On the final day for public comment on the Trump administration's blueprint to lower prescription drug prices, rural providers and advocates reiterated their support for the drug pricing program.
While the overall prescription drug pricing plan elicited more than 2,000 responses, the 340B program component generated about two dozen comments from rural health systems, disproportionate-share hospitals (DSH), and 340B Health, a leading advocate for the program on Capitol Hill.
The final day for comment came about one week after Health and Human Services Secretary Alex Azar addressed a 340B conference about the future of the program, urging improved oversight and accountability measures.
Attendees gave the speech a chilly reception, due in large part to the administration's cuts to the program and proposed delays to several final rules, which have left some systems hamstrung.
340B Health's public comments on the drug pricing plan focused on the services provided by the program, arguing that it "helps preserve the health care safety net" and does not contribute to manufacturer's high set list prices.
"To the extent that drug companies pay additional rebates over the statutory 340B discount for drugs that have been dispensed to 340B patients with commercial insurance, those are the result of business decisions made by manufacturers," Maureen Testoni, interim CEO of 340B Health, wrote in their comment. "Manufacturers voluntarily enter agreements with commercial insurers to pay rebates in exchange for the companies’ drugs being placed on the insurers’ formularies.
Rapid City Regional Health in South Dakota also commented on the blueprint, stating that it utilizes the program to offset $57 million in annual uncompensated care costs.
"The 340B program is vital to RCH's community-focused mission of providing healthcare services to low-income, uninsured and underinsured patients," Michael Diedrich, Vice President of Government Relations, wrote in their comment.
Below are comments from rural providers expressing support for the program as the administration looks to curb prescription drug costs.
Wickenburg Community Hospital in Arizona, Boone County Hospital in Iowa, as well as Ridgecrest Regional Hospital and Oroville Hospital in California submitted comments which mirrored the language in 340B Health's submission, calling on the administration to lower list prices, avoid duplicate discount prices, and clarify program eligibility.
Delta County Memorial Hospital in Colorado wrote: "The insinuation that drug prices rise because of the 340B Program is false. Prices rise because of consolidation in the drug industry, single source drugs, drug shortages, market control through specialty pharmacies, limited distributions networks, collusion with insurance carriers, and downright greed."
"As our prices rise and reimbursement falls, rural healthcare delivery becomes impossible without the 340B Program," Delta County Memorial added.
SSM Health, a Catholic system with business in four states, said it received $75 million from the 340B program in 2016. "Without the 340B Program, we would be unable to provide access to critical health care services for those in need."
"Far from contributing to higher drug prices, the 340B program has been a critical tool for our hospital to continue to care for our community," Mick Zdeblick, CEO of Asante Rogue Regional Medical Center in Oregon, wrote. "If the 340B program is curtailed, it will be our patients and the broader community we serve who will pay the price through more limited access to needed services."
Piedmont Health Services in North Carolina wrote that more than 40% of its patients are uninsured and over 95% are low-income, describing the 340B program as "vital."
The announcement brings together the multistate Midwestern health system and a technology giant with the goal of improving patient outcomes and reducing the cost of care for employers as well.
In a joint press release Thursday, the organizations emphasized the importance of enhancing preventive care, constructing a "smart city" connectivity infrastructure, and investing in innovative physician training programs based on precision medicine.
"Our employees' health is our top priority," Leonard Wu, CEO of Foxconn Health Technology Business Group, said in a statement. "We are thrilled to partner with Advocate Aurora Health not only to bring together two organizations committed to health technology innovations but to provide first class health care and medical services to our Foxconn US employees."
The collaboration comes three months after the Advocate-Aurora merger was finalized and one year after Foxconn announced it would build a $10 billion factory in Wisconsin.
Employer-based solutions are centered on Foxconn's AI capabalities and predictive modeling platform, with the aim to forecast healthcare costs and improve value outcomes.
Additionally, the "smart city" concept is based on developing a secure provider network through Foxconn's technology so that Advocate Aurora patients and doctors can access data relating to health, fitness, and dietary decisions. The goal is to connect healthcare support entities through an intelligent network outside of the physical hospital building.
"Foxconn supports our relentless pursuit of safety and quality, and we look forward to exploring breakthrough connections to extend these offerings to consumers across environments," Jim Skogsbergh, CEO of Advocate Aurora Health, said in a statement. "Our newly announced plans of expansion in Racine County, the same community where Foxconn recently broke ground, provides the perfect location to pilot these value-added opportunities for consumers."
