Tenet Healthcare Corporation will no longer be entering into Connecticut to acquire five hospitals, according to a statement released by Tenet and Gov. Malloy. Both sides have failed to come to an agreement and have ended negotiation talks. The news comes after Tenet and the Malloy Administration promised in January to revive the deals. Tenet has spent two years trying to make the acquisitions, which included Waterbury, St. Mary’s, Bristol, Manchester Memorial, and Rockville General hospitals. In a statement, Malloy said “the environment for both providers and state governments is complex and rapidly changing. Unfortunately, the issues that separated us simply could not be overcome.”
According to a Modern Healthcare analysis of CMS data on penalties for fiscal year 2015, more than three dozen hospitals across the U.S. will be penalized more than 3% on most of their CMS reimbursements in 2015. 2015 is also the first year in which CMS’s three Medicare quality and safety incentive programs will be in effect. The penalties and rewards were calculated by combining the percentages for the three quality programs included in the Patient Protection and Affordable Care Act. Starting in 2015, hospitals can be penalized for excessive 30-day readmissions up to 3% of revenue from base operating diagnostic-related group payments by CMS. New in 2015 is also a 1% penalty on all Medicare revenue if a hospital falls into the bottom quartile in performance on hospital acquired conditions. Despite these issues, there are hundreds of hospitals getting it right by improving their performance. Additionally, nearly 800 hospitals will face either no penalties or will be earning rewards based on their performance in the value-based purchasing program.
The Affordable Care Act is now entering its second year. With continued implementation of its many provisions, both patients and providers are still getting use to the new law. 2015 will see a steady increase in the number of patients becoming insured-many for the first time. With higher out-of-pocket costs, more and more patients will become financially responsible for larger portions of their claims. Therefore, as a provider, it is integral to set financial policies in place, so that you are able to collect all monies for your services.
In an effort to assist providers with collections, we have put together a few strategies any organization can implement:
Establish a financial policy. Practices should establish a financial policy that is reviewed and distributed every year. This comprehensive policy should provide patients with a clear understanding of the practice’s expectations with regards to patient balances. Make sure each patient signs a copy which you should keep in his or her file. Please note, it is important to update your financial and insurance verification policies annually to reflect requirements of your individual practice.
Collection of patient demographic and insurance information should be obtained when the patient makes the appointment. Make sure to enter insurance information into the system prior to the visit for eligibility verification. Advise each patient in advance to bring a copy of current insurance cards, applicable co-pays, and any deductibles owed. We also suggest that you advise your patients to verify benefits with their particular insurance company prior to the appointment. This way, the patient thoroughly understands his or her contractual obligations.
Eligibility verification process. For providers that use our software, Caretracker/Optum PM and Physician EMR, it performs an automatic eligibility check for the next five dates of service. Each patient’s eligibility history is automatically updated when their check is complete. Other systems may work differently and it is important to utilize this functionality to capture your patients’ current insurance information. If you do not have software that checks eligibility, we suggest that you designate a staff member to verify your patients’ insurance prior to visits.
Co-pay collection. Practices should collect applicable co-pays prior to visits.
Payment plan. With higher out-of-pocket costs and increasing premiums, there’s a good chance there will be a patient who is unable to pay for a service at the time of visit. For situations like these, it may be helpful to set up a payment plan with a promise to pay. Draft a form and make sure the patient signs it. Give the patient a copy and keep one in your accounts receivable section. This way, you will be alerted with a reminder to process a credit card, or collect cash or a check. Be sure to always follow up with a patient who has not paid on time.
Credit cards. Another great option for your organization is to have a credit card machine. Credit cards are a safe option to ensure payments are made on time.
Healthcare organizations are constantly seeking new ways to improve the patient experience. To help providers achieve this goal, here are few strategies you and your staff can implement:
Ensure the patient feels respected during their visit. Let them know their views and opinions are valued.
