ROI realized from pre-bill review of documentation and coding

Posted on by • Posted in Clinical Documentation Improvement (CDI), Health System, Hospital, Hospital Industry, Physician, Return on Investment, Rev Cycle Management, Revenue Cycle • Leave a comment

https://www.healthcarefinancenews.com/news/roi-realized-pre-bill-review-documentation-and-coding

Hospitals can decrease denials by having physicians involved in the mid-revenue cycle review process.

Involving physicians in the mid-revenue cycle process can increase hospital ROI by 700%, according to Enjoin CEO Dr. James Fee.

Hospitals and health systems can improve revenue through a pre-bill review prior to claims submission, according to Fee. Enjoin does this work as a revenue cycle consulting business focused on documentation and coding. 

One of the first things Enjoin physicians check is that the care of the patient has been properly recorded. 

“We’re never taught how to communicate with those who record our work, so it can be captured in the coding system,” said Fee, who continues to practice as a physician in Baton Rouge, Louisiana.

Secondly, hospitals need to check the accuracy of the representation of that patient. 

“You want to make sure the severity of the patient is justified to get appropriately reimbursed,” Fee said.

WHY THIS MATTERS

Documentation and coding falls in the middle of the revenue cycle. Through a pre-bill review of the estimated 30-50% of cases that are chosen for review at this stage because of their complexity, organizations can ensure the documentation supports coding compliance, MS-DRG accuracy, quality performance data and other measures.

Results have shown an impressive 700% percent ROI on average and in some cases, 1,000%, according to Fee. On average, the process shows a 17% decline in denial rates.

Hospitals already have clinical staff in the rev cycle. Physicians add a layer of review. 

“We have practicing physicians who understand the disease process,” Fee said. “We look at a case to make sure the diagnosis is correct. What was the focus of care for that hospital stay? That takes a level of clinical interpretation.”

Enjoin, which has been around for about 30 years, does not offer a software product, but uses an analytics platform. It partners with clients as consultants in a technically agnostic way.  

Fee will speak on the topic “Mid-Revenue Cycle Drives Financial Stability During COVID19: How One Academic Medical Center Prospered,” in-person during the Healthcare Financial Management Association annual conference, Monday, November 8, in Minneapolis. 

AUTOMATION

As revenue cycle directors look to automate, this is more easily done on the front and back ends of the revenue cycle rather than the mid-cycle process, according to Fee. This is one area that will have to wait until AI makes it possible to interpret the data seen by physicians and other clinicians, he said.

“Automation is easy to say as one-stop shopping for an easy solution, but you need to understand what you’re automating,” he said.

There can be an automation component to the prioritization of reviews, something Enjoin plans to bring to market soon.

“Automation will continue to rapidly grow,” Fee said, “but there will always be that people component.”

THE LARGER TREND

As in other areas of healthcare, COVID-19 brought a level of uncertainty about the proper testing and diagnosis recorded in the revenue cycle.

During the most recent wave of COVID-19, many hospital ICU beds were again full, and health systems once again were canceling elective surgeries, with a resulting loss of revenue. 

Higher expenses for labor, drugs and supplies, as well as a continuation of delayed care, are projected to cost hospitals an estimated $54 billion in net income over the course of this year, according to Kaufman Hall analysis released last month by the American Hospital Association.

“The biggest impact for reimbursement was the loss of patient care,” Fee said. “We were in a fee-for-service model and margins were driven by elective surgeries.”

COVID-19 also shifted the commercial dominance of margins to lower-paying government reimbursement as employees lost their jobs, according to Fee.

During the first COVID-19 wave in 2020, CFOs were asking he said, “How do I adapt to that?” Many looked to prevent financial leakage in employing resources they already had. 

“That’s where CDI (Clinical Documentation Improvement) is helpful,” Fee said.

