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Medicaid Acceptance by Healthcare Providers Drops in 2015

Medicaid Acceptance by Healthcare Providers Drops in 2015 | Healthcare and Technology news |

Given the size of the Medicaid program and its importance to America’s low-income population, HealthPocket examined government records on Medicaid acceptance for a broad cross-section of healthcare providers. HealthPocket’s review of over one million records found that in 2015 only 34% of the healthcare providers examined were listed as accepting Medicaid insurance. The 2015 results represent a 21% decrease from the listings of Medicaid acceptance as compared to 2013 data for the same categories of healthcare providers.

Since both the 2013 and 2015 analyses relied upon the same government data source and provider categories, the marked decline in Medicaid acceptance is significant. In particular, the data calls into question whether the temporary two-year increase in Medicaid payments to primary care physicians effected any lasting improvements to Medicaid acceptance.

Healthcare provider reluctance to accept Medicaid has numerous reasons, most notably the level of reimbursement from Medicaid for healthcare services. Medicaid typically pays 61% of what Medicare pays for the same outpatient physician services. Medicare itself typically pays 80% of what commercial health insurers pay. Consequently, in comparison to commercial health insurance from private insurance companies, Medicaid payments represent a reduction on a reduction.

“HealthPocket has stressed many times that health insurance is only as good as the doctors and hospitals that accept it,” said Kev Coleman, Head of Research & Data at HealthPocket, “In the case of Medicaid, there is an overwhelming number of healthcare providers who do not accept the insurance which, in turn, undermines the value of the insurance provided.”

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How hospitals are tackling costs in 2015

How hospitals are tackling costs in 2015 | Healthcare and Technology news |

It's no secret that Americans pay a pretty penny for their healthcare – the highest in the developed world, in fact. What's more, by many reports, they're not even getting the quality outcomes to match that hefty price tag.

As providers face pressure to reduce costs on the front end – for their patients – they're also feeling the pinch on the back end: their bottom lines. For hospitals and health systems, especially, 2015 is a landmark year for everything related to costs.

In 2013, national health expenditures approached $3 trillion, representing $9,255 per person and accounting for a whopping 17.44 percent of the gross domestic product. In the wake of the Affordable Care Act, the industry now more than ever is facing pressure to be accountable and value based. That's often a struggle for many.

So as the industry works to comply with myriad regulatory changes that have been implemented, what’s top of mind this year for the healthcare finance folks?
For Karen Mihalik, executive director of revenue cycle managementat the Cleveland Clinic, there are several things that come to mind.
For one? This year, risk-based contracting is going to be tough, said Mihalik, who works with an RCM team comprising 1,700 FTEs. Also, ACOs and handling bundled paymentswill pose big challenges.
"This year is different in that we really need to make sure that we align again with the clinical component, and that we're building the right business model and administrative model to manage that risk-based population," she said.
One risk-based model, the Medicare ACO, has been a serious challenge for many provider groups. The federal government's Pioneer ACOprogram, for instance, which originally started with 32 participants has whittled down to 19 organizations as of September 2014. 
For the folks at the Denver-based Physician Health Partners, one of the groups that dropped out of the Pioneer model back in 2013, the benchmark setting process within the Pioneer model needed some serious re-working.
We can't take that much risk when the game keeps changing a little bit," Kenneth Nielsen, president and CEO of Physician Health Partners, told Healthcare IT News back in 2013, especially when these adjustments aren’t geographically based. "The Denver market, where our benchmark was $8,000 per beneficiary, per year is a lot different than an East Coast market where their benchmark was twice that."
For PHP, it wasn't all bad news, however. It was able to decrease its readmissions and hospitalizations rates and met all the quality metrics. But, financially, it wasn’t viable. It reported shared losses for fiscal year one, which was anticipated, Nielsen said, but another two years before reaping the supposed financial benefits? It proved just too risky. "We just weren't able to take enough time to take the risk over three years at this point," Nielsen added. Right now, he said, "We're between bleeding edge and cutting edge."
Cleveland Clinic passed on the Medicare ACOs in the first round, with its CEO Toby Cosgrove saying the organization was "disappointed" with the Centers for Medicare and MedicaidServices ACO proposal, claiming they requirements weren’t outcomes based and had other reporting requirements that were burdensome to healthcare organizations. 
Another item on the to-do list this year, aside from risk-based contracts? Payers have some work to do with the insurance verification process.
Specifically, Cleveland Clinicneeds to be able to identify patients enrolled in an ACA-related plan and gather crucial information related to their coverage, said Mihalik. Having the ability to know who these specific patients are and how they are doing in digesting this "new world" is essential, she added. 
For year two, Cleveland Clinic is really focused on making sure payers are able to specifically identify those patients as being in an ACA-related plan and subsequently providing that data to the clinic as part of the registration verification process. 
"We want to be able to take a look at that population, and we really can't effectively do that right now because the payers haven't built the right models," said Mihalik, "so the system changes really aren't needed on our side; they're needed on the payer side."
Mihalik isn't alone. In fact, 62 percent of MGMAmembers said they had moderate or extreme difficulty with identifying patients with ACA coverage, according to a 2014 MGMA survey. "We are going to have to hire additional staff just to manage the insurance verification process," one MGMA practice manager reported in the survey. 
As far as the IT goes, the payers are the ones with the work to do, Mihalik added. 

