Healthcare

MACRA’s anticipated future impact on the healthcare industry has many provider organizations contemplating what actions and resources are necessary to participate in alternative payment models (“APMs”). Provider organizations facing the immediate options of getting involved with a CMS or commercial APM have significant operational decisions to make that will impact the future make-up of their organizations. Today we will discuss some of the considerations in preparing for APM participation.

Think you can’t afford to invest in a cost-accounting system? The truth is, you can’t afford not to. As Medicare and other payers increasingly tie payments to value, understanding and reducing your cost structure will become an even more urgent priority.

Community Health Needs Assessments (CHNA), unfortunately for many, are conducted simply to fulfill the Section 501(r) of the Internal Revenue Code which requires a tax-exempt hospital to conduct a CHNA. Also, community health assessment is a prerequisite of public health accreditation under PHAB standards. As we have discussed in a previous blog, a hospital’s CHNA can achieve so much more than fulfilling a regulatory obligation.

Healthcare providers face $42 billion in cuts in 2018 under Medicare’s traditional fee-for-service program. Those payment rate reductions, which were put in place by the Affordable Care Act, are scheduled to cut deeper with each year—from $53 billion in 2019 to $86 billion in 2022.

Last week, the WannaCry ransomware attack hit over 150 countries and infected tens of thousands of systems worldwide. Among those victimized were England’s National Health Service, automobile manufacturers, and government systems. The worm’s ominous red ransom screen, informing the user that all files have been encrypted, was found on only on users’ desktops, but also on ATM screens, parking meters, digital billboards, and industrial control systems.

The post-acute care (PAC) sector is a target for significant change. Facing criticism of excessive spending, the sector is facing an overhaul of the payment system that, when it finally arrives, could disrupt the healthcare landscape once again.

With health care spending growth still increasing, the Medicare Payment Advisory Commission (MedPAC or the Commission) continues to pursue its mission to advise US Congress on the Medicare program and its costs, which ultimately are borne by all taxpayers.

As high deductibles and escalating costs drive patients to take a more active role in their health care, providers are waking up to the fact that they need to pay attention to what buyers want. But uncovering those consumer insights and using them to drive organizational strategy remains a challenge for most providers.

One of the first words that come to mind when I think of medical care is hygiene. Let’s face it, poor hygiene practices in a healthcare provider’s facilities can cause major issues and possible loss of life. Consumers of healthcare services, trust that their provider is taking every precaution possible to protect them from disease or infections that can occur if proper hygiene is not practiced. 

Last week’s sudden pull of the American Health Care Act from House vote caused uncertainty around what’s next for the healthcare industry. This week, the AHLA Institute on Medicare and Medicaid Payment Issues, brought together key representatives from CMS, hospital associations and healthcare lawyers from around the nation. Here are three Medicare/Medicaid insights on current and upcoming issues:

As discussed frequently in compliance and health care conferences and forums and on this page, fair market value (FMV) of payments to referring physicians is an essential compliance requirement of the Stark law and federal anti-kickback statute. Physician compensation in excess of FMV is at the crux of much health care enforcement activity. As noted by Richard Kusserow, former Inspector General, “Arrangements with physicians are the highest compliance risk area in 2017” (“Kickback Cases Remain Top DOJ and OIG Priority in 2017,” Strategic Management Services, LLC; Jan. 2017). Mr. Kusserow further explained that whistleblowers are a significant source of enforcement activity.

Consider a small U.S. town that doesn't have local access to a cardiologist. The community can't support one on a full-time basis, so the hospital brings in a cardiologist twice a month. The physician pays to use the hospital's facilities, equipment, support staff and nurses during those two days. Patients are able to access the specialized care they need without having to travel, and the physician pays only for the space and support that he or she needs.

A long time ago (the mid-90’s), there was a television series titled Highlander. It was a sci-fi action series whose main character, Duncan MacLeod, hailed from a race of immortals. The opening voice-over would end with the proclamation, “There can be only one!” You see, these immortals sought each other out until it was the “last man standing.” Duncan was a force for good that battled other immortals of darkness. Each episode featured an epic battle that ended with Duncan annihilating his immortal foe, whose power transferred to Duncan.