Tag Archives: Health System

What’s eating up cardiovascular service line margins: My ‘top 5’ list

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http://www.beckershospitalreview.com/finance/what-s-eating-up-cardiovascular-service-line-margins-my-top-5-list.html

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Supplier marketing tactics continue to artificially prop up physician and patient demand for high-end products, including some with unintended negative consequences from both a financial and quality standpoint. This has been the situation for decades, but is fast becoming an untenable situation for hospitals—especially those that have failed to calculate the true cost of ownership.

I recently unearthed a reference sheet I penned in 2003, when drug-eluting stents first hit the market, offering steps healthcare providers could take to prepare for the financial impact of the then-new technology. It could just as easily been written about bioresorbable stents now taking hospital finances by storm. My suggestions, in short:

• Do a deep-dive analysis of how supplies are currently being utilized for stent procedures
• Determine the expense of treating patients impacted by the new stent (based on conversion estimates)
• Share the results with your finance team and negotiate carve-outs with payers
• Perform a supply expense projection
• Share the analysis with your physicians
• Combine intelligence gained from physician discussions with expense projection to estimate proportion of patients who will receive the new stent
• Share projections with hospital board of directors
• Develop and implement guidelines for use with medical staff, based on approved uses and clinical studies

But planning for the impact and actually limiting it are two different things entirely. The challenges in preserving cardiovascular service line margins have barely budged over the years, even as the consequences of inaction have grown exponentially. Year after year, a handful of high-end products make headlines with the only certainty being that costs will ramp up 5 to 10 percent. Below are what I see as the five perennial culprits.

California healthcare advocates rally against Trump

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http://www.sacbee.com/news/politics-government/capitol-alert/article116320043.html

California Secretary of State Alex Padilla the Democratic National Convention in Philadelphia on Wednesday, July 27, 2016.

They backed Obamacare, and they’re not letting it go without a fight.

The federal healthcare overhaul could be one of the first casualties of President-Elect Donald Trump, who has joined the Republicans controlling Congress in vowing to dismantle the law. Since winning the presidency Trump has softened his stance somewhat, speaking favorably about popular provisions that prohibit insurers from turning away people with pre-existing conditions and allow people to stay on their parents’ plans until they turn 26.

Still, Trump’s election has California healthcare advocates on high alert, not to mention the state’s new U.S. senator. California could forfeit billions of federal dollars that support Medi-Cal, the insurance program for poor Californians, and subsidize private insurance purchases. They’re worried about the fate of Medicare, a program that Speaker Paul Ryan, R-Wisconsin, said has “serious problems because of Obamacare” and is “going broke.”

 A rally today in Los Angeles offers the latest example of a policy rift between California and Washington, D.C., with elected officials joining healthcare workers and patients for an event billed as a push to “protect our health care.” Among the expected speakers are Senate Health Committee chair Ed Hernandez, D-West Covina, Los Angeles County Health Agency Director Mitch Katz, and California Secretary of State Alex Padilla, whose public denunciations of Trump have become a recurring feature.

BY THE NUMBERS: 13.6 million is the number of Californians enrolled in Medi-Cal as of June 2016, the most recent data available, a net increase of about 800,000 from a year earlier and about double Medi-Cal enrollment a decade ago. The total includes almost 3.4 million people who became eligible for Medi-Cal under the state’s optional Obamacare expansion. The Legislative Analyst’s Office last week reported that Medi-Cal caseload should grow by about 100,000 annually through mid-2021 among families, children and people covered by ACA expansion. Enrollment among senior citizens and people with disabilities will grow by an estimated 50,000.

California Braces For Medi-Cal’s Future Under Trump And The GOP

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California Braces For Medi-Cal’s Future Under Trump And The GOP

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California grabbed the first opportunity to expand Medicaid and ran with it, helping cut the number of uninsured people in half in a few short years.

Thanks in part to billions of dollars in federal funding, a third of California’s residents — including half its children — are insured by Medi-Cal, the state’s version of Medicaid.

Now, with the election of Donald Trump and a Republican-controlled Congress, the state that bet so heavily on the Medicaid expansion is bracing to see how much of its work will be undone. While no one knows yet exactly what will happen, many policymakers and advocates fear the federal government will end or severely limit funding for the expansion.

“There are no easy cuts in Medi-Cal,” said Stan Rosenstein, a former Medi-Cal administrator. Reduced federal funding “could have a major impact on the uninsurance rate, on the viability of our hospitals, and it could have a very negative impact on the economy.”