ICD-10 confusion not helping

Hospitals and health systems are businesses. Sure, their purpose is to provide patients with quality care at lower costs, but at the end of the day if they're not financially viable and their bottom lines are consistently in the red, there's a big problem.
For Arnette Marbella, director of HIM and CDM revenue cycle at Tufts Medical Center, it's the ICD-10limbo that's concerning from a financial perspective. There's talk that ICD-10 will be delayed yet again, pushing its go-live data of October 2015, even further down the road. The revenue implications in that is that most hospitals have already started at least a year or a year and a half ago on preparing for the transition," said Marbella. 
This preparation, of course, means systems are tested, making sure that the systems are upgraded to be able to accept the news codes, physicians are trained on documenting. That part – clinical documentation is integral, she added. If you think about it, she said, the industry is going from some 14,000 diagnosis codes to nearly 70,000 codes, so "there's no one-to-one match for the codes."
Ultimately, clinical documentation translates to "we have to be more specific on the codes that we assign, and that in turn translates to the reimbursement that we get or the bill that we submit to the payers and they reimburse and then we get," she said. A loss of revenue due to coding errors or administrative/procedural issues is a "concern in every hospital," Marbella added. 
Mihalik has her own concerns about ICD-10. 
It impacts really nearly every system," she said. "Most of our systems work off of diagnosis data, so the work we're doing around remediation and cross walks and testing is significant but very, very necessary," she added. The other area we're really focused on has to do with our coding and clinical documentation so that we are prepared now as we can be prior to go-live in making sure that we have quality training and audits going on to help make sure that we're there to the level that we need to be."
Investments in technology that they’re leveraging with computer assisted coding is also key, she said. 
With all of these items on providers to-do lists, it's difficult to focus on much else. But there is more, said Mihalik. Patients and their engagement are absolutely key. Our focus is really on what's still to come," she said, "because there are significant changes still in front of us related to primarily patient engagement so our world is really focused on first and foremost patients and being able to provide them timely and integrated information."

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Hospital Impact - 7 digital resolutions for hospitals

Hospital Impact - 7 digital resolutions for hospitals | Healthcare and Technology news |

It's the beginning of 2015 and time for people to take a closer look at their lives and make resolutions for the coming year. It's also a good time for hospitals to take another look at their social media and digital initiatives and determine what's working and what's not.

The good news is that U.S. hospitals have embraced social media. In fact, 99.41 percent of the 3,371 U.S. hospitals have ongoing social media initiatives, according to a recent report from the Journal of Medical Internet Research. But are they using the right channels and achieving the results they want?
Here are some social media resolutions for hospital marketers for the coming year:

