Tag Archives: Health System
What Recruiters Look for in a Clinician Executive
The ranks of physicians and nurses in the C-suite are growing, but aspiring leaders must be prepared for strategic roles.
Lack Of Medicaid Expansion Hurts Rural Hospitals More Than Urban Facilities
http://khn.org/news/lack-of-medicaid-expansion-hurts-rural-hospitals-more-than-urban-facilities/
It isn’t news that in rural parts of the country, people have a harder time accessing good health care. But new evidence suggests opposition to a key part of the 2010 health overhaul could be adding to the gap.
The finding comes from a study published Wednesday in the journal Health Affairs, which analyzes how the states’ decisions on implementing the federal health law’s expansion of Medicaid, a federal-state insurance program for low-income people, may be influencing rural hospitals’ financial stability. Nineteen states opted not to join the expansion.
Rural hospitals have long argued they were hurt by the lack of Medicaid expansion, which leaves many of their patients without insurance coverage and strains the hospitals’ ability to better serve the public. The study suggests they have a point.
Specifically, the researchers, from the University of North Carolina Chapel Hill, found that rural hospitals saw an improved chance of turning a profit if they were in a state that expanded Medicaid — while in city-based hospitals, there was no improvement to overall profitability. Across the board, hospitals earned more if they were in a state where more people had coverage and saw declines in the level of uncompensated care they gave.
To put it another way: All hospitals generally fared better under the larger Medicaid program, but there’s more at stake for rural hospitals when the state expands coverage.
A 20-year lookback: Has the hospitalist movement actually improved patient care?
http://www.nejm.org/doi/full/10.1056/NEJMp1607958?query=featured_home&
http://www.nejm.org/doi/full/10.1056/NEJMp1608289?query=featured_home
In the last 20 years the healthcare industry has welcomed a new type of specialist that focuses on the general medical care of hospitalized patients. Since the concept was first introduced in 1996, 75 percent of U.S. hospitals now employ these hospitalists and the field has grown to 50,000 physicians.
And the specialty continues to expand with more physicians becoming post-acute care hospitalists and laborists.
But is hospital care better for it? That’s a question The New England Journal of Medicine explores in two new articles in recognition of the 20th anniversary of the field.
In many instances, hospitalists do add value to improve quality, safety and innovation,writes Robert M. Wachter, M.D., a professor at the University of California, San Francisco School of Medicine, and Lee Goldman, M.D., who works for the College of Physicians and Surgeons, Columbia University, New York, in the first commentary. And they believe that the model is the best way to guarantee hospitals provide high-quality, efficient inpatient care.
The model has led to reductions in length of stay, cost of hospitalization and readmission rates, but there are challenges.
“Although hospitalists have been leaders in developing systems (e.g., handoff protocols and post-discharge phone calls to patients) to mitigate harm from discontinuity, it remains the model’s Achilles’ heel,” they write.
7 ways Stark and Anti-Kickback laws hurt hospital care coordination
Click to access barrierstocare-full.pdf
Anti-kickback and anti-fraud regulations, such as the Stark Law, have the unintended consequence of major barriers to care coordination, according to a new report from the American Hospital Association (AHA).
The passage last year of the Medicare Access and CHIP Reauthorization Act (MACRA) removed one regulatory barrier to care but called on legislative groups to make recommendations for removing other similar obstacles. The AHA report identifies seven barriers created by the Anti-Kickback Statute and Stark Law. These barriers, according to the report, obstruct:
- The sharing of electronic health records
- Incentives for efficiency and effective treatment
- Collaboration to ensure coordinated care at discharge
- Assistance for patients to keep themselves healthy after returning home
- Assistance with discharge planning
- Alignment of incentives in services of better outcomes
- Rewards for team-based care that incorporates non-physician clinicians
The report also calls for numerous legislative solutions to these obstacles. For example, Congress should develop “safe harbors” under the Anti-Kickback law, both to protect shared savings and incentive programs and to develop the assistance patients need to recover. Current rules on safe harbors and exceptions, the report states, “are not in sync with the collaborative models that reward value and outcomes.” Legislators should also refocus the Stark Law to align it with its original purpose of regulating compensation agreements, report authors write.
The report comes around the same time as a report from the Senate Finance Committee on ways to improve the Stark Law. The suggestions range from establishing new exceptions and waivers for risk revenue to loosening current restrictions on waivers. Others consulted for the report, however, argued that expanding exceptions would only further complicate the regulatory framework and repealing the law entirely would be a better option.
Hospitals still confronting RAC backlogs
Hospitals continue to contest a large proportion of claims denied by recovery audit contractors (RACs) through the multi-level appeals process, and a backlog of claims continue to clog federal administrative law courts.
According to the most recent data from the American Hospital Association’s RACTrac Survey of 676 hospitals nationwide, 45 percent of denials were appealed through the second quarter of 2016, with 56 percent of those appeals related to inpatient coding denials. That’s down slightlyfrom the first quarter, where 47 percent of denied claims were appealed.
The average dollar value of an automated denial–which are caught through computer algorithms–is $741. Complex denials involve far more money, with an average dollar value of $5,418.
