FURTHER MEDICARE EXPANSION COULD DIMINISH HOSPITAL REVENUES, BUT ACTION REQUIRED

https://www.healthleadersmedia.com/finance/further-medicare-expansion-could-diminish-hospital-revenues-action-required?utm_source=silverpop&utm_medium=email&utm_campaign=ENL_190321_LDR_FIN%20(1)&spMailingID=15334448&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1601649422&spReportId=MTYwMTY0OTQyMgS2

Medicare for All

Potential Medicare expansion plans would drastically impact the financial standing of health systems, though some may be more pragmatic solutions than others.


KEY TAKEAWAYS

Implementing Medicare for All as a single payer healthcare system is estimated to create a 22.1% negative impact on a mid-size regional provider’s net margin.

However, a voluntary buy-in plan, also known as ‘Medicare for more,’ might result in only a slight dip to the net margin compared to the status quo.

Regardless, some amount of legislative action regarding Medicare expansion will be necessary in the next five years, according to the study’s authors.

Hospital and health systems should remain aware of the financial impact that several Medicare expansion proposals could have on their respect organizations, according to a Navigant study released Friday afternoon.

Fresh off the 2018 midterm elections where healthcare played a critical role in the electoral shift that saw Democrats retake the House of Representatives, 2020 presidential candidates are heralding sweeping policy proposals to expand coverage through Medicare. 

While several versions of Medicare for All legislation exist, other policy proposals such as ‘Medicare for more’ or the public option have drawn consideration from lawmakers as potentially more viable or pragmatic solutions to America’s healthcare problems.

In its analysis, Navigant found a medium-sized, nonprofit, multi-hospital system with revenues of more than $1 billion and a current operating margin of 2.3% would endure vastly different financial implications under several proposed federal healthcare policy changes.

Medicare for All would reduce revenues by around $330 million, a margin drop of just over 22%, the public option proposal would cause revenue declines in the neighborhood of $153 million, a margin impact of -6.3%, and the ‘Medicare for more’ expansion plan is estimated to have a neutral impact compared to the status quo.

Still, Navigant’s study points out that if Congress does not act on Medicare expansion until after the next presidential election, hospitals could face a scenario with a financial impact comparable to the public option proposal.

Using the model health system as an example, status quo projections without any cost reduction initiatives would see the organization’s net margin decline from 2.3% to negative 6.2% from 2018 to 2023, with operating costs rising between 4.5% to 5% per year and revenues growing at 2.5% to 3% per year.

“There’s going to be a need to control hospital cost structures going forward, regardless of whether it’s in the status quo with baby boomers aging into Medicare and payer mix shifts occurring, or in a scenario that has limited expansion, moderate expansion, or robust Medicare for All,” Jeff Leibach, director at Navigant, told HealthLeaders in an interview. “There are obviously varying degrees of impact on hospitals, but all of them are going to require a level of attention and and management of revenue strategy and cost structure that I think hospital CFOs are struggling with today and will benefit from through continued focus on performance improvement and revenue strategy.”

PLANS, DETAILS, AND IMPACT:

‘Medicare for more’

  • Voluntary buy-in at age 50 and over
  • In one scenario, choice between employer coverage and Medicare
  • No Medicare payment relief
  • No reduction in revenue cycle management operations compared to the status quo
  • 15% reduction in current disproportionate share hospital payments

Public option

  • All lives covered regardless of age
  • Choice between employer coverage and Medicare
  • Range from no Medicare payment relief to payments at 110% of Medicare rate
  • 1.5% reduction in revenue cycle management operations compared to the status quo
  • 70% reduction in current disproportionate share hospital payments

Medicare for All

  • All lives covered regardless of age
  • Single payer healthcare coverage
  • Range from no Medicare payment relief to payments at 120% of Medicare rate
  • 2.5% reduction in revenue cycle management operations compared to the status quo
  • 100% reduction in current disproportionate share hospital payments

Leibach said that the analysis arrives at the early part of the conversation surrounding widespread Medicare expansion at the federal level, which makes it difficult to gauge how health system leaders will react to Navigant’s findings.

