies have been counter-cyclical players through the economic downturn, getting bigger and hiring more people while other businesses were forced to cut back. But now that the Massachusetts economy appears poised for recovery, there are signs the steady growth enjoyed by healthcare, biotechnology, and related industries may be coming to an end. Cost containment efforts by federal and state governments, and at private insurance companies, are putting fresh pressure on the same state providers that went through a growth spurt two years ago when Massachusetts passed a law improving residents’ access to healthcare, the Boston Globe reports.
General Motors will offer only high-deductible health insurance to its salaried workers starting next year, the latest sign of the way employers are looking to shift some of the burden of rising health costs to workers, according to the Wall Street Journal Health Blog. One recent survey found that nearly two-thirds of employers plan to shift more of the cost of care to workers and their families through higher premium contributions, deductibles, and copayments.
Earlier in October, the government was forced to announce that only about 28 million doses of swine flu vaccination would be available by the end of the month, about 30% below the 40 million it had previously predicted. Since the outbreak of the H1N1 swine flu occurred in April, federal projections have been consistently overoptimistic and have had to be ratcheted down several times, the New York Times reports. As recently as late July, the government was predicting having 160 million doses by this month. The reasons for the receding estimates start with the fact that the H1N1 virus is not growing as fast as expected in the eggs used to produce vaccine.
Following an agreement completed on Thursday, the proposed House healthcare reform bill will include a provision that would change the way Medicare pays hospitals and physicians—by moving from a formula that pays for the volume of tests and procedures performed to a value-based formula that emphasizes quality care and cost-effectiveness.
Fifteen legislators, primarily from Midwestern and West Coast states, had been pressuring for the change, saying that many of their providers who deliver high-quality, low-cost services were being reimbursed far less than providers in other parts of the country.
Rep. Ron Kind (D-WI), one if the key supporters of the change, said that providers in his region "have long been delivering the kind of high-quality, low-cost care that has been looked to as a national model."
He added that the agreement "ends discrimination" against patients in the low-cost areas by preventing the cost shifts that occurs when private insurers increase payments to providers to make up the difference in the amount providers are reimbursed for Medicare patients.
The agreement calls for two studies to be carried out by the Institute of Medicine: One would address geographic variations in payment, and the other how to reset Medicare payments to providers.
Under the agreement, the IOM's recommendations could not lead to a rise in total Medicare spending; the final recommendations would be carried out unless Congress objected.
Firming up how Medicare payments would be made in the future was seen crucial by the Democratic leadership in getting the 218 or more votes needed to pass a healthcare reform bill when it is finally introduced on the House floor.
A bill is anticipated by early next month. The bill is expected to have a public insurance option in place, and one of the option formulas calls for basing provider payments on how much Medicare pays plus 5%.
St. Joseph Medical Center in Houston has been preparing for RACs for months now, says Cucharras Martin, vice president of revenue enhancement at the hospital and chair of the RAC team. But even though she began long ago, it doesn't mean she and the rest of her RAC team are now sitting back and waiting for the audits to begin at her hospital.
"We're still refining," she says. Even though her processes have been in place for a long time, Martin is continuously tweaking them.
Martin's RAC team started by outlining process flows, determining the path RAC correspondence would take through the hospital. The team then assigned roles for everyone involved in the process and determined the necessary timeline for each step. The goal was to have a medical record request fulfilled within 30 days, as opposed to the 45-day deadline set by the RACs.
Martin then decided to test hospital's processes. She took a sample RAC record request letter and, without informing other staff members when it would occur, sent it to her facility. After working the letter through the work flow, the team realized where changes were necessary.
"We found out we really had to have some sort of log where [the RAC team] could sign off on having seen a medical record request," she says. The log they developed is now in a binder that tracks each step of the process, and requires signoff when each step is completed. There is also a comment section where staff members could record any relevant notes. "If there is a denial, we can go back and see what we initially said for each claim. This helps us track and document that records were reviewed [prior to submitting them to our RAC]," Martin says.
The test was so effective that she plans to do it again soon. The first time around her team learned which time frames worked, and which didn't. They also learned where they needed additional resources to make the process effective, such as staff time or something as simple as a binder to track the letter's path. Martin expects additional tests to show her where else the process works well, but also where it still needs improvement, and she knows that now is the time to refine, while her hospital has not yet been audited.
Developing such a process has also helped her hospital deal with other types of audits—not just RACs. They now track all audits. "Now everyone is aware of all of the auditing activity going on," she says.
Martin is also taking the following steps to prepare:
Data mining to uncover potential vulnerabilities. She has learned from other payers conducting audits on her facility where some vulnerabilities may exist, so she's looking at those areas for RACs too, even if they may not have been approved as issues—yet.
Conducting education for her staff members. She presents educational sessions to individual departments, taking care to explain what the RACs are looking for, the department's role in the process, and how to handle any correspondence or medical record requests.
Posting educational information on the hospital's intranet where staff members can go to find out more information. There, staff members can find helpful links and other information they may need.
Distributing information to physicians. She created a weekly newsletter, "What's up Doc?" which the medical staffing office faxes to the physician offices. It contains pointers and information specifically for the physicians so their practice can prepare. And she knows they're reading it. "I get comments back, and they ask for it when they don't receive the fax each Wednesday." She also has a physician liaison on their board.