Meanwhile, the appeals process remains sluggish. Nationwide, three-quarters of survey respondents said that administrative law courts have taken longer than the mandated 90 days under federal statutes. In the Upper Midwest, 93 percent of hospitals say the process has taken longer than 90 days. Altogether, 27 percent of all appeals ever filed by hospitals since the RAC program began in 2010 continue to be sitting in the appeals process. In 2014, the feds briefly suspended the program after the number of claims being appealed topped 350,000.
Last year, the Centers for Medicare & Medicaid Services (CMS) offered to settle the backlog of appeals involving disputed short-stay hospital stay for 68 cents on the dollar, for a total settlement of about $1.6 billion.
Nevertheless, hospitals have enjoyed considerable success in the appeals process, with 60 percent of appeals leading to a denial being overturned.
Still, the financial burden of appealing a RAC denial is fairly costly. Twenty-percent of hospital said during the second quarter they spent at least $10,000 on administrative costs related to addressing RAC issues; 12 percent spent more than $25,000, 7 percent spent more than $50,000, and 5 percent spent more than $100,000.
IRS taking harder look at non-profit hospitals
The Internal Revenue Service (IRS) is ratcheting up surveillance of non-profit hospitals regarding their levels of community benefits and patient financial assistance.
The IRS reviewed 692 hospitals in fiscal 2016, which ended late last month, Bloomberg BNA has reported. Of those, 166 were referred for a closer “field examination.” The increased scrutiny is specific to 501(r) requirements under the Affordable Care Act, which mandate that hospitals formulate clear written financial assistance policies for patients and make reasonable efforts to determine if patients are eligible for assistance prior to taking any collection actions. The IRS is supposed to review each hospital every three years.
The U.S. Treasury Department issued regulations as to how the rules are to be enforced in 2014. Penalties for non-compliance include being subject to an excise tax or even losing a tax exemption entirely.
“We’ve entered into the enforcement phase now,” Donald B. Stuart, a partner with the law firm Waller Lansden Dortch & Davis LLP told Bloomberg BNA. “We’ve just moved into this new phase and new stage of 501(r), which is going to be a little bit of a wake-up call for a lot of people.”
The hospital sector has pushed back on enforcement, saying that some of the requirements were too burdensome.
Red flags included a hospital’s lack of a community health needs assessment or financial assistance guidelines. Hospitals that are out of compliance risk being audited, which can lead to other issues, such as scrutiny of unrelated business income.
ICD-10 turns 1: Was it so bad?
http://www.healthcaredive.com/news/icd-10-turns-1-was-it-so-bad/427115/
R51: headache. Gearing up for the switch from ICD-9 to ICD-10 last October, many providers expected nothing but headaches. The new system increased the number of diagnostic codes from around 13,000 to about 68,000, requiring clinicians to sift through highly specified conditions — and some unusual ones, such as W61-62XD: struck by duck.
But after a year of using the ICD-10 — and the impending end of a one-year grace period that ensured providers wouldn’t be denied Medicare Part B claims as long as they used a code from the correct family — most physicians say the implementation process went better than expected.
“The fear that this was really going to impact us financially because of the potential inability to process the new codes really never transpired,” says Michael Munger, a family physician with Saint Luke’s Medical Group in Overland Park, KS, and president-elect of the American Academy of Family Physicians.
In fact, the error rate for claims tracked by the AAFP was the same this year as it was for ICD-9 — 10%. The fact that commercial insurers didn’t have the grace period bodes well for the loss of flexibilities, since doctors should be used to being more specified in their claims.
Joint Commission addresses workplace violence in healthcare
- The Joint Commission established an online resource center to prevent workplace violence in healthcare settings.
- The Workplace Violence Prevention Resources page on the Joint Commission website offers access to presentations, newsletter articles, research reports and blog posts detailing strategies for preventing workplace violence.
- The resource center was established as part of a partnership with the Occupational Safety and Health Administration.
The Joint Commission workplace violence resource was established in response to growing rates of violence in healthcare settings. Outside of law enforcement, healthcare is the most violent industry in the nation and healthcare workers face more non-lethal violence than employees in any other industry.
Workplace violence in healthcare settings could be even worse than statistics show. A study published in the New England Journal of Medicine found incidents of violence against providers are under reported. Providers often excuse violent behavior when they are under the influence of drugs and alcohol or who are otherwise in an altered state of mind.
Hospitals in particular face various challenges when it comes to preventing workplace violence. Several physicians working in hospitals told Healthcare Dive in the past about the difficulty of gauging a patient’s capacity for violence during triage and to screen for weapons.
There are seven states with laws requiring employers to run workplace violence prevention programs and 26 states with laws covering assaults on nurses, but no federal laws that specifically address workplace violence in healthcare settings. Establishing an online resource center is a small first step by the Joint Commission.
The case of the disappearing hospital beds
http://www.healthcaredive.com/news/the-case-of-the-disappearing-hospital-beds/427211/
Click to access 2016chartbook.pdf
Healthcare is leaving the traditional four walls of hospitals. As patients, payers, and providers seek to reduce costs and improve quality, they are relying less on inpatient stays and more on outpatient services. A growing reliance on outpatient services could drive healthcare costs down as costly inpatient services are increasingly reserved for patients who truly need them.
HENRY KOTULA 