Some may be hesistant to support plans that are projected to create such a negative material impact on their respective bottom lines, but others may be willing to consider a policy proposal that significant decreases or even eliminates bad debt costs associated with a large uninsured population.

Even before the report was released, however, the American Hospital Association declined to voice support for Medicare for All late last month. 

Leibach added that he was surprised by the “nominal impact” of the voluntary buy-in plan, arguing that could hospital leaders may rally around that proposal as a compromise to expanding Medicare without fully deteriorating their financial standing.

This approach would also be the least disruptive to the commercial insurance market, according to Leibach, assuming that the Medicare for All proposal would be a true single-payer platform that eliminates private insurers.

 

 

 

 

WHAT’S TO KEEP AMAZON FROM COMPETING IN BRICK-AND-MORTAR HEALTHCARE? NOT MUCH

https://www.healthleadersmedia.com/strategy/whats-keep-amazon-competing-brick-and-mortar-healthcare-not-much

Amazon could join retail clinics already competing with hospitals and health systems to provide outpatient healthcare services.


KEY TAKEAWAYS

Amazon’s launch of new ‘urban grocery stores’ could serve as a possible beachhead for expansion into outpatient medical care services.

Amazon plans to offer goods besides food in the grocery stores, creating a potential entry point for it to get into brick-and-mortar retail healthcare.

Even in a digital age where more services are headed online, e-commerce retail giant Amazon could be poised, alongside retail healthcare clinics, to compete with hospitals and health systems on their brick-and-mortar playing fields.

And there’s little preventing Amazon from doing this, especially after news the company is looking to launch new “urban grocery stores,” which could serve as a possible beachhead for expansion into outpatient medical care services. Amazon would join retail providers Walgreens, CVS Health, and Walmart, which are competing already with hospitals and health systems to provide outpatient services in their communities.

This potential competition to hospital outpatient business comes as CVS is testing a “HealthHub” store concept in Houston following its acquisition of health insurer Aetna, and as Walgreens is dedicating armies of Microsoft scientists to a “store of the future.” Analysts expect these retail clinics to change the way U.S. healthcare is delivered, which includes efforts to give patients less need to use the hospital and its ancillary outpatient services.

And why not Amazon as well?

“Amazon’s basic approach has been to create a transactional platform that supports an ecosystem of interrelated products and services,” says Ken Kaufman, managing director and chair of consulting firm Kaufman Hall. “Adding brick-and-mortar stores to its online platform will support Amazon’s grocery business and its competition with Walmart but could be applied to other products and services, including healthcare, which is very much on Amazon’s radar.”

Amazon last year acquired the online pharmacy PillPack and formed a new venture recently named Haven with Berkshire Hathaway and JPMorgan Chase to examine ways to lessen the cost of care and improve health outcomes for the three corporate giants’ 1.2 million employees. Amazon’s announcements don’t directly impact hospitals and health systems, though analysts say Amazon, like Walmart, has a laboratory in its large workforce to test what works.

For now, Amazon “plans to launch urban grocery stores that could offer a spectrum of goods that include beauty products alongside food,” as The Wall Street Journal reported. Amazon declined HealthLeaders‘ request for comment on its plans.

But Kaufman sees this as a potential entry point for Amazon to get into brick-and-mortar retail healthcare, given its history to add on services over time from the successful platforms.

For example, Amazon in recent years has opened brick-and-mortar bookstores in New York, Chicago, and Washington, D.C. Earlier this month, Amazon said it is closing 87 of the pop-up kiosk variety stores in malls and Kohl’s stores, but it is maintaining Amazon Books and Amazon “4-star” stores that are largely stand-alone sites.

Amazon is looking at a grocery store model that includes leases with more flexibility than traditional commercial leases, as the Journal reported. That could allow Amazon to jump into healthcare services more quickly.

Though it’s unclear what kind of healthcare services and products Amazon could offer, Kaufman thinks that there’s not much keeping Amazon from exploring brick-and-mortar healthcare delivery in the future.