The announcement elicited positive reaction from both the legislative and business circles in the Badger State.
Robin Vos, Speaker of the Wisconsin State Assembly, tweeted his approval, "More good #Foxconn news. #FoxconnBonus."
The Wisconsin Economic Development Corporation tweeted, "And yet another example of the ripple effect of Foxconn's decision to establish operations in Wisconsin."
The White House Council of Economic Advisers issued a report that found most non-disabled working-age adult Medicaid recipients work less than 20 hours per week.
As nearly a dozen states consider implementing work requirements for Medicaid recipients, the White House has released new data on the non-disabled working-age adults enrolled in the program.
The Council of Economic Advisers (CEA) released a report Thursday on the Trump administration's reform of federal welfare programs, focusing on the population most likely to be affected by the proposed Medicaid work requirements.
The report also included information on non-disabled working-age adults who receive federal welfare assistance through the Supplemental Nutrition Assistance Program (SNAP) and rental housing assistance programs.
CMS announced in January that it would consider submissions from states for Medicaid work requirement waivers. Kentucky received the first approval for a Medicaid work requirement plan, which would mandate recipients work 20 hours per week, totalling 80 hours per month. Since then, CMS has approved plans for four states and are reviewing seven other pending waivers.
However, only three states have begun implementing Medicaid work requirements, as Kentucky's proposed waiver plan was struck down by a federal judge last month. In recent days, CMS Administrator Seema Verma indicated that the agency plans to appeal the decision.
Below are the statistical highlights from the White House economic report on Medicaid work requirements:
61% of Medicaid recipients are non-disabled working-age adults
There are 28 million non-disabled working age adult Medicaid recipients and 22.2 million child recipients
Between 22 and 28% of non-disabled working-age adults on Medicaid live in a house where the youngest child is between one and five-years-old
Between 19 and 14% of non-disabled working-age adults live in a household where the youngest child is between 6 and 17-years-old
60% of non-disabled working-age recipients worked less than 20 hours per week
Non-disabled working-age adults without children are less likely to work than are those with children.
The highest percentage out of that group were non-disabled working-age adults without children between the age of 50 and 64-years-old, at 72%
78% of all non-disabled working-age adults work less than 40 hours per week, which constitutes full-time employment
Medicaid is the largest non-cash welfare program, receiving $566 billion in funding for its 71 million beneficiaries.
Between 1969 and 2017, the share of the population covered by Medicaid grew from 6 to 22%
The CEA listed three reasons that supported the administration's push to implement Medicaid work requirements:
Decades of declining self-sufficiency, hampered by economic hardship, could be addressed by increased motivation through work requirements.
Other options to that could serve as an "alternative solution of increasing positive incentives for work," might raise high implicit taxes on low-skill part-time workers exponentially.
The White House argued that welfare programs with work requirements in exchange for benefits increase employment and could improve outcomes for children.
"The timing is ideal for expanding work requirements among non-disabled working-age adults in social welfare programs," the report stated. "As was the case in the period of welfare reform in the mid-1990s, current labor markets are extremely tight and unemployment rates are at very low levels, even for low-skilled workers."
"Quite the opposite of harming people, expanded work requirements can improve the lives of current welfare recipients and at the same time respect the importance and dignity of work."
Employers across the board saw health plan costs rise for a variety of reasons, but employers with less than 500 workers were especially vulnerable to cost effects, according to a national survey from last year.
Most small employers have faced increasing costs associated with their health plans, while suffering from a lack of leverage and resources to manage the costs.
Though health benefit cost growth has remained steady at 3% annually, a survey of employer-sponsored health plans conducted by Mercer, a healthcare consulting firm, found that employers of varying sizes faced a wide range of health plan cost increases during 2017.
Employers with 10-499 employees:
34% saw costs increase by more than 10%
29% saw no change
19% saw costs increase 5% or less
18% saw costs increase 6 to 10%
Employers with more than 500 employees:
31% saw no change
28% saw costs increase 5% or less
22% saw costs increase 6 to 10%
19% saw costs increase more than 10%
Employers with more than 20,000 employees:
50% saw costs increase 5% or less
36% saw no change
14% saw costs increase 6 to 10%
11% saw costs increase more than 10%
The survey attributed the cost increases to a number of factors, namely expensive new treatment options and a rapidly aging population. A new cost driver is the slow rise of uninsured patients, which ticked up in 2017 and is likely to lead to providers shifting the costs of uncompensated care onto employer health plans, according to Mercer. The firm highlighted the importance of maintaining a vibrant workforce in order to counter the effects of rising costs associated with uninsured populations.
