Tag Archives: Health System
This telemed app aims to replace the patient visit entirely
Failed merger won’t stop Mass. hospital from $200M expansion
20 things to know about balance billing
http://www.beckershospitalreview.com/finance/20-things-to-know-about-balance-billing.html
As payers and providers wage war over reimbursement rates for medical services, patients have been increasingly strapped with unanticipated healthcare bills that can have detrimental financial effects.
The practice of balance billing refers to a physician’s ability to bill the patient for an outstanding balance after the insurance company submits its portion of the bill. Out-of-network physicians, not bound by contractual, in-network rate agreements, have the ability to bill patients for the entire remaining balance.
Balance billing may occur when a patient receives a bill for an episode of care previously believed to be in-network and therefore covered by the insurance company, or when an insurance company contributes less money for a medical service than a patient expected.
In recent years, the rise in out-of-network payer-provider reimbursement clashes have spawned a growing number of balance billing cases. Last October, Aetna discouraged members from seeking emergency medical care at in-network Allegheny Health Network hospitals in Pittsburgh after out-of-network emergency physicians began ‘aggressively’ balance billing policy holders. In a more drastic move, UnitedHealthcare announced last year the insurer would no longer cover medical bills for members who unknowingly received out-of-network treatment by physicians at in-network hospitals.
Patients, caught in the financial crosshairs, often feel powerless to negotiate costs. Consumer advocacy groups and federal and state legislators are turning their attention to balance billing practices this year with renewed vigor, forcing payers and providers to find other ways to settle financial disagreements.
50 things to know about Epic and Judy Faulkner
With roots dating back to 1979, Epic Systems has become a major player in the health IT world.
The vendor has achieved this status without going public, and without significant marketing efforts.
Epic is one of the biggest EHR providers for hospitals and health systems nationwide. As of March 2015, it was the third most commonly used EHR among hospitals and health systems participating in meaningful use, according to data from CMS. Additionally, a September KLAS report found Epic was one of just two vendors that did not lose any clients in 2014 (athenahealth was the other).
Here are 50 things to know about Epic Systems and the woman behind it all.
10 states with the costliest employer-sponsored health insurance
The Agency for Healthcare Research and Quality recently released data from its Medical Expenditure Panel Survey, a large-scale study of families, individuals, providers and employers in the U.S. concerning the cost and use of healthcare and health insurance.
Here are the 10 states with the costliest employer-sponsored health insurance in 2015, listed with the average single premium per enrolled employee at private-sector organizations:
INTERIM HEALTHCARE CHIEF RESTRUCTURING OFFICER (CRO) – A CEO’S MOST POWERFUL ALLY DURING TRANSFORMATION
http://www.jacksonexecutives.com/2016/07/19/interim-healthcare-chief-restructuring-officer-cro/
When the survival of the organization is at stake and things have reached crisis proportions, traditional chief restructuring officers are a solid option and best fit. A CRO immediately brings credibility and objectivity to the restructuring process, while stabilizing the ranks and quickly devising a plan to lead the turnaround.
Confidence builders and skilled communicators, they bring deep financial and industry-specific experience. This allows them to identify the root cause(s) of under-performing organizations, and to work in concert with CEOs to transform organizations from the inside out using strong strategic and negotiation skills.
iFHP cost report highlights cause for concern over lack of provider competition
The International Federation of Health Plans (iFHP) today released its2015 Comparative Price Report, detailing its annual survey of medical prices per unit. Designed to showcase the variation in healthcare prices around the world, the report examines the price of medical procedures, tests, scans and treatments in seven countries.
The report undercuts the idea of what’s being played out in the recent Sutter Health case which alleges the health system is overcharging insurers causing medical costs to be pushed downstream to patients. Last Friday, the suit was allowed to seek class-action status. Matthew Cantor, partner and attorney at Constantine Cannon and lead lawyer for the plaintiffs, told Healthcare Dive the plaintiffs allege to have contracts which require health plans to purchase all the hospital services that Sutter provides in Northern California.
Sutter is “leveraging its larger power in those markets to say to these health plans that they have to also purchase Sutter Health hospital services elsewhere and not only do they have to purchase them but they have to purchase those Sutter services at higher, super competitive prices,” Cantor said, adding that this, in turn, raises the costs of medical services to health plans. These higher costs, Cantor said, are then sent downstream to insurance policyholders.
“Competition is not working,” Sackville told Healthcare Dive. “The market’s not working because if it was, no one would get away with charging $17,000 [for a day of hospital care].”
The report put a focus on the lack of provider competition and consolidation. There’s been a fair amount of consolidation in various states and more systems are pursuing the idea of mergers or partnerships. Such activity, in theory, could bring down competition in an area and tick up costs for consumers as hospitals’ market power grows. “Powerful hospital systems have the ability to raise the prices of medical care. Health plans have no alternative but to take these forced, higher costs upon them because [if they refused] then no one would buy their insurance,” Cantor told Healthcare Dive.
Kaiser Permanente promotes 2 execs to lead largest divisions
Kaiser Permanente, one of the biggest health care systems in the country, has promoted two executives to run its largest regions: Northern California, with roughly 4 million enrollees, and Southern California, with 4.2 million.
Together, the two Golden State units cover 77 percent of Kaiser’s 10.6 million enrollees nationally.
Janet Liang, currently the unit’s chief operating officer, was named president of the Northern California region. Kaiser said her current job will be folded into the new one.
Julie Miller-Phipps takes on the same role in Southern California.
Healthcare spending will make up 20% of U.S. economy within a decade
Healthcare spending will comprise 20 percent of the U.S. economy by the middle of next decade, according to new data from the Office of the Actuary of the Centers for Medicare & Medicaid Services and published in Health Affairs.
Expenditures on healthcare services will grow at an average rate of 5.8 percent per year between 2015 and 2025, about 1.3 percent higher than projected annual growth in the U.S. gross domestic product, CMS concluded. By 2025, healthcare spending will comprise 20.1 percent of the U.S. economy, up from 17.5 percent in 2014. Expenditures totaled $3.2 trillion last year.
Despite the seemingly robust spending growth, it remains lower than the 8 percent annual growth clip that occurred in the two decades before the Great Recession of 2008, which helped to slow expenditures significantly. In 2015, spending grew at a 5.5 percent rate. This year, it is projected to be 4.8 percent, attributable in part to the slower expansion of newly insured under the Affordable Care Act.
“The Affordable Care Act continues to help keep overall health spending growth at a modest level and at a lower growth rate than the previous two decades. This progress is occurring while also helping more Americans get coverage, often for the first time,” said CMS Acting Administrator Andy Slavitt in a statement.
HENRY KOTULA 