“It is always difficult to predict the long-term intentions behind Jeff Bezos’ short-term moves,” Kaufman said.

“The more comfortable Amazon gets with physical commerce, the easier it will be to pivot toward healthcare,” he added.

 

 

 

CHI Franciscan settles antitrust case: 5 things to know

https://www.beckershospitalreview.com/legal-regulatory-issues/chi-franciscan-settles-antitrust-case-5-things-to-know.html?origin=cfoe&utm_source=cfoe

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An antitrust lawsuit filed by the Washington state attorney general against CHI Franciscan will not go to trial, according to the Kitsap Sun.

Five things to know:

1. The lawsuit, filed in 2017, alleged Tacoma, Wash.-based CHI Franciscan’s affiliation with two physician groups in Kitsap County raised healthcare prices and decreased competition.

2. “Both transactions also enabled CHI Franciscan to capture more patient referrals and shift services to its wholly owned hospital, Harrison Medical Center, the only civilian acute care hospital in Kitsap County,” states an August 2017 press release from the Washington state attorney general’s office. “The transactions have hobbled CHI Franciscan’s competitors while allowing it to reap the benefit of more expensive, hospital-based rates.”

3. A trial in the case was slated to begin March 19 but was called off March 15 after the parties notified the court that the matter was resolved.

4. Specifics about the settlement have not been released. The parties have until April 29 to file documents outlining the settlement and requesting the case be dismissed, according to the Kitsap Sun.

5. A CHI Franciscan spokesperson told the Kitsap Sun that the settlement will ensure the health system’s affiliations with the two physician groups remain in place.

“This is good for patients and doctors on the peninsula, keeps our highly skilled doctors in our community, and ensures everyone has access to great care close to home,” the spokesperson said.

Access the full Kitsap Sun article here.

 

 

7 blockchain companies to know in 2019

https://www.beckershospitalreview.com/healthcare-information-technology/7-blockchain-companies-to-know-in-2019.html

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Healthcare leaders are all on different pages when it comes to blockchain. Nonetheless, tech companies continue to invest their efforts in blockchain.

Here are seven top blockchain companies to know in 2019, according to digital media website Coindoo.

1. IBM

2. Intellectsoft Blockchain Lab

3. LeewayHertz

4. Innovecs

5. MLG Blockchain

6. Coinfabrik

7. Empirica Software

To read the complete report, click here.

 

 

 

Industry Voices—This is the real issue that should be driving the national healthcare conversation

https://www.fiercehealthcare.com/hospitals-health-systems/industry-voices-real-issue-should-be-driving-healthcare-conversation?mkt_tok=eyJpIjoiTUdFNU9UQTFaV1U1TWpsayIsInQiOiJuOXFyQVwvWGx0NUFJdnhjK0ZEZ0ZwamdmMU8wXC9ZWkNPZkMydnJIOHR4eW9mT0RJVmphWGd5b3F4aFB6RTZaOG8yU21uZm91UVJFUGU4UWxBXC9DdXdoaWIwTFRFYW53dTlRWVwvRUs1dUN4WWtONjF1ZEJJemVCM2ZnQURGWnB1Z1EifQ%3D%3D&mrkid=959610&utm_medium=nl&utm_source=internal

Healthcare is traditionally one of the top issues voters say they want Congress to address. This year, the sentiment has intensified. From presidential town hall meetings to congressional hearings to recent public opinion polling, an overwhelming majority of Republican and Democratic voters want Congress to address rising healthcare costs.

But employers and their employees have more at stake than just the cost of utilizing a drug or service, the narrative that is driving today’s healthcare discussion in Congress.

Indeed, employers are at a crossroads in addressing the critical issue of healthcare costs. The fact of the matter is that most employers have no idea how their benefit programs affect employee health outcomes. While it sounds logical that employers understand the link between the benefits they purchase and their employees’ long-term health status, they don’t. Most employers manage their benefits program in separate silos with a single-minded focus only on short-term costs.

When employers focus only on unit costs and transactions in healthcare, employees are undertreated and employers overpay.