  • Make your website work for you: Your website is your most important digital property because it's the first place people go to learn about your organization and the services you provide. However, websites are no longer the online brochures they were in the 1990s. They need to be searchable and updated on a regular basis to remove stale and outdated content. A good resource to help you know where to focus your efforts is your site's Google Analytics, which will tell you which pages get the most views and how long site visitors spend on each page.
  • Make your content easier to find: It's not enough to create compelling content, people need to be able to find it. You may have a beautiful, informative website, but are you making the most out of Search Engine Optimization (SEO)? This is important, but can be a time-intensive task. Or have you spent a lot of time creating compelling videos and posting them on YouTube, but wonder why they may not attract viewers? A simple way to fix this is by not just posting key words, but by posting the entire video transcript.
  • Reach the right people: Research shows that hospitals tend to post generic content or information about employee-related issues and achievements. While this approach helps build critical mass by engaging hospital employees (which is especially important when launching social media programs), it won't help turn people into patients. It's important to know your audience and know what topics interest them, which will help increase followers and stimulate engagement.
  • Give the people what they want: Not only is this the name of a great album by the Kinks, it's a good social media mantra for hospitals. Your site's Google Analytics will help you identify whether people are coming to your site to learn about your heart and vascular program or maternity services, or simply want directions to your hospital. This information will help you identify topics for future blogs and social media posts and will help ensure that you continue to provide content that interests people.
  • Focus on what works: Hospital marketing departments are stretched thin and it's often difficult for staff to find enough hours in the day to do their work and manage all of their organization's social media properties. Rather than having a mediocre presence in multiple social media channels, focus your efforts on a couple of major channels. Or create an educational social media campaign that encourages people to take control of their own health, such as getting a mammogram or having a colon cancer screening.
  • Listen to what people say: One of the most important parts of social media engagement is listening to what people say. The challenge is to keep up with the channels as they evolve. For example, Yelp is where people go to get restaurant reviews--but patients also use it to review the care they receive at their local hospital. It's important to hear what people say and respond to their concerns. It's amazing how listening to people and addressing their concerns can help turn a detractor into an advocate.
  • Be part of the bigger conversation: In addition to listening to patient comments, hospitals should listen to the issues and concerns that other organizations in their community, including other hospitals, talk about. Listening to others allows you to be more relevant and become part of the bigger conversation.
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Last Chance to Enroll in Obamacare for 2015

Last Chance to Enroll in Obamacare for 2015 | Healthcare and Technology news |

Americans eligible for health insurance under the Affordable Care Act (ACA) are facing an important deadline. This year's sign-up period ends Sunday, Feb. 15.

For most people, it will be the last chance to select an ACA marketplace health plan or switch plans for 2015. That's why health advocates are urging uninsured Americans to take advantage of this final window of opportunity.

The 2015 open enrollment period kicked off on Nov. 15, 2014, with barely a hiccup compared with the online problems that dogged sign-ups for 2014, the inaugural year of the new insurance marketplaces, or exchanges.

The ACA, or Obamacare, requires most citizens and U.S. nationals to have health insurance coverage or pay a fine. Some people may qualify for exemptions due to religious beliefs, financial hardship or other extenuating circumstances.

If you are enrolled in a qualified health plan for 2015, you are considered covered under the law. The list of qualified plans includes Medicare, Medicaid, the Children's Health Insurance Program, job-based health insurance, military or veterans' health coverage and health insurance purchased on or off the Affordable Care Act marketplaces.

Penalties for not having health insurance in 2015 jump to 2 percent of household income or $325 per adult (and $162.50 per child) -- whichever is higher.

Close to 10 million people have already signed up for marketplace coverage for 2015, federal health officials reported earlier this month. That figure includes some 7.5 million who selected a health plan or re-enrolled in coverage through, the federal enrollment website serving people in 37 states. Others have secured coverage through state-operated health insurance exchanges.

Although the Congressional Budget Office had previously projected 13 million enrollees in 2015, federal health officials last November revised projected enrollment to between 9 million and 10 million for the year.

The ACA was designed to expand affordable coverage to people who cannot afford health insurance on their own. It does that, in part, by subsidizing insurance premiums for people of modest means.

If you make up to 400 percent of the federal poverty level (as much as $95,400 for a family of four), you may qualify for federal tax credits to defray your monthly health insurance premium. People with very low incomes will pay little or nothing for coverage.

The amount of the subsidy depends on your household income and the number of people in your household.

Many low-income people may qualify for reduced out-of-pocket costs as well.

Americans who choose a health plan before this year's cutoff date could have coverage as soon as March 1. After Feb. 15, the federal and state ACA marketplaces will only enroll people in health coverage for 2015 under special circumstances, such as a birth, death or move.

There's no deadline for enrolling in Medicaid or the Children's Health Insurance Programs.

The next ACA open enrollment period begins Oct. 1, 2015, for coverage that would kick in no earlier than Jan. 1, 2016.

For those hoping to squeak in under the wire for 2015, can tell you whether you live in a state with a state- or federally operated health marketplace. You can also find local experts to help you enroll.

Consumers can call the government's 24/7 hotline at 1-800-318-2596 for assistance.

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Digital health in 2015: What's hot and what's not?