"Employers need to manage benefit cost and help employees thrive," the study read. "These two goals may sound as if they are in opposition – but they don’t have to be. Employers can slow cost growth while helping their employees to receive better care and a better patient experience."
Disproportionate share hospital participation in the 340B program could be drastically reduced thanks to a congressional bill raising the threshold to participate, which has invited pushack from 340B advocates.
A congressional proposal seeking to raise the eligible theshold to qualify as a disproportionate share hospital (DSH) in the 340B Drug Pricing Program, could reduce participation by roughly 50%, according to a new study.
340B Health released its analysis Monday of the Protecting Safety-Net 340B Hospitals Act, sponsored by Rep. Joe Barton, R-Texas, finding that the amount of DSH hospitals currently covered under the 340B program would be greatly reduced through the legislation.
"This proposal would decimate the 340B drug pricing program and leave millions of low-income Americans with higher costs and less access to care," Maureen Testoni, Interim CEO of 340B Health, said in a statement. “Such a drastic change would put enormous pressure on safety net hospitals, clinics, and health centers.”
Proposed changes and likely impact:
The bill would raise the minimum Medicare DSH adjustment percentage required for hospitals to participate in the 340B program from 11.75% to 18%.
This change would cause an estimated 573 DSH hospitals, 51% of all DSH hospitals currently enrolled in the program, to be terminated as a result.
340B Health stated that those hospitals provided $10.8 billion in uncompensated and unreimbursed care in 2016.
Almost 75% of states would see 50% or more of their DSH hospitals terminated, with five states seeing all of their DSH hospitals eliminated.
The study was released one day after Health and Human Services Secretary Alex Azar addressed the 340B Summer Conference, promising action and increased oversight on the much-maligned federal program.
A spokesperson for America's Essential Hospitals issued a statement to HealthLeaders Media in response to the study's findings.
"Rep. Barton’s proposal raises serious concerns for our hospitals," said Beth Feldpush, senior vice president of policy and advocacy. "Some likely would fall out of the program despite providing significant levels of care to uninsured and underinsured patients. This change would structurally alter the 340B program and harm care for vulnerable patients."
The HHS secretary promises the Trump administration will act to reform the 340B Drug Pricing Program, urges community to embrace change to assist patients who are paying too much.
Health and Human Services Secretary Alex Azar addressed the 340B Coalition Summer Conference Monday, where he affirmed the Trump administration's position to reform the 340B Drug Pricing Program.
Azar highlighted proposed areas of improvement for the much-maligned federal program while promising that 340B-covered entities responsibly investing their savings have nothing to fear.
Azar said the approach to caring for vulnerable patients is constantly changing, adding that those in the 340B space understand the importance of embracing change.
"If our systems are not adapting, more than likely they are standing in the way," Azar said.
One of the main goals for the administration is to address "sky-rocketing list prices," though he admitted that it was challenging due to a lack of systematic financial incentives, he added.
2. Reached the 'tipping point'
Though some in the 340B community believe the delays handed down from HHS show a deference to the pharmaceutical industry, Azar said the administration only defers to American people, adding that they are "tired of high drug prices."
Azar said the administration is not deferring responsbility to the pharmaceutical industry to lower drug prices, calling Monday a "tipping point."
He specifically referenced President Trump's afternoon Tweet aimed at Pfizer for raising drug prices "for no reason," saying the administration "will respond!"
3. Transparency and price reform needed
Azar said the growth of the 340B program in conjunction with Medicaid expansion under the ACA was to be expected but noted that while federal programs grow fast, they usually do not grow as fast as 340B has.
He said the administration is working to increase oversight on the program, which he admitted was lacking in recent years.
Transparency was an area where Azar said the administration could help patients by ensuring they are no long paying the cost-sharing price while doctor only pays for discounted drug price.
Reactions from conference attendees
340BHealth Interim CEO Maureen Testoni received laughter from the audience while taking the podium after Azar's speech, which she noted was "very frank."
Testoni added, "We knew that we were in for a fight."
340B Matters tweeted, "44% of Americans under the age of 65 have to pay high deductibles. How does @SecAzar expect low-income families to cope with skyrocketing drug prices and uncertain #340B reforms?"
The organization added a follow-up tweet: "@SecAzar wants to reform #340B but how will these changes to vital drug discounts affect real American lives?"
As he takes the helm of the Amazon-backed healthcare project, will Gawande's opinionated political nature be a corporate asset or impediment?
Monday marks Dr. Atul Gawande's first day leading the Amazon–Berkshire Hathaway–JPMorgan Chase healthcare venture aimed at improving the American healthcare system.
For nearly three decades, Gawande has been one of the most influential physicians and healthcare writers in the country, impacting prominent policymakers and business leaders alike.
"The Cost Conundrum," Gawande's 2009 article in The New Yorker, played a critical role in shaping President Barack Obama's view on reforming healthcare as his administration worked to pass the ACA. The report also caught the eye of Charlie Munger, Berkshire Hathaway CEO Warren Buffett's longtime investing partner.
Nearly a decade later, Gawande's influence on health policy, connections to industry power players, and personal political views hold serious weight as he assumes his new position.
Gawande himself briefly entertained a political career, earning a degree in philosophy, politics, and economics from the University of Oxford as a Rhodes Scholar, and working as a health policy advisor for both then-Sen. Al Gore and then-Gov. Bill Clinton before continuing to serve in the White House.
Despite his role in Washington, Gawande returned to Harvard and practiced medicine, telling The Independent, "I didn’t like the idea of my future being dependent on politics."
However, Gawande's writings for The New Yorker and public statements on social media about the Trump administration and health policy proposals, could factor into how the highly anticipated project attempts to fix healthcare costs.
Longtime Trump critic
As evidenced by his social media activity, Gawande frequently criticized Donald Trump throughout the 2016 presidential campaign and the first 18 months of his presidency.
"The arc of history is long, but at times it bends toward madness," Gawande tweeted the morning after Trump was elected president.
Later that same day, Gawande added, "There is nothing consistent about Trump’s policies except incompetence, moral indifference, and destruction."
Skeptical of single payer
President Trump is not the only subject of criticism from Gawande, as he has also expressed dissatisfaction with the proposal for a single payer government-run healthcare system.
In a January 2009 article for The New Yorker entitled "Getting There from Here," Gawande referred to single payer as a "siren song."
Gawande also stated that supporters of single payer "reserve special contempt for the pragmatists, who would build around the mess we have."
"Grand plans admit no possibility of mistakes or failures, or the chance to learn from them," Gawande wrote. "If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have."
In May 2016, Gawande also tweeted, "The costs of rapid transition to single payer are either much higher or more disruptive than advocates acknowledge."
Politics of the project leaders
Gawande's politics are of interest because of his immediate role leading the new organization, but the financial backers of the project also have publicly and financially expressed their own political preferences over the years.
Dimon has been a longtime donor to the Democratic Party, including support for former Secretary of State Hillary Clinton, though he described himself as "barely a Democrat" in 2012.
Additionally, Dimon participated in the White House's Strategic and Policy Forum to advise President Trump, though he withdrew and the group eventually disbanded after Trump's comments about the Charlottesville riots in August 2017.
Buffett was critical of Trump as a candidate but has been more reserved in his public critiques since he took office. Buffett was also a vocal campaign supporter of both Clinton and Obama.
Despite the public war of words, Bezos did attend the first meeting of the American Technology Council roundtable hosted by the White House in June 2017.
The political ideologies of Gawande and the business leaders behind the new healthcare project are well-known but still leave questions about what they will mean for the organization going forward in a highly politicized climate.
In May, Alan Murray, president of Fortune, wrote in Time that CEOs taking political stances in the current era "risk alienating customers and adding to polarization."
Murray added that the decision to separate business from politics has "clearly moved," though he said several CEOs are working to "understand where the new line should be drawn."
A 2017 study by researchers from the University of Mississippi and the University of Texas at Austin looked into the connection between a CEO's degree of political liberalism and subsequent impact on the organization.
The study found that the degree of political liberalism positively impacted the organization's rate of new product introductions (NPI) and was associated with higher stock return volatility.
Additionally, the impact of CEOs' political liberalism on NPIs was weakened by low CEO power, high CEO equity-pay ratios, and economic boom.
