Why clinical documentation is the missing link to value-based reimbursement

http://www.beckershospitalreview.com/finance/why-clinical-documentation-is-the-missing-link-to-value-based-reimbursement.html

The key to successfully making the jump from the old era of healthcare — one where fee-for-service is king — to the new era of healthcare — one where transparency, consumerism and value dominate — may actually be as simple as improving clinical documentation, according to Anthony Oliva, DO, vice president and CMO of Nuance Healthcare.

“For those who thought, ‘Maybe we can just hold out and [value-based care] will all go away,’ it’s never going to go away; it’s only going to get worse,” Dr. Oliva said at the Becker’s 2nd annual CIO/HIT + Revenue Cycle Conference in Chicago.

Healthcare is a classic example of a model explained in Ian Morrison’s book The Second Curve, according to Dr. Oliva. This two-curve model posits that any market undergoing transformation has two curves: the old and the new. Companies must ride the first curve and learn how and when to jump to the second, Mr. Morrison explains in the book.

Consumerism and RCM: 3 challenges posed by high deductibles & how to meet them

http://www.beckershospitalreview.com/finance/consumerism-and-rcm-3-challenges-posed-by-high-deductibles-how-to-meet-them.html

As high deductible health plans become more common, patients are becoming the new payers. This puts responsibility back in the hands of the provider to provide a consumer-friendly billing experience and collection strategy to maintain the speed of the revenue cycle management process.

At the Becker’s 2nd annual CIO/HIT + Revenue Cycle Conference in Chicago, the following five panelists discussed the top three challenges of consumerism and how RCM can meet those challenges: Steve Collins, vice president of business development at Zotec Partners; J. Wade Shields, owner and managing partner of Practice Partners; Susan Hawkins, executive director of revenue cycle at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif.; Amanda Cancelliere, vice president of operations and business performance services at McKesson Technology Solutions; and Brooke Murphy, writer/reporter with Becker’s Healthcare.

51 hospitals, health systems with interest-free loan programs

http://www.beckershospitalreview.com/finance/50-hospitals-health-systems-with-interest-free-loan-programs.html

 

Presence Health closes on $1B bond sale

http://www.beckershospitalreview.com/finance/presence-health-closes-on-1b-bond-sale.html

Treat Employees Right So They Treat Customers Right

http://www.forbes.com/sites/micahsolomon/2015/08/17/four-seasons-leader-isadore-sharp-treat-employees-right-so-they-treat-customers-right/#4bd846a85017

Isadore Sharp,  Founder And Chairman, Four Seasons Hotels And Resorts (Photographer: Bryan Mills for Four Seasons)

Isadore Sharp, Founder And Chairman, Four Seasons Hotels And Resorts

Starting from a modest offshoot of his family’s construction business (“The Four Seasons Motor Hotel,” if you can believe that), founder and chairman Isadore Sharp has built one of the great brands and organizations in the hospitality industry, the privately-held Four Seasons Hotels and Resorts, with 93 highly-rated luxury hotels and resorts under management worldwide.

Most impressive to me is that the Four Seasons organization  has been built in alignment with Mr. Sharp’s longstanding commitment to The Golden Rule, to applying this principle of fairness to all of the entities involved in creating their hospitality experience; to quote the Four Seasons corporate framework, “In all our interactions with our guests, customers, business associates and colleagues, we seek to deal with others as we would have them deal with us.”  The success of this approach in employee retention –Four Seasons has one of the lowest turnover rates in the industry–and engagement–Four Seasons has been ranked in the “100 Best Places To Work” for 18 years straight–is evident, and Mr. Sharp also credits this philosophy with allowing Four Seasons to provide what he says is the single most important factor in the success of his company: a superior level of customer service.

Florida scam reveals breadth of compound pharmaceutical billing

http://www.fiercehealthcare.com/antifraud/florida-scam-reveals-breadth-compound-pharmaceutical-billing?mkt_tok=eyJpIjoiTTJNNE9ESmpNR1psWmpWaSIsInQiOiJXOXlcL0xySWFOazE4RUJ3cUNVaWtoMnZ3WVZDMUdQUGlLUmNaemNHZklCMEhJQW1xS01MNE1pRGNXUlpURXBUVGtDOE5nQWxqUmRMZ3BOSGZwT1pDajV4dHRma0hQZ1F4amlFNnBEZGhqdW89In0%3D&mrkid=959610&utm_medium=nl&utm_source=internal

DrugsDrugs

Eight Florida residents were charged last week with billing the federal government more than $633 million for compounded pharmaceuticals over a three-year period, according to the U.S. Attorney’s Office for the Middle District of Florida–events that underscore the intensity of emerging fraud concerns about compounded drugs.

A group of eight co-conspirators, led by Nicholas A. Borgesano—the president of five pharmacies and several medical billing companies in Tampa Bay and Miami—billed Medicare, Tricare and private insurance companies more than $633 million for compounded pharmaceutical prescriptions between October 2012 and December 2015, according to the indictment.

The group was paid more than $157 million for illegitimate prescriptions that were often allegedly the result of elaborate kickbacks. In some instances, the group allegedly misrepresented some claims by billing for certain high-priced ingredients that were not included in the final compounded prescription.

As part of the arrest, authorities confiscated 17 properties, 15 luxury vehicles and several boats.

Earlier this year, federal and state authorities raided pharmacies in four states, including Florida, as part of a widespread bust involving compounding pharmacies. Federal officials have been targeting compounding pharmacies following a spike in high-priced Tricare claims. Investigators and legal experts have said the cases and investigations brought forward thus far are “just the beginning.”

Appeals court reopens whistleblower’s case against Medicare Advantage orgs

http://www.fiercehealthcare.com/payer/appeals-court-reopens-whistleblower-s-case-against-medicare-advantage-orgs?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTTJNNE9ESmpNR1psWmpWaSIsInQiOiJXOXlcL0xySWFOazE4RUJ3cUNVaWtoMnZ3WVZDMUdQUGlLUmNaemNHZklCMEhJQW1xS01MNE1pRGNXUlpURXBUVGtDOE5nQWxqUmRMZ3BOSGZwT1pDajV4dHRma0hQZ1F4amlFNnBEZGhqdW89In0%3D

In a newly issued opinion, a federal appeals court gives a whistleblower another chance to make his case that major health insurers inflated Medicare Advantage risk scores to collect greater government payments.

The Centers for Medicare & Medicaid Services pays Medicare Advantage organizations based on a risk score calculated by measuring a beneficiary’s overall health, with higher payments for sicker patients.

But whistleblower James Swoben claims that UnitedHealth, Aetna, WellPoint, Health Net and physician group HealthCare Partners gamed the system by conducting biased retrospective reviews of medical records already submitted to CMS. Such reviews would violate the False Claims Act.