Medi-Cal cuts could restrict who is eligible for coverage, slash health care benefits, limit access to doctors and reduce payment rates to medical providers — already among the lowest in the nation, health policy experts and advocates said. Medi-Cal covers a host of services for low-income residents, including maternity care, prescription drugs, long-term care services, mental health treatment and hospital stays.

Laurel Lucia, a health care program manager at the University of California, Berkeley Labor Center, said a well-funded Medicaid program benefits everyone, not just those currently on the program.

“A lot of people are just a layoff away from needing Medicaid,” she said. “The Republican plans for Medicaid threaten to undermine that safety net.”

Why Some States Declined to Expand Medicaid

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http://www.definitivehc.com/medicare-cms/why-some-states-declined-to-expand-medicaid?source=newsltr-blog&utm_source=newsletter&utm_medium=email&utm_campaign=11-22-16

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The vast majority of healthcare organizations and professional groups support Medicaid expansion, the Obamacare initiative to widen eligibility for Medicaid to individuals earning up to 138% of the federal poverty level. To them, the benefits of expansion, such as less bad debt and uncollectible bills, better patient access to services, and an overall healthier patient population, outweigh the additional costs for states to bear after the full federal reimbursement period expires. But a subsequent Supreme Court ruling left the decision to implement Medicaid expansion up to the individual states. To date, 31 states and DC have implemented the expansion, the majority of them launching new Medicaid eligibility guidelines starting in 2014. Why hasn’t it been approved in the other 19? Often it is attributed to the state’s dominant political party, but that alone isn’t a reliable indicator, given that red states like Ohio and North Dakota expanded the program, while others like Maine and Virginia did not. Judging from a review of Definitive Healthcare data, there is another possibility: hospitals in non-expansion states were in a better financial position and so there was less political pressure to widen Medicaid eligibility.

Northwell releases 37-point rescue plan for Brooklyn hospitals

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http://www.beckershospitalreview.com/finance/northwell-releases-37-point-rescue-plan-for-brooklyn-hospitals.html

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Northwell Ventures, the consulting division of Great Neck, N.Y.-based Northwell Health, recently released a report that includes a rescue plan for Brooklyn’s distressed community hospitals.

In 2015, the State of New York allocated $700 million to overhaul the healthcare delivery system in Brooklyn, N.Y. In early 2016, the state awarded a grant to Northwell Ventures to prepare a feasibility and sustainability study to identify ways to improve the quality of healthcare in central and northeastern Brooklyn.

Northwell’s recently released report primarily focuses on four financially troubled hospitals in Brooklyn: Brookdale University Hospital and Medical Center, Interfaith Medical Center, Kingsbrook Jewish Medical Center and Wyckoff Heights Medical Center. In fiscal year 2017, the four hospitals will require more than $300 million in state operating assistance to remain open, according to the report.

The 165-page study includes 37 recommendations for the Brooklyn hospitals. Under the plan, the four hospitals would join together to form a new regional health system with a single board. “The market and financial forces confronting these hospitals make it virtually impossible for them to succeed as stand-alone hospitals,” the study reads.

The study also recommends Kingsbrook scale back by consolidating its inpatient services with the Brookdale campus, and moving its behavioral health beds to Interfaith. “From the standpoint of availability of services, it should be noted that Kingsbrook would maintain an emergency department and serve as a location for ambulatory care programs,” the study reads.

In addition to the clinical restructuring of services, the study also includes recommendations to address facility infrastructure deficiencies, develop an expanded ambulatory care network and deploy an enterprise-wide health IT platform.

Nixed Hershey-PinnacleHealth marriage could send them into arms of someone else

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http://www.pennlive.com/news/2016/11/nixed_hershey-pinnaclehealth_m.html

PinnacleHealth System and Penn State Milton S. Hershey Medical Center said a marriage made sense for many reasons.

Not the least of which was to gain size and strength needed to fend off megasystems from outside their traditional service area. Those systems, they said, are positioning to siphon away patients needing the most advanced care, thereby eroding revenues needed to support those services in Harrisburg-area counties.

But the Federal Trade Commission opposed the merger on the grounds it would create a local hospital monopoly, and Hershey and Pinnacle subsequently called off their engagement.

 Still, experts say the forces that pulled the one-time rivals together are real and won’t go away. Those forces have triggered a wave of health system consolidation all over the country. In the Harrisburg region, they have prompted players such as Geisinger Health System, WellSpan Health and the newly-merged Lancaster General Health-University of Pennsylvania Health System to eye the territory traditionally served by Pinnacle and Hershey.

Those systems now surround Pinnacle and Hershey. At the same time, health care has entered an era where health systems are forever trying to attract more patients. That often requires expanding their footprint.

“It’s going to be hard for them to maintain what they’re doing as stand-alones,” said David Sarcone, an associate professor of business management and health studies at Dickinson College.