A 2013 study by the Samuel Curtis Johnson College of Business at Cornell University found CEOs with liberal ideologies are also more likely to emphasize corporate social responsibility than conservative CEOs, even when financial performance is low.
The Cornell study also indicated that a CEO's political ideologies are "more widely consequential" due to their significant relation to corporate political action committee allocations.
Following the holiday weekend, Pine Tree State legislators are expected to vote on a funding source for Medicaid expansion after another veto from Gov. Paul LePage, while also considering a potential tax on hospital revenues.
Medicaid expansion is once again at the center of debate in Maine, where Gov. Paul LePage, voters, and health policy advocates are at loggerheads over the issue.
In a referendum last November, voters approved a plan to expand Medicaid to nearly 80,000 Mainers under the Affordable Care Act (ACA). This made Maine the first state to expand Medicaid via ballot initiative.
However, LePage vetoed the expansion effort Monday, citing a lack of long-term funding for the program and calling the proposed funding solution "budget gimmicks."
Expansion talks after another veto
Once the holiday weekend is over, legislators are expected to take up debate on funding for the program, which was set to begin enrolling residents Monday.
Medicaid expansion is expected to cost the state at least $807 million over 10 years, according to a 2014 report from the Maine Department of Health and Human Services (HHS), and increase enrollment to nearly 100,000 residents.
The state legislature will try to find a Medicaid expansion plan that will appeal to the veto-friendly governor.
In 2013 and 2014, the legislature approved Medicaid expansion plans but received instant vetoes from LePage following passage.
LePage's efforts to block Medicaid expansion have been challenged in state court by ACA-supporters, who accuse him of ignoring the ballot initiative. Last month, a state judge ordered LePage to implement Medicaid expansion, citing the "complete failure to act" by HHS.
Hospital tax on the table
Since stable funding for Medicaid expansion is one of the primary reasons for LePage's vetoes, he has proposed an increase on the state hospital tax to cover the cost of expansion.
Currently, the tax rate is 2.2%, which could rise to 6% under LePage's proposal.
Policy analysts expect the Virginia tax to provide private acute care hospitals with $880 million in benefits over two years, mostly due to expanded revenue options under Medicaid and increased reimbursement rates for providers.
A Maine Hospital Association representative told the Associated Press that Maine hospitals already pay $100 million in taxes annually and would oppose the measure.
The sale gives Centene a foothold in the Empire State, a prize in the managed care market, and allows the Archdiocese to establish a multi-billion dollar health foundation.
The sale of the nonprofit health plan came after months of review from state regulators and final approval from interim Attorney General Barbara Underwood.
Related: Fidelis-Centene Deal Gets Crucial Regulatory Approval from New York State
"We are pleased to have completed our transaction with Fidelis Care on schedule and to enter the New York market by joining with a company with which we are closely aligned on many levels," Michael F. Neidorff, CEO of Centene, said in a statement.
Centene laid out additional details about its entrance into the New York market:
Rev. Patrick J. Frawley will continue to serve as CEO of Fidelis, which will remain in headquartered in Queens.
"The integration planning process reaffirmed the alignment between our two companies, and I look forward to what we will be able to accomplish as part of Centene, including through their comprehensive, state of the art technology and medical management, wellness and care management systems," Frawley said.
The health plan will also continue its operations in Albany, Buffalo, Rochester, and Syracuse.
Centene expects to add nearly 4,000 members to its network through the purchase.
Centene will now have plans available in the four largest managed care states: New York, California, Florida, and Texas.
Creation of Mother Cabrini Health Foundation
As mentioned in the purchase agreement from last fall, the Catholic Church announced the creation of the Mother Cabrini Health Foundation to provide assistance to "needy New Yorkers of every color, every religion, and every background."
The Archdiocese stated that the foundation has assets totalling $3.2 billion, plans to issue $150 million in annual grants to New Yorkers in need, and will be directed by a board consisting of "health experts, business leaders, and philanthropists."
"The Mother Cabrini Health Foundation will aim to transform the lives of underserved New Yorkers from all corners of the state and set a national model for addressing the health and wellness needs of low-income communities," Cardinal Timothy Dolan, Archbishop of New York, said in a statement.
The deal gained attention earlier this year when Gov. Andrew Cuomo's executive budget proposal included a provision to create a "healthcare shortfall fund," which would ensure funding for New Yorkers in the absence of continued federal funding.