HCA’s profit more than triples to $2.3B in Q3

Posted on by • Posted in For-Profit, Health System, Hospital, Hospital Industry, Net Income, Nonoperating Income, Operating Expenses, Operating Income, Operating Margin, Operating Metrics, Operating Performance, Operating Revenue • Leave a comment
https://www.beckershospitalreview.com/finance/hca-s-profit-more-than-triples-to-2-3b-in-q3.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
HCA's profit more than triples to $2.3B in Q3 - NewsBreak

Nashville, Tenn.-based HCA Healthcare saw strong growth in revenue and profit in the third quarter of 2021 compared to the same period last year. 

The 183-hospital system posted revenue of $15.3 billion in the quarter ended Sept. 30, up 14.8 percent from the $13.3 billion recorded in the third quarter of 2020.

Compared to the third quarter of 2020, HCA said same-facility admissions increased 6.8 percent; emergency room visits increased 31.2 percent; inpatient surgeries declined 4.9 percent; and same-facility outpatient surgeries increased 6.4 percent.

Revenue per equivalent admission increased 5.2 percent because of increases in the acuity of patients and favorable payer mix, HCA said.

After factoring in expenses and nonoperating items, HCA’s net income totaled $2.3 billion in the third quarter of 2021, more than triple the $688 million recorded in the third quarter last year. 

HCA said the results of the third quarter include more than $1 billion in gains on the sale of four hospitals in Georgia and other money from investments. 

For the nine months ending Sept. 30, HCA recorded a net income of $5.1 billion on $43.6 billion in revenue. In the same nine-month period in 2020, HCA saw a net income of $2.3 billion on $37.2 billion in revenue.  

“During the third quarter we experienced the most intense surge yet of the pandemic, and our colleagues and physicians delivered record levels of patient care to meet the demand caused by the delta variant,” said Sam Hazen, CEO of HCA Healthcare. “Once again, the disciplined operating culture and strong execution by our teams were on display. I want to thank them for their tremendous work and dedication to serving others.”

The in-person interactions CEOs prioritize in the workplace

Posted on by • Posted in Communication, Leadership, Leadership Conversation, Leadership Culture, Leadership Listens, Leadership Messaging, Leadership Presence, Pandemic, Sign of the Times, Talent Management, Virtual Hospital, Virtual Work, Virtual Workforce • Leave a comment
https://www.beckershospitalreview.com/hospital-management-administration/the-in-person-interactions-ceos-prioritize-in-the-workplace.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
The Pandemic Conversations That Leaders Need to Have Now - HBS Working Knowledge

A lot of communication in the workplace is conducted electronically. However, it is essential for hospital and health system leaders to have face-to-face conversations with employees in some situations.

Becker’s asked healthcare executives to share the interactions they prioritize when they’re in person at their organizations. Many expressed their preference for the deeper connections in-person interactions allow, citing inspiration and team building as reasons to facilitate face-to-face communication. Below are their responses:

Russell F. Cox. President and CEO of Norton Healthcare (Louisville, Ky.): Healthcare, by its very nature, requires in-person interactions.

With the onset of the COVID-19 pandemic, we made a quick and successful shift to virtual visits for the safety of our patients and providers. This enabled patients with a variety of time and transportation constraints to receive convenient care from a trusted provider. However, telemedicine will never completely replace in-person visits, and the opportunity for our patients and community to interact in-person with our patient care providers is very important to me, and to our team.

And, although the pandemic created the need for virtual meetings, I have always prioritized in-person interactions and meetings with all team members. Whether that be rounding in our  hospitals and facilities, holding in-person meetings, celebrating employee accomplishments or milestones, or dropping by one of our community vaccine or testing centers — web meetings will never replace what can be accomplished face to face. It became even more important to interact in person with our caregivers and employees during the pandemic. It was important to show my support for their hard work and extraordinary sacrifices during this time. I’m thankful that with the vaccine, more in-person events, with proper safety precautions, are resuming.

Our motto has been and continues to be: Stay safe. Keep the faith.