Become an active listener and elicit patient concerns. Patients and doctors often do not understand/agree on the main problem. Take the time and learn to listen to your patients.
Communicate clearly and in a way the patient understands. Patient healthcare literacy averages at the 8th grade level, according to experts. Physicians must communicate in a manner that the patient will understand.
Work with the patient to identify needs and then set up mutually agreed upon goals. Help your patients see the benefits of behavior changes and make sure to set small, attainable goals.
Take the time to learn new approaches on how to engage patients. Often times, physicians have very little communication training. Find educational programs to help teach you and your staff on how to better communicate.
According to CMS, health spending continued to grow at a slow rate last year at the Office of the Actuary (OACT). In 2013, health spending grew at 3.6 percent and total national health expenditures in the country reached $2.9 trillion, or $9,255 person. The annual OACT report shows health spending continued a pattern of low growth – between 3.6 percent and 4.1 percent for five consecutive years.
Other findings from the report include:
Medicare spending, which represented 20 percent of national health spending in 2013, grew 3.4 percent to $585.7 billion, a slowdown from growth of 4.0 percent in 2012. This slowdown was primarily caused by a deceleration in Medicare enrollment growth, as well as net impacts from the Affordable Care Act and sequestration. Per-enrollee Medicare spending grew at about the same rate as 2012, increasing just 0.2 percent in 2013.
Medicaid spending grew 6.1 percent in 2013 to $449.4 billion, an acceleration from 4.0 percent growth in 2012. Faster Medicaid growth in 2013 was driven in part by increases in provider reimbursement rates and some states’ expanding benefits.
Spending for physician and clinical services increased 3.8 percent in 2013 to $586.7 billion, from 4.5 percent growth in 2012. Slower price growth in 2013 was the main cause of the slowdown, as prices grew less than 0.1 percent. Growth in spending from private health insurance and Medicare, the two largest payers of physician and clinical services, experienced slower spending growth in 2013, while Medicaid growth accelerated as a result of temporary increases in payments to primary care physicians.
CMS recently released a proposal to strengthen the Shared Savings Program for Accountable Care Organizations (ACOs) by placing greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. CMS is seeking to continue this dialogue to ensure that the Medicare Shared Savings Program ACOs are successful in providing seniors and people with disabilities with better care at lower costs. The proposed rule is part of CMS’ continued commitment to reward value and care coordination, rather than volume and care duplication. CMS encourages doctors, hospitals and other healthcare providers to work together to better coordinate care, which can ultimately reduce healthcare costs and improve outcomes.
In our last post, we looked at how providers can develop an implementation strategy, including an assessment of the impact of ICD-10 on their organization. This post will explore other key ICD-10 transition steps after your initial assessment.
Start by contacting your business associates periodically to follow up on their readiness status. This includes payers and system vendors. Ask them for updates regarding their ICD-10 transition process and any changes to their readiness timeline. Also, along with your coding staff, continue to increase your familiarity with the ICD-10 code sets and the associated coding guidelines. Inpatient coders should start familiarizing themselves with ICD-10 definitions, such as root operations and approaches.
Next, complete any tasks identified during your impact assessment, including implementing system changes and completing internal testing of system changes. Once vendors, payers and other business associates are ready for testing, begin the testing process and modify or develop policies and procedures from your initial assessment.
Also, start to educate other individuals in your organization (besides coding staff) identified during your assessment. Educate these individuals about differences in the classification of diseases and procedures in ICD-10 and what their role in the ICD-10 transition process will be. Continue to modify the ICD-10 project plan and timelines as needed and assess the quality of medical record documentation. If medical record documentation is lacking, implement documentation improvement strategies and monitor the impact of these strategies. Lastly, this stage should include assessing the potential reimbursement effect of transition; communicate with your payers about these anticipated changes.
Stay tuned to the ICD-10 Implementation Is Less Than A Year Away: What You Need To Do To Be Ready series to learn more tips for a successful transition to ICD-10.