Currently, New York faces a $4 billion budget deficit and dwindling federal payments for cost-sharing reductions and the Medicaid Disproportionate Share Hospital program.
The statute would collect an estimated $750 million annually over the next four years by taxing proceeds from the sale of nonprofit health companies to for-profit health companies.
Bill Hammond, health policy director for the Empire Center for Public Policy, viewed the policy as a way to capitalize on the Fidelis-Centene deal.
The Queen's Medical Center revamped its revenue cycle operations with automated billing and quickly reduced write-offs by $2.7 million.
With declining reimbursement rates and shrinking operating margins, health systems have increasingly focused on effectively recouping as much as they can from outstanding patient bills.
The Queen’s Medical Center (QMC), a 533-bed nonprofit hospital in Hawaii, recognized the need to improve its in-house billing and claims services last summer.
By implementing a third-party automated billing and claims system, QMC reduced write-offs from $2.7 million to $92,000 and improved its cash flow by $5 million
This strategy offers health systems and hospitals an effective digital solution to control the exponential costs of their in-house billing operations and better utilize their employees.
Pate focused on how to receive more timely and accurate payments while delivering clean claims, though she said improving staff productivity was another important goal.
Endowment makes revenue cycle operations important
For QMC, improving its billing and collections operations is critical to the larger financial health of the system and maintaining its endowment.
Founded in 1859 by Hawaiian royalty, QMC resides on land set aside after the passing of Queen Emma and has access to an endowment fund created by her remaining assets that exceeds $1 billion according to Pate.
The four hospitals in the system provide healthcare access to a large native Hawaiian population on the islands. Overall, 30% of the state population is enrolled in Medicaid or Medicare, with another 5% uninsured, according to the Kaiser Family Foundation.
When QHS hospitals are not profitable, they can receive funding from the endowment to cover hospital operation costs. Pate said that the improved cash flow from automated billing and collection services allows the hospitals to fund all operations, including capital funding requests, without tapping into the endowment.
Pate said one of the goals for the system is to eventually reach a point of consistent cash flow and bolstered operating margins while allowing the endowment to grow.
"In revenue cycle there is always continuous improvement, and I try to set reasonable, achievable goals," Pate said.
"Each year we're lowering our days in AR goal, increasing our expected cash collections, the timeliness of the collections, and the timeliness of processing charges. When you have your [AR] days down in the 40s, there isn't much room for improvement, but we're [always] shooting for the top 25 percentiles on a national basis," she says.
Financial and clerical results
Since implementing new automation billing services last August, QMC has experienced a drop in candidate for billing from 6.1 days to 3 days by the end of May. This means hospital was able to distribute final bill claims to patients with an account beyond the hold period. Pate said the reduction occurred before the internal goal set for the end of fiscal year 2018 in June.
QMC also saw a two-day reduction in days in accounts receivable (AR), which Pate said was a "significant" amount. In fiscal year 2017, QMC collected 66% of AR due within the first three months and 78% in the first six months. In fiscal year 2018, about 75% of AR due was collected within the first three months and 94% in the first six months.
The improvements have not only been confined to QMC's financial performance. The billing staff has seen its work become more effective and efficient, according to Pate.
Previously, follow-up staff were spending most of their time pursuing claims with various payers, receiving claims status updates, and working to secure timely collection on accounts.
Pate said the billing department has been "much happier" as the accounts and payers have provided more timely payments through the new automated system.
What did the programs do?
Automated bots work electronically with QMC's adjudication system, reaching out to the payer electronically, receiving an electronic claim status, and feeding it back into the EHR system hosted by Epic.
The notes are automatically added to the account so that the follow-up staff doesn't have to spend time on the phone pursuing a claim, which often took at least 30 minutes.
Additionally, some payers would limit the account inquiry to three accounts, meaning the follow-up staff would have to choose the top three accounts, either by age or dollar accounts.
The staff would then redial and wait another 30 minutes to get a status update on another three accounts.
QMC currently has 19 employees working on claims that have been returned by payers for additional documentation or a medical necessity review. When payers return to QMC, the follow-up team coordinates with various billing and collection departments to receive additional documentation or justification.
However, Pate said most of the time employees were waiting on the phone to receive claim status updates. The bots circumvented this process, instead allowing employees to work on accounts that needed manual intervention to secure payment.