Jim Dunn, PhD. Executive Vice President and Chief People and Culture Officer of Atrium Health (Charlotte, N.C.): Recognition is part of our organizational DNA, and in-person delivery is an essential component of that — especially as we continue working through the COVID-19 pandemic. One thing our teammates love is the “Surprise Patrol,” which we employ for some of our most special and meaningful awards, such as our annual Pinnacle Award — the highest award given by our organization to those who best exemplify our Culture Commitments: Belong, Work as One, Trust, Innovate and Excellence. Executives, leaders, teammates and loved ones come together to celebrate honorees with balloons, cupcakes, cheers and even a few happy tears. Our honorees are shocked, uplifted and proud to be recognized in-person for their outstanding accomplishments, and our “Surprise Patrol” participants are honored to be a part of such a special moment. Whether we’re celebrating small wins, personal successes, birthdays or prestigious awards, in-person recognition — where and when possible — is a vital part of the teammate experience and culture at Atrium Health.

Robert Gardner. CEO of Banner Ironwood Medical Center (Queen Creek, Ariz.) and Banner Goldfield Medical Center (Apache Junction, Ariz.): Over the past few years in particular, I’ve spent some time reflecting on the differences between motivation and inspiration. More often than not, it seems like leaders don’t know the differences and often confuse the two as being synonymous or interchangeable. Put in overly simplified terms, I see motivation as being the metaphorical carrot or the stick. We can motivate with reward (aka the carrot) and with discipline (aka the stick), and both are used frequently in life. Motivation tends to be more surface level. However, inspiration is something much deeper, more intimate, and therefore much more complex. Inspiration is getting to a point of genuinely desiring to change, do more, be better, etc.

For me, knowing the differences is critical when it comes to prioritizing being in person in the workplace. Virtual meetings, emails, newsletters and other forms of electronic communication can work incredibly well when it comes to items of motivation; and believe me, there are plenty of these items. However, when it comes time to inspire the team, I heavily prioritize these meetings to take place in person. Items that fall into this category will be mission-critical initiatives and overall reminders on living our mission, purpose values, etc. It’s so ironic to me that despite the increasing complexity, regulation, bureaucracy and proverbial red tape that healthcare has become famous for, that an inspirational dose of simplicity has more effect on change than any other bestseller leadership book on how to motivate performance through some sort of complicated multistep process.

Brian Koppy. Chief Financial Officer of Cano Health (Miami): As a rapidly growing primary care provider, we have found that face-to-face interactions at our offices are as essential as they are in our medical centers. Our providers provide the best care when they see patients in person because it builds lifelong bonds that improve patient outcomes. In our offices, our team members feel more connected and integrated into the Cano Health family when we are together, both formally and informally. This, of course, does not mean we do not have a flexible work environment, which we do. It simply means our priority is on the employee benefits and outcomes that come from working in the office.

At the beginning of the pandemic, we moved many corporate employees to remote work and moved about 95 percent of our patient interactions to televisits. That did not last long, however. Within a month or two, our employees were asking to come back to the office. Our medical centers never closed their doors, and our visits rapidly returned to mostly in person. 

It’s the seemingly inconsequential daily interactions that often have the greatest impact on a company’s employees and their connection to the mission, values and culture of the organization. The quick stop-ins to someone’s workstation, the chance hallway encounters, the team lunches — these are so important in developing relationships and, in turn, maximizing efficiency. Employees who know and personally interact with each other work better together.  They discuss ideas, they strategize freely, and they execute on the company’s goals together and more effectively. 

At Cano Health, our high-touch approach to primary care is key to our success. And we believe that daily face-to-face interactions among employees are equally important to create a rewarding experience for our employees, but also expanding Cano Health’s services across the country.

Christopher O’Connor. President and incoming CEO of Yale New Haven (Conn.) Health:We are prioritizing one-on-one meetings and small groups. With our vaccination mandate, we feel it is critical to have that in-person contact and fill that void that video can’t replicate. This is a relationship business, and spending the time to build and nurture those relationships is critical.