Stephen Foreman, an associate professor of health care administration at Robert Morris University in Pittsburgh said, “I can’t say I think their positions are all that great right now.”

 

The Future of Health Care Mergers Under Trump

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Though there has been a flurry of merger and acquisition activity in recent years, industry experts are unsure whether the merger momentum will continue under President-elect Donald Trump’s administration, according to The New York Times.

Here are five things to know about how M&A activity in the healthcare industry may be affected under the Trump administration.

1. President-elect Trump nominated Sen. Jeff Sessions (R-Ala.) to replace Attorney General Loretta Lynch. While it is unclear how the department will handle antitrust cases under Sen. Sessions, the impact from the change in leadership will not be felt immediately. The outcomes of the two major antitrust cases in the insurance market, the Anthem-Cigna and Aetna-Humana mergers, are expected to be decided before Mr. Trump takes office in January. However, the new administration might still have an impact on the mergers, particularly if either the companies or the government decide to appeal the decision, according to the article.

2. According to the article, there is little expectation the Department of Justice under President-elect Trump would drop the cases if the insurers lost and appealed. However, any agreed upon settlement deal may be less onerous to the insurers involved.

3. There is a chance the federal government’s approach to healthcare mergers may not change, according to the article. “There is a history of bipartisan support for antitrust enforcement in healthcare,” said Leslie Overton, a partner at Alston & Bird and a former DOJ official. “I don’t think we should expect a wholesale shift, based on the change from Democratic to Republican.”

4. The Federal Trade Commission’s position on M&A activity may change even less, according to industry experts interviewed by The New York Times. The independent agency is less subject to the political preferences of the president and of Congress.

5. Industry experts also suggest the possible repeal of the ACA will not impede the increasing M&A activity of the past few years. According to the article, hospitals may feel more pressure to join together if the ACA is repealed due to reduced Medicare and Medicaid payments and increased volumes of uninsured patients.

Pence says Trump plans to repeal ACA right ‘out of the gate’

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http://www.beckershospitalreview.com/hospital-management-administration/pence-says-trump-plans-to-repeal-aca-right-out-of-the-gate.html

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President-elect Donald Trump has decided repealing the ACA will officially be among his top priorities when he takes office, Vice President-elect Mike Pence told Chris Wallace on Fox News Sunday.

“Decisions have been made by the President-elect that he wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare with the kind of free market solutions that he campaigned on,” Mr. Pence said on Fox News.

The Trump-Pence transition team has been working with congressional leaders from both political parties to move Mr. Trump’s “aggressive policy agenda” forward, Mr. Pence said. This weekend Mr. Pence met with Senate Minority Leader Chuck Schumer, D-N.Y., Senate Majority Leader Mitch McConnell, R-Ky., House Minority Leader Nancy Pelosi, D-Calif., and House Speaker Paul Ryan, R-Wis., according to the interview.

Later on the show, Fox News spoke with Sen. Schumer, who said the ACA is one of the issues on which Democrats plan to “oppose [Mr. Trump] tooth and nail.” Sen. Schumer said Mr. Trump would not be successful in his efforts to repeal the healthcare reform law.

“He won’t be able to do it, because now even he, after his meeting with President Obama, said, ‘Oh, I want to keep the good things.’ Well, you can’t keep the good things without keeping [the] ACA,” Sen. Schumer told Fox News.

Scott Becker, publisher of Becker’s Hospital Review, says it is still unclear if Mr. Trump can or will be able to push through an ACA repeal. “It’s a fascinating statement because it’s not clear Republicans have the votes to repeal this without making complicated accommodations on a few levels, particularly for preexisting conditions and some funding issues,” Mr. Becker says.

Fitch: ACA repeal would be credit negative for hospitals

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http://www.beckershospitalreview.com/finance/fitch-aca-repeal-would-be-credit-negative-for-hospitals.html

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http://www.businesswire.com/news/home/20161109006033/en/Fitch-Trump-Victory-Rattles-Healthcare-Industry

 

8 key strategies for improving a hospital’s margins

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http://www.beckershospitalreview.com/hospital-management-administration/8-key-strategies-for-improving-a-hospital-s-margins.html

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As healthcare shifts toward value-based care, hospitals are looking for new ways to improve quality without unnecessarily increasing the cost of care.

“We think less about cost cutting and more about margin improvement,” says Allen Miller, CEO of COPE Health Solutions. “Folks are going to be more successful taking a strategic approach and focusing on improving margins by taking risks and building the type of infrastructure that will support value based contracts through which they take financial risk instead of the traditional cost-cutting approach.”

Here are some key strategies for financial success: