Posts Tagged ‘reimbursement’

Infographic: Using Technology-Enabled Communications To Address Revenue Cycle Challenges

September 22nd, 2017 by Melanie Matthews

Healthcare providers are missing opportunities to drive timely payments, grow revenue and maximize reimbursements, according to a new infographic by Televox.

The infographic examines the revenue opportunities that healthcare providers are missing and how providers can avoid penalties and earn additional reimbursement.

Since the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM. Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare’s existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

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HINfographic: Chronic Care Management’s Path to Patient-Centered Care Coordination

December 2nd, 2015 by Melanie Matthews

A commitment to chronic care management (CCM) not only offers providers additional revenue via Medicare Chronic Care Management reimbursement but also can be a stepping stone to patient-centered care models like the medical home or accountable care organization (ACO). An inaugural Chronic Care Management survey by the Healthcare Intelligence Network captured current trends in chronic care management.

A new infographic by HIN examines current trends in Medicare chronic care management reimbursement.

2015 Healthcare Benchmarks: Chronic Care ManagementThe desire to improve health outcomes for individuals with serious illness coupled with opportunities to generate additional revenue have prompted healthcare providers to step up chronic care management initiatives. The Centers for Medicare and Medicaid Services now reimburses physician practices for select chronic care management (CCM) services for Medicare beneficiaries, with more private payors likely to follow suit.

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. Click here for more information.

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7 High-Impact Ideas to Prioritize Prevention

February 22nd, 2013 by Jessica Fornarotto

Reimbursement for prevention efforts and employer engagement are among seven high-impact recommendations from the Trust for America’s Health (TFAH) to prioritize prevention and improve the health of Americans.

“A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years”, a new TFAH report, illustrates the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective.

The report outlines top policy approaches to respond to studies that show that more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented; and also that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents.

The seven recommendations documented in the report are:

  1. Advance the nation’s public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities;
  2. Ensure insurance providers reimburse for effective prevention approaches both inside and outside the doctor’s office;
  3. Integrate community-based strategies into new healthcare models, such as by expanding ACOs into accountable care communities;
  4. Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs;
  5. Maintain the prevention and public health fund and expand the community transformation grant program so all Americans can benefit;
  6. Implement all recommendations for each of the 17 federal agency partners in the National Prevention Strategy; and
  7. Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs.

“A Healthier America” also features more than 15 case studies from across the country that show the report’s recommendations in action.

The report also includes recommendations for a series of 10 key public health issues: reversing the obesity epidemic; preventing tobacco use and exposure; encouraging healthy aging; improving the health of low-income and minority communities; strengthening healthy women and healthy babies; reducing environmental health threats; enhancing injury prevention; preventing and controlling infectious diseases; prioritizing health emergencies and bioterrorism preparedness; and fixing food safety.

New Video Documents ACO Activity: Accountable Care Doubles in Last Year

July 17th, 2012 by Patricia Donovan

Along with bundled payments, the accountable care organization would be the healthcare model to watch in 2012, predicted healthcare consultant Steven T. Valentine late last fall.

And as this new ACO video from the Healthcare Intelligence Network can attest, The Camden Group president knew what he was talking about. According to 200 healthcare companies who took the HIN ACO survey in May, participation in accountable care organizations doubled in the last year.

The survey also found that today’s ACO is leaner and more efficient, with more physicians at the helm than hospitals and less time necessary to get the ACO up and running.

For the uninitiated, ACOs create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. Built into the ACO model is a business opportunity: provide a focal point of care while attaining health and cost containment goals.

The bundled payment method referenced by Valentine refers to the practice of aligning payments for services delivered across episodes of care or “bundled” care.

Narrated by HIN COO and Executive VP Melanie Matthews, HIN’s second annual ACO analysis delves into ACO administration, size, and the model’s impact on healthcare utilization and care delivery. And in case you missed Valentine’s forecast last fall, his comments are included here.

If you prefer to read an executive summary of the survey results, download it here. A more detailed analysis is available in the HIN bookstore.

Are Payment Tides Turning for Primary Care?

July 16th, 2012 by Patricia Donovan
Primary Care Pay

Value-Based Payments

Several indicators this month point to more dollars flowing into primary care offices, either in the form of higher provider salaries, increased reimbursement, or both. And new market data finds physicians leading the majority of accountable care organizations (ACO).

A study released last week by Medical Group Management Association found that median pay for primary care physicians (PCPs) grew 5 percent last year to $212,840, capping a five-year increase of 16.7 percent from 2007 to 2011. While an actual PCP paycheck pales next to a specialist’s, of note is MGMA’s finding that PCP compensation grew at a faster rate than specialist pay over the last five years.

The reimbursement stage is being set for patient-centered care delivery models like the patient-centered medical home and the ACO that put a premium on care coordination, with many payors offering a combination of traditional fee for service (FFS) payment topped off with a care coordination fee, with possibly a little shared savings thrown in to sweeten the payment pot.

Sixty-one percent of respondents to the sixth annual HIN 2012 Patient-Centered Medical Home survey reported they operate under an FFS plus care coordination fee model.

And earlier this month, CMS proposed payment increases for family physicians of approximately 7 percent and for other practitioners providing primary care services of between 3 and 5 percent. As it has in other initiatives resulting from healthcare reform, the proposed rule offers additional financial incentives for care coordinated during critical transitions in care, such as when a patient is discharged from the hospital:

For 2013, CMS is proposing for the first time to explicitly pay for the care required to help a patient transition back to the community following a discharge from a hospital or nursing facility. The proposals calls for CMS to make a separate payment to a patient’s community physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay.

Dr. Carrie Nelson, medical director of special projects for Advocate Physician Partners (APP), lauds CMS’s proposal. “It’s a long time coming that that kind of recognition has translated into reimbursement for primary care physicians,” notes Dr. Nelson, a family physician herself. “I know first-hand the amount of work that goes into making sure your patients aren’t falling through the cracks and getting the care they need in an efficient manner, especially after a hospitalization or major clinical situation.”

However, it’s critical that those dollars given to primary care for care coordination actually go toward that function, Dr. Nelson cautioned, and that quality measures are established in parallel with this funding. “There’s a risk that these funds could be seen as ‘new money,’ she said. “I think primary care feels undervalued and underpaid, and there is some validity to that. But at the same time, reimbursement for care coordination may not translate into actual care coordination unless there are some quality measures associated with that in order to make sure that the dollars go toward the purpose for which they were intended.”

With eight years of clinical integration (CI) under its belt, involving more than 4,000 physicians and 10 hospitals, APP can speak from experience. Its nationally recognized CI effort has achieved record performance in almost all measured areas, resulting in improved patient outcomes and significant cost savings. The CI program laid the groundwork for a value-based payment contract between APP and Blue Cross Blue Shield of Illinois. Dr. Nelson will share lessons learned from contract implementation during a July 18, 2012 webinar, Bending the Cost Curve with a Commercial Value-Based Payment Contract.

Self-Examination: Industry Questioning Necessity, Cost Irregularities of Healthcare Services

May 2nd, 2012 by Cheryl Miller

Regardless of whether the Supreme Court overhauls health reform, the industry is seriously thinking about ways to cut healthcare spending, either by reexamining the need for commonly administered services or unraveling the mysteries of medical bills.

As we reported in a recent news story here, a coalition of nine leading physician specialty societies representing nearly 375,000 physicians have identified specific tests or procedures that they say are commonly used but not always necessary in their respective fields.

Coordinated by ABIM Foundation’s Choosing Wisely campaign, the lists of “Five Things Physicians and Patients Should Question” provide specific, evidence-based recommendations physicians and patients should discuss when making healthcare decisions. Among the tests that patients might not necessarily need are stress imaging tests for annual checkups if the patient is an otherwise healthy adult without cardiac symptoms, according to the American College of Cardiology, and chest X-rays for patients going into outpatient surgery, according to the American College of Radiology. Most of the time, the x-ray images will not result in a change in management and have not been shown to improve patient outcomes, college officials say.

A recent opinion piece from the New York Times echoes the feeling that more evaluation of health services and costs is necessary, and sheds some light on the abundance of medical tests. The article, Why Medical Bills are a Mystery, written by Robert S. Kaplan and Michael E. Porter, professors of accounting and strategy, respectively, at Harvard Business School, states that:

The lack of cost and outcome information also prevents the forces of competition from working: Hospitals and doctors are reimbursed for performing lots of procedures and tests regardless of whether they are necessary to make their patients get better. Providers who excel and achieve better outcomes with fewer visits, procedures and complications are penalized by being paid less.

The article goes on to cite a lack of uniformity for healthcare costs and reimbursements, and suggests that by analyzing costs, hospitals can save money and improve care:

Because health care charges and reimbursements have become disconnected from actual costs, some procedures are reimbursed very generously, while others are priced below their actual cost or not reimbursed at all. This leads many providers to expand into well-reimbursed procedures, like knee and hip replacements or high-end imaging, producing huge excess capacity for these at the same time that shortages persist in poorly reimbursed but critical services like primary and preventive care.

A new University of California San Francisco (UCSF) study published online this week in Archives of Internal Medicine underscores the concerns voiced by Kaplan and Porter:

The study looked at nearly 20,000 cases of routine appendicitis at 289 hospitals and medical centers throughout California. The patients – all adults – were admitted for three or fewer days. The researchers uncovered an enormous discrepancy in what different hospitals charge, ranging from a low of $1,529 to a high of nearly $183,000. The median hospital charge was $33,611. The startling cost variation reveals a “broken system,” the authors said.

“Consumers should have a reasonable idea of how much their medical care will cost, but both they and their healthcare providers are often unaware of the costs,” said lead author Renee Y. Hsia, MD, an assistant professor of emergency medicine at UCSF.

What to do? The Journal of the American Medical Association (JAMA) weighed in on ways to cut waste and improve quality in U.S. healthcare. In a recent article researchers identified six categories where cuts could result in a significant reduction in healthcare costs. In these six categories: overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse, the sum of the lowest available estimates exceed 20 percent of total healthcare expenditures.