As a nation, Americans pay more per capita, through government programs and out-of-pocket, for healthcare than almost any other country but without achieving better health. But the U.S. isn't the only country looking for a better way to provide care. Foreign health plans also struggle to make ends meet, to improve care, and to tame public bureaucracies.
Massachusett-based Caritas Christi Health Care System has fired back at a former executive who sued the hospital system for slashing his severance package. In a court filing, Caritas Christi said it was justified in canceling a nine-month, $250,000 consulting agreement with Michael Metzler, the former president of Caritas's St. Anne's Hospital in Fall River, because he failed to promptly report a discrimination complaint.
It is gamble that no one will be hurt as nurses with histories of drug abuse, negligence, violence and incompetence continue to provide care across California, according to a report from the Los Angeles Times. While the inquiries drag on, many nurses maintain spotless records while new employers and patients have no way of knowing the risks.
Representatives of some of the biggest players are beginning to express concern behind the scenes that President Obama's healthcare overhaul won't do enough about to contain runaway medical costs. And, some say, the ballyhooed deals the White House recently struck with hospitals and drug makers to keep them at the negotiating table could make the problem worse. Labor leaders are scheduled to have a closed-door meeting with Obama to push for more aggressive action to hold down costs.
Federal stimulus funding is helping community health centers nationwide deal with an influx of newly uninsured patients. The centers will be able to serve 2.8 million new patients this year, thanks to funding distributed in March from the stimulus package that Congress passed earlier this year, according to the Department of Health and Human Services. That money includes $155 million for the construction of 126 new health centers and $338 million to help 1,100 centers expand services or keep longer hours, says Mary Wakefield, head of HHS's Health Resources and Services Administration.
The National Retail Federation, the retail industry's biggest trade group, is launching a broad attack against Wal-Mart Stores Inc. for supporting congressional proposals requiring employers to help pay for health insurance. The Federation plans to send an aggressively worded letter to its members encouraging them to take a stand against Wal-Mart's backing of an employer-healthcare mandate.
Fort Worth, TX-based Cook Children's Health Care System is taking a comprehensive step toward the electronic health record future championed by the Obama administration. Cook Children's plans to install Web-based electronic health records and data integration technology at its 60 offices and clinics throughout Texas. It is also offering personal health records, controlled by the families of its patients, that can follow them throughout their lifetimes.
Hospital emergency departments in the region surrounding Washington, DC, are overflowing with patients affected by the recession and are increasingly using hospitals as their primary source of healthcare, according health officials. The Virginia Hospital and Healthcare Association said many of its members are at the breaking point and to ease the strain, hospitals and community organizations are setting up primary-care clinics to serve low-income and uninsured patients at little or no cost.
It seems like potential pandemics these days require an animal in the title—especially if the word "flu" is involved. But influenza pandemics are no laughing matter, and, with swine flu still on everyone's mind, facilities need to ask: Are we ready for the next pandemic?
Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor and columnist for Briefings on The Joint Commission, points out that several federal agencies have offered guidelines to prepare for a potential outbreak.
The Department of Health and Human Services has released a number of guidelines for facilities to prepare for a pandemic. HHS warns that, when a pandemic virus strain emerges, somewhere between 25% and 30% of the population could develop the disease. Certain things can be assumed during a pandemic, says the HHS:
Pandemic flu susceptibility will be universal.
Illnesses will be highest among school-aged children—in the 40% range—and decline with age
Of those infected, half will seek outpatient care
The number of hospitalizations and deaths is difficult to predict—based on the virulence of the virus, the estimates range widely
Hospital discharge
The CDC has issued guidance for discharging patients with H1N1 influenza. The local department of health should be notified within 24 hours prior to discharging a patient with the virus, or if a patient leaves the hospital against medical advice. (More information on this can be found at www.cdc.gov/h1n1flu/guidance_homecare.htm.)
The CDPH states that patients in an acute care facility who are either confirmed or probable cases of H1N1 should not be transferred to long-term healthcare facilities until seven days after the onset of the illness (or their acute symptoms have been resolved). If the long-term healthcare facility is capable of handling the appropriate infection control steps, transferring the patient is acceptable.
The last thing you want to learn at your hospital, as a patient sits at your registration desk:
They can't pay, and no one knew prior to service
Their insurance changed, and authorization is required
They recently lost their job and have not paid their COBRA benefits.
At this point, you may end up with an unpaid account—and in this economy, that's not good news when hospitals continue to lose reimbursement dollars.
Pre-authorizations are crucial today. It is vital to cover all the key areas and prevent the patient and the hospital from learning bad news. The process covers more than just a pre-registration:
Insurance verification
Upfront payment notification to the patient
Total out-of-pocket payment
Payment options when full payment cannot be made
Opportunities to screen for government assistance programs
Medical Necessity check
Medicare Secondary Payer check
Accurate demographic/financial information
Prior to this year, the four hospitals of Baptist Health System Birmingham, AL, struggled with a success rate of "well under 50%," for pre-registration of scheduled patients, says Betty McCulley, CHAM, system access director/consolidated business office at Baptist's headquarters, Princeton Medical Center.
The 1,080-bed system fell behind in many areas because pre-registration staff members often were sent to help register patients during staffing shortages. Pre-registration numbers suffered.
"We were not meeting our pre-registration goals," says McCulley, who manages the patient access managers at the four facilities and serves as the National Association of Healthcare Access Management's Southeast regional delegate. Patients sat with registrars longer because they were not pre-registered. Insurance issues delayed the patient even further.
"And as we all know, 'wait time' is the No. 1 reason patients and their families become so upset," McCulley says. "They are sick, afraid of what they may be facing, and here we are holding them up and asking for information and money. Because the patient had not been contacted prior to arrival they were not prepared to pay upfront."
In February of this year, Baptist and McCulley's team decided to outsource its prearrival responsibilities 24 hours in advance of the appointment. The goal is 90% pre-registrations, which includes obtaining pre-authorizations, verification of benefits and patient contact for collections.
Upfront collections means the hospital does not have to pay fees to a company to collect after the service (and while the account sits aging in AR).
It's too early to measure its effectiveness, but McCulley says the percentage of pre-authorized patients and upfront collections have each increased. Baptist also saved five FTE positions because of the outsourced work.
As an added benefit for physicians offices, the outsource company obtains their pre-authorizations as well as those for the hospital. This was not meant to eliminate jobs; rather just allow physician office staff members time to complete other duties.
McCulley states the impact of increased pre-registrations on processes as well as point-of-service collections is already showing a positive trend.
Patients who are scheduled for elective services and have not received financial clearance are given the option to reschedule. Of course, the revenue cycle staff first checks with their physicians first before suggesting a reschedule.
"We don't do it without making sure the doctor feels it will not be harmful for the patient to reschedule," McCulley says.
And naturally, Baptist offers a variety of payment options to avoid rescheduling – from upfront and prompt pay discounts to bank loan arrangements.
"Some patients say they can't pay, then when you ask them to reschedule, they write you a check right then and there," McCulley says. "Once they know the appointment will be canceled, with their physician's approval, it's surprising how many people come up with the money."
Editor's note: This is the fifth in a series of stories on HealthLeaders Media talking to revenue cycle managers about coping in a tough economy. The previous installments were:
