Healthcare

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.

The 1989 movie Field of Dreams is one of my favorite baseball movies. In it, an Iowa farmer hears a mysterious voice tell him, “If you build it, he will come.” The voice is talking about building a baseball field in the middle of an Iowa cornfield to attract the ghosts of the Chicago White Sox players banned from baseball for throwing the 1919 World Series. The ghosts appear, including the farmer’s father, and so do thousands of spectators.

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.   

The ambulatory surgery center (ASC) market has seen a lot of growth and success since first arriving on the scene over 40 years ago. While the ASC market has grown significantly over this time, that growth has slowed in the last 10 years and ASCs now appear to be operating in a “maturing” market. At the same time we are seeing rapid change in the market where ASCs operate and many of these changes may have a significant impact on the value of ASCs. Below are some of those areas that could have tremendous impact on ASC values.

A major change to pension plan reporting takes place in fiscal year 2015 that could become a significant headache for governmental hospitals if they don’t get started now preparing for it. The ramifications of GASB 68 are substantial enough without the stress of waiting too long to prepare. Here’s why: 

For twenty years, the 340B program administered by The U.S. Department of Health and Human Services administration (HHS) has helped safety-net providers to stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services. Over the past few years, with the passing of the Affordable Care Act (ACA), the number of qualifying health care entities (and patients) has grown. So have the number of contract pharmacies that can disperse 340B drugs to patients.

The program expansion has caused pharmaceutical companies to lobby for changes and clarifications to 340B. This has resulted in much political upheaval and the promise of mega changes to the program that were supposed to materialize this summer. That didn’t happen. But the program is definitely under scrutiny, so that means it’s important to document your 340B  transactions and understand the compliance requirements around this program.

Here’s what you need to know now about 340B to make sure your hospital or clinic is in compliance:

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: 

Many rural hospitals are struggling in the new health care marketplace. Reimbursement from government and (soon) private payors is now more dependent on providing a collaborative and leaner process that rewards reducing variations in patient care and treatment in the appropriate setting. Additionally, hospitals in states that have opted out of receiving Affordable Care Act (ACA) funding face increased costs with no funding to cover them.