Healthcare

As discussed in my previous blog post, the IRS is ramping up compliance audits of governmental hospitals who are exempt under 501(c)3. However, the IRS isn’t the only one monitoring your tax-exempt hospital. Other organizations have started policing these requirements.

The Affordable Care Act created the CMS Innovation Center to allow Medicare and Medicaid programs to test innovative payment and delivery models that improve patient care and lower healthcare costs.

The HORNE Healthcare team has been blogging recently about the necessary business model changes we think are inevitable to healthcare transformation. We’ve focused on the macro level, urging healthcare organizations to take action. While I believe our advice is sound for large systems, I am additionally concerned about the pressures physicians are feeling in their practices, particularly in small practices. In this blog, I’d like to introduce three issues I think will be important to physicians going forward. I will write in greater depth on each topic in the coming weeks. 

At a recent national conference, I heard top executives from some of the largest healthcare systems in the country discuss their business models and their healthcare delivery transformation during the past several years. We can count on the Geisingers and the Mayos, as well as other large systems, to lead the way, but I was struck by the extent of their progress towards offering value and outcomes to patients rather than the traditional models present today in many systems. They are doing, quite successfully, what many smaller systems are only beginning to debate. They are proving that new models can deliver better patient care and still be profitable.

Futurists identify hard trends and build prognostications around what will take place. They also use the identification of hard trends to seize opportunities in order to transform businesses. 

Here’s a potentially disturbing statement: “Rural healthcare needs healthcare – not buildings.”

I’ve been watching rural hospitals closely as they cope with the changing healthcare landscape, and I’ve come to believe this statement is true. You might find it disturbing because of its implications – if rural hospitals don’t need buildings, what happens to their staffs, their service, their presence in the community and their stakeholders? And most of all, without a physical presence in a community, what happens to urgent care and its lifesaving role in rural areas? 

2015 was a tumultuous year in many ways. Mergers and acquisitions changed the landscape for both healthcare providers and the insurance industry, and legal challenges to the ACA provided uncertainty. Healthcare organizations continued to move from volume to value as they restructured and addressed costs and service delivery. Improving population health moved from discussion to action in many organizations.

I’ve been thinking about the implications of UnitedHealth Group’s recent announcement to reduce its exposure on the healthcare exchanges.

The company’s CEO Stephen Hemsley said UnitedHealth had sustained heavy losses this year from policies on the exchanges, and as a result, will stop marketing efforts for 2016 plans and will cut commissions to brokers in efforts to limit the number of enrollees in exchange plans next year. He also indicated that the company is considering complete withdrawal from the marketplace in 2017.

As you know by now, the U.S. Supreme Court issued an opinion yesterday allowing subsidies in states using the federal healthcare exchange. In other words, the decision was a big win for the ACA. Details of the opinion in King v. Burwell are available from many sources, so I won’t rehash them here. I plan to discuss the effects of this ruling in greater detail in a later blog. Today, I would like to offer three brief observations from yesterday’s decision.

Are you wondering about the status of your Medicare Disproportionate Share Hospital (DSH) payments in light of the recent Allina DSH court ruling? You’re not alone.  An April 2014 ruling from a U.S. Court of Appeals for the District of Columbia Circuit upheld a previous ruling that a Health and Human Services (HHS) rule change in 2004 (codified in 2007) was procedurally defective. The lawsuit had to do with a rule change the HHS made to determine DSH payments in 2007. The hospitals claimed there was not proper notification. Although the court ruled favorably for the hospitals, what happens next is still unknown. 

The appeals court included instructions in the ruling that gave the HHS room to reach the same policy decision through administrative adjudication. The bad news for providers is that adjudicatory findings can be applied retroactively. The Centers for Medicare and Medicaid Services (CMS) has not yet issued a definitive guideline on how to retrofit the reimbursement fractions for the years in question. 

Earlier this month, the Journal of Accountancy published a detailed article about the shared-responsibility provisions of Section 4980H of the Affordable Care Act. The 3200-word article, titled "The Sec. 4980H assessable payment for large employers," demonstrates how time-consuming and complex traversing the provision can be, and time is running out for employers to determine if they are "applicable large employers" and, more importantly, put the necessary payroll systems in place to comply with the provision.

In this spotlight series we will explore changes to care delivery driven by the Affordable Care Act (ACA) and the increasing sophistication of patients who want health care that is affordable, transparent, and accessible. 

Today the spotlight is on retail medicine. 

Retail medicine is increasing its presence in the U.S. and a variety of health care organizations and analysts are taking notice. First the stats: 

There have been serious, but somewhat quiet experiments going on for years around using bundled care to improve patient outcomes and cut costs. Prepare for some noise as states like Arkansas start figuring out the formula for making it work. The spotlight on bundled care as a potential successor to the Fee-for-Service (FFS) model is getting brighter driven by the Affordable Care Act (ACA) and the search for new payment models that can support the high costs of offering health care benefits to an expanding (and aging) population.