Healthcare

Home healthcare enables many patients to receive appropriate medical attention from the comfort of home. Patients utilizing these services also enjoy considerable cost savings in comparison to a hospital setting, proven research of better health, and reduced stress for the patient and family. Home health agencies (HHAs) treat patients who may only require a short-term need for care, as well as patients who may need long-term treatment for illnesses such as diabetes, heart disease, and pulmonary disease.

Historic times are taking place in the healthcare industry.  Are you going to stay on the sidelines or are you going to get in the game? 

Yesterday’s sessions at the HFMA Region 9 Conference in New Orleans reinforced two key themes:

While attending the Healthcare Financial Management Association Region 9 Conference in New Orleans, we learned that bundled payments are near and healthcare facilities should start preparing now.   

Bundled payments consolidate reimbursement into a single payment for the care and services related to a specific procedure or episode along the continuum of care. These payments are designed to incentivize the coordination of care among various health care providers, such as physicians, hospitals and post-acute care facilities, as well as to emphasize accountability for the cost and quality of care provided to patients. The Centers for Medicare and Medicaid Services estimates that by 2016, 30 percent of Medicare payments will be value-based and will expand to nearly 50 percent by 2018.   

On Nov. 2, President Obama signed the Bipartisan Budget Act of 2015 (H.R. 1314).  One of the more significant provisions, aside from the suspension of the national debt ceiling and aversion of a government shutdown, is the matter of site-neutral payments, the antithesis of the site-of-service differential. This legislation is not completely unexpected, as MedPAC has recommended for quite some time that payment differentials should be eliminated. 

Clinically Integrated Networks (CINs) are gaining traction in many areas of the country, but the concept of clinical integration isn’t new. The terminology pre-dates the ACA by over a decade, as the FTC coined the term in 1996 in its Statements of Antitrust Enforcement Policy in Health Care. Today’s CINs, however, have a different look and feel than one of their more common predecessors, the Physician-Hospital Organization (PHO). The PHO similarly attempted to integrate hospitals and physicians through hospital sponsorship and physician membership, but most PHOs never reached the levels of financial and clinical integration necessary to accept risk-based payer contracts. Today’s CINs, spurred on by ACA reforms and the gradual shift from fee-for-service payment models, are making strides in collaboratively increasing the quality of care while reducing costs.

Healthcare reform has undoubtedly created more integrated delivery and payment models based on a culture of quality-focused and cost-efficient clinical management. In one example, many healthcare systems have begun implementing clinical co-management arrangements (“CCMAs”) to accomplish the physician alignment and integration required to achieve these goals. 

If I had to guess, I’d say you are reading this on your iPhone, iPad, Galaxy or some other mobile device. I’m not clairvoyant; research shows more than half of all emails are opened on mobile devices. It’s likely that if you use tablets or smart phones, you use them in almost every facet of your life from communicating with your friends, family members and work associates to helping with homework, paying bills and working from home. Fortunately, the security built into the systems is generally adequate for most of your personal needs. 

As a healthcare consumer, I feel an urgency to do my part to decrease unnecessary cost and improve quality. As a member of HORNE's Healthcare team, I have a greater understanding of why our healthcare system cannot continue in its current state and I've learned that reducing variation and eliminating waste is our “how”; however, since I am not a healthcare provider, my impact is limited in what I can do as a patient as I view my own healthcare, and the care of my loved ones, through a new lens. 

Among the models found in the healthcare market, joint ventures (JVs) can benefit organizations that have an interest in pursuing a service together. Examples of services operated in JVs include the following:

Recently, thousands of medical transcripts detailing the medical histories of children and adults, as well as notes made by doctors and psychiatrists, were publicly listed on an Internet search engine. Without proper encryption, confidential and extremely personal information was exposed to anyone who wanted to access it.

Today’s urgent care center has become a highly regarded primary care delivery model, sought after by physicians, group practices, hospitals, and management companies because of its unique appeal to providers and patients and its prospects for continued profitability. With busy emergency rooms and longer wait times for primary care clinic appointments, the urgent care center (UCC) gives low-acuity patients a convenient option for affordable primary care. For physician groups, the UCC appeals to the suburban market segment and patients who prefer a no-appointment-necessary format and short wait time for minor injuries or illnesses. For hospitals, the UCC relieves expensive emergency departments and represents a primary care entry point into the system.

Have you taken a look lately at the statistics that tell the story of the future of health care in the U.S.? It’s sobering. The outdated payment model is just one part of the challenge. Between baby boomers retiring and overloading the system with aging patients that need more care, and the doctor pipeline dwindling, there is a fundamental need to change the delivery model before it crashes. 

C-Suite executives and physicians are inundated with accounts of qui tam litigation and settlements with the Department of Justice over hospital payments to physicians, which serve as a reminder of the risks of payments in excess of FMV. Without going into a detailed legal analysis, it’s safe to say that in most transactions and compensation arrangements between hospitals and physicians who have the ability to refer patients to the hospital, FMV is a requirement for compliance with the most often used exceptions under the Stark law and safe harbors provided by the federal anti-kickback statute.