Thomas J. Senker. President of MedStar Montgomery Medical Center (Olney, Md.): Before and especially during the pandemic our priority has been the well-being and engagement of our front-line staff and essential personnel. And while in-person activities have been limited, our executive team makes regular rounds visiting each unit, expressing gratitude, providing snacks and refreshments, and sharing important hospital updates directly. We believe these face-to-face interactions are critical opportunities to gain feedback and focus on areas of improvement across different areas of MedStar Montgomery Medical Center’s operations.

Pfizer vaccine 91% effective in kids 5-11, study says

Posted on by • Posted in Childcare, Children's Health, Children's Health Insurance Coverage, Children's Hospital, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy • Leave a comment
https://www.beckershospitalreview.com/pharmacy/pfizer-vaccine-91-effective-in-kids-5-11-study-says.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Pfizer says Covid vaccine more than 90% effective in kids

Pfizer’s COVID-19 vaccine is nearly 91 percent effective at preventing symptomatic infections in children between ages 5 and 11, according to a study released by the FDA Oct. 22. 

The study involved 2,268 children given COVID-19 vaccines that are one-third the dosage of the vaccines given to people ages 12 and up. They were given two doses spaced three weeks apart, the same as the adult version of the vaccine. It found that the children developed antibody levels just as strong as older children and adults given the full dosage.

The FDA’s Vaccines and Related Biological Products Advisory Committee is set to meet Oct. 26 to discuss the evidence and vote on whether to recommend FDA authorization for the shots in kids ages 5 to 11. 

The CDC’s vaccine advisory panel is set to meet the first week of November to discuss recommending the shots for the age group. That means shots for kids ages 5 to 11 could be authorized in the first week of November. There are about 28 million children in the age group in the U.S.

The vaccines will come in orange capped vials to make them easily distinguishable from adult doses, according to ABC News.

Find the full study results here. 

The growing burden of mental health on emergency departments

Posted on by • Posted in Access, Access & Quality of Healthcare, Behavioral Health, Deferred Healthcare, Emergency Care, Health Insurance Coverage Adequacy, Health Policy, Health System, Hospital, Hospital Industry, Mental Health, Pandemic • Leave a comment

https://mailchi.mp/9d9ee6d7ceae/the-weekly-gist-october-22-2021?e=d1e747d2d8

The stress, disruption, isolation, and lives lost during the pandemic have exacerbated longstanding challenges in access to mental healthcare. In the graphic above, we highlight how COVID has impacted the state of mental health across generations. 

Younger Americans are faring much worse. This week, the nation’s leading pediatric professional societies declared a national mental health emergency for children and adolescents, and nearly half of “Generation Z” reports that their mental health has worsened during COVID. 

Mental health-related emergency department (ED) visits increased in 2020 across all age groups, with the steepest rise among adolescents. Because of a national shortage of inpatient psychiatric beds, patients with mental health needs are increasingly being “boarded” in the ED—even as nearly two-thirds of EDs lack psychiatric services to adequately manage patients in crisis.

Case in point: research on behavioral health access in Massachusetts shows one in every four ED beds is now occupied by a patient awaiting psychiatric evaluation. ED boarding of patients in mental health crisis not only delays necessary care, but leads to throughput backups in hospitals, and increases caregiver stress and burnout. 

Access to inpatient treatment is most challenged for children and adolescents, as well as “med-psych” patients, who also have significant physical health needs that must be managed. New solutions have emerged during the pandemic: burgeoning telemedicine platforms don’t just increase access to outpatient therapy, they also enable psychiatrists to evaluate emergency patients virtually.

In the long term, a three-part approach is needed—new virtual solutions, expanded inpatient capacity, and greater community resources to address the social needs that often accompany a behavioral health diagnosis.

What to Know About the New Delta Sublineage

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy • Leave a comment

https://www.medpagetoday.com/special-reports/exclusives/95166?fbclid=IwAR2R-mSr-LHmqBo4mnO8HL542LlFsF1vi38PiW8mrohiYNjPu-O55qQk33c

As the now ubiquitous Delta variant continues to mutate, it’s spawned a new descendant that’s spread in the U.K. and made its way to the U.S.

The Delta sublineage, known as AY.4.2, is characterized by two “S-gene mutations” on A222V and Y145H, both located on the gene that encodes the spike glycoprotein of SARS-CoV-2.

CDC Director Rochelle Walensky, MD, acknowledged during the White House’s latest COVID-19 Response Team press briefing that the AY.4.2 sublineage has been identified “on occasion” in the U.S. without increased frequency or clustering to date.

Since August, AY.4.2 with these mutations has appeared in a total of three cases in the U.S.: in California, North Carolina, and Washington, D.C., according to Outbreak.info, which collects COVID-19 sequencing data from GISAID, a global genomic data-sharing initiative.

“At this time, there is no evidence that the sub-lineage AY.4.2 impacts the effectiveness of our current vaccines or therapeutics, and we will continue to follow up,” Walensky said.

Experts think the new Delta sublineage is slightly more transmissible, but say it’s likely less worrisome than its predecessor Alpha or Delta variants, which made bigger jumps in transmissibility. There’s a level of uncertainty over its exact advantage in spreading, however.

“There was a bit of a hope that Delta had, ideally, reached a kind of bound in transmissivity, so that will be a bit of a disappointment,” said Francois Balloux, PhD, computational biologist at University College London and director of the UCL Genetics Institute, in an interview.

Balloux predicted that at some point, almost everyone will be exposed to the “already so bloody transmissible” Delta variant, which makes up around 80% of sequenced cases in the U.K. He said AY.4.2 could be up to 15% more transmissible.

A lower estimate comes from Christina Pagel, PhD, the director of University College of London’s Clinical Operational Research Unit. On Twitter, she said that AY.4.2 could be up to 10% more transmissible: “We don’t know if it’s (a bit) more transmissible than other Delta strains *or* if it just got caught up in some superspreader events that seeded it.” That is, a large gathering of people could have amplified the effect of a strain that wasn’t intrinsically better at spreading.

“No reason to think it’s more immune evasive & might well be nothing. Something to keep an eye on but not panic over,” Pagel added.

The CDC lists AY.1 and AY.2 in its COVID Data tracker, and AY lineages generally under its “Variants of Concern” classification, but does not list AY.4 or AY.4.2 specifically. Balloux said that in the U.K., unlike the U.S., the genetic sequencing effort is nationally centralized. This makes it easier to track variants more quickly and accurately.

AY.4.2 was first spotted this spring in the U.K., where it represents 14,247 cases for a cumulative prevalence of 1% there at the time of publication, according to Outbreak.info.

The U.K. Health Security Agency reported on October 15 that AY.4.2 “is currently increasing in frequency” and that it made up 6% of the sequences analyzed. Balloux estimated that a more up-to-date number would be 7% to 8% because of a week-long lag in sequencing.

Notably, AY.4.2 spreads despite being characterized by S-gene mutations that are not known to make the virus intrinsically more transmissible. “Fundamentally, these are two very boring mutations,” Balloux said.

He clarified that this strain of SARS-CoV-2 is not “Delta plus” because it lacks a different mutation that defined that sublineage.

U.S. Places with Highest Reported Coronavirus Cases per Capita

Posted on by • Posted in Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Unvaccinated, Vaccination, Vaccine, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment

The Pitfalls of Cost Sharing in Healthcare

Posted on by • Posted in Copayment, Cost Sharing, Deductible, Deferred Healthcare, Health Insurance Benefit Design, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, Healthcare Screenings, High Deductible Health Plans, Low Value Care, Out of Pocket Expenses, Outcomes, Preventative Care, Reference Pricing, Unnecessary Care • Leave a comment
The Pitfalls of Cost Sharing in Healthcare
The Pitfalls of Cost Sharing in Healthcare – Health Econ Bot

Cost-sharing is the practice of making individuals responsible for part of their health insurance costs beyond the monthly premiums they pay for health insurance – think things like deductibles and copayments. The practice is meant to inspire more thoughtful choices among consumers when it comes to healthcare decisions. However, the choices it inspires can often be more harmful than good.