Digital health in 2015: What's hot and what's not? | Healthcare and Technology news |

I think it’s fair to say that digital health is warming up. And not just in one area. The sheer number and variety of trends are almost as impressive as the heat trajectory itself. The scientist in me can’t help but make the connection to water molecules in a glass — there may be many of them, but not all have enough kinetic energy to ascend beyond their liquid state. The majority are doomed to sit tight and get consumed by a thirsty guy with little regard for subtle temperature changes.

With this in mind, let’s take a look at which digital health trends seem poised to break out in 2015, and which may be fated to stay cold in the glass. As you read, keep in mind that this assessment is filtered through my perspective of science, medicine, and innovation. In other words, a “cold” idea could still be hot in other ways.

Collaboration is hot, silos are not. Empowerment for patients and consumers is at the heart of digital health. As a result, the role of the doctor will shift from control to collaboration. The good news for physicians is that the new and evolved clinician role that emerges will be hot as heck. The same applies to the nature of innovation in digital health and pharma. The lone wolf is doomed to fail, and eclectic thinking from mixed and varied sources will be the basis for innovation and superior care.

Scanners are hot, trackers are not. Yes, the tricorder will help redefine the hand-held tool for care. From ultrasound to spectrometry, the rapid and comprehensive assimilation of data will create a new “tool of trade” that will change the way people think about diagnosis and treatment. Trackers are yesterday’s news stories (and they’ll continue to be written) but scanners are tomorrow headlines.

Rapid and bold innovation is hot, slow and cautious approaches are not. Innovators are often found in basements and garages where they tinker with the brilliance of what might be possible. Traditionally, pharmaceutical companies have worked off of a different model, one that offers access and validation with less of the freewheeling spirit that thrives in places like Silicon Valley. Looking ahead, these two styles need to come together. The result, I predict, will be a digital health collaboration in which varied and conflicting voices build a new health reality.

Tiny is hot, small is not. Nanotechnology is a game-changer in digital health. Nanobots, among other micro-innovations, can now be used to continuously survey our bodies to detect (and even treat) disease. The profound ability for this technology to impact care will drive patients to a new generation of wearables (scanners) that will offer more of a clinical imperative to keep using them.

Early is hot, on-time is not. Tomorrow’s technology will fuel both rapid detection and the notion of “stage zero disease.” Health care is no longer about the early recognition of overt signs and symptoms, but rather about microscopic markers that may preempt disease at the very earliest cellular and biochemical stages.

Genomics are hot, empirics are not. Specificity — from genomics to antimicrobial therapy — will help improve outcomes and drive costs down. Therapy will be guided less and less by statistical means and population-based data and more and more by individualized insights and agents.

AI is hot, data is not. Data, data, data. The tsunami of information has often done more to paralyze us than provide solutions to big and complex problems. From wearables to genomics, that part isn’t slowing down, so to help us manage it, we’ll increasingly rely on artificial intelligence systems. Keeping in mind some of the inherent problems with artificial intelligence, perhaps the solution is less about AI in the purest sense and more around IA — intelligence augmented. Either way, it’s inevitable and essential.

Cybersecurity is hot, passwords are not. As intimate and specific data sets increasingly define our reality, protection becomes an inexorable part of the equation. Biometric and other more personalized and protected solutions can offer something that passwords just can’t.

Staying connected is hot, one-time consults are not. Medicine at a distance will empower patients, caregivers, and clinicians to provide outstanding care and will create significant cost reductions. Telemedicine and other online engagement tools will emerge as a tool for everything from peer-to-peer consultation in the ICU to first-line interventions.

In-home care is hot, hospital stays are not. “Get home and stay home” has always been the driving care plan for the hospitalized patient. Today’s technology will help provide real-time and proactive patient management that can put hospital-quality monitoring and analytics right in the home. Connectivity among stakeholders (family, EMS, and care providers) offers both practical and effective solutions to care.

Cost is hot, deductibles are not. Cost will be part of the “innovation equation” that will be a critical driver for market penetration. Payers will drive trial (if not adoption) by simply nodding yes for reimbursement. And as patients are forced to manage higher insurance deductibles, options to help drive down costs will compete more and more with efficacy and novelty.

Putting it all together: What it will take to break away in 2015?

Beyond speed lies velocity, a vector that has both magnitude and direction. Smart innovators realize that their work must be driven by a range of issues from compatibility to communications. Only then can they harness the speed and establish a market trajectory that moves a great idea in the right direction. Simply put, a great idea that doesn’t get noticed by the right audience at the right time is a bit like winking to someone in the dark. You know what you’re doing, but no one else does.

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