Instead of a short-term cost approach, designing healthcare benefits that align the interests of employees and employers around health, and focus on connecting employee health status, care options and outcomes will help employers attain the ultimate goal of a healthy, productive workforce that drives business value for the company.

Employers are recognizing the urgency of this choice but aren’t yet doing enough to address it. If employers don’t start doing a better job of purchasing benefits that help keep employees healthy and productively at work, in part through effective treatment of manageable diseases, our future global competitiveness will be greatly challenged.

For example, better use of medicines can improve health and overall quality of life, which can lead to improved productivity from lower disability and fewer missed days of work. A study found adults with multiple sclerosis that improved medication adherence by 10 percentage points decreased the likelihood of an inpatient or emergency room visit by 9% to 19% and days of work lost by 3% to 8%. Another study found that for workers with asthma or chronic obstructive pulmonary disease, better medication adherence resulted in less time out of work and more than $3,100 in savings on average per worker annually.

Yet, time and again when it comes time to decide on benefits coverage, the choice offered to employers by payers centers on the cost of therapy and not the value it delivers.

What should employers do to define the best path ahead? We believe that when it’s time to negotiate benefits packages with payers, employers must take a more holistic approach to foster key components of healthy, productive workers by addressing the following guiding principles:

  • The health and well-being of a workforce is a long-term investment for employers.
     
  • Tangible outcomes for both employers and employees should be clearly defined and include input from both stakeholder communities.
     
  • Benefits should be designed to optimize positive outcomes (both health-related and readiness for work) for the heterogenous population of covered lives.
     
  • Employers should be able to access data to see both unit cost and total cost of care for any given mix of interventions. Employers should evaluate currently available data to define gaps and call on vendors to aid in bridging those information voids.

As price and upfront cost continue to dominate the headlines, a substantive policy conversation among all different healthcare stakeholders about what constitutes value is needed. Without such inclusive dialogue, the value narrative will continue to revolve solely around “whether to pay or not to pay” for a particular intervention. For employers at the crossroads who know that determining value isn’t a binary exercise, the correct path forward is focusing on a definition of value that includes broader outcomes and recognizes the heterogeneity of covered lives.

Our employees depend upon it.

 

 

 

 

SURVEY SAYS POPULATION HEALTH INITIATIVES ARE STALLING

https://www.healthleadersmedia.com/innovation/survey-says-population-health-initiatives-are-stalling

Population health initiatives are stalling

Numerof’s annual report indicates some disturbing trends are emerging in industry’s progress to new models of care. Financial loss, culture, and cancelation of mandatory bundled pricing programs may be to blame.

While healthcare executives agree that population health is essential, most organizations are dragging their feet when it comes to embracing these new models of care, according to The State of Population Health Fourth Annual Numerof Survey Report.

The report, produced by global healthcare consultancy Numerof & Associates in partnership with David B. Nash, MD, MBA, founding dean of the Jefferson College of Population Health at Jefferson in Philadelphia, is based on surveys and interviews conducted with more than 500 C-Suite healthcare executives between August and October 2018.

PROGRESS HAS STALLED

While 94% of respondents agree that population health is the future, and 99% predict that they will have revenue in upside gain/downside risk models in the next two years, the majority of respondents in risk-based agreements report that 10% or less of revenue came through such contracts. Compared to earlier surveys conducted by Numerof, this measure remains flat and fell significantly short of the projections by previous respondents regarding how much revenue would be at risk in 2018.

A Numerof executive posits that the absence of external pressure may be partially responsible for the stall in population health initiatives, but warns that that outside forces may change the game.

“Healthcare delivery organizations may breathe a sigh of relief as policymakers ease the pressure for change, but their comfort should be short-lived, as a slew of nontraditional competitors like Amazon, JPMorgan, Berkshire Hathaway, Apple, Google and others are on the prowl,” said Michael Abrams, managing partner of Numerof & Associates in the news release. “A $3 trillion industry with a deeply dissatisfied customer base is attracting a wave of innovation from entities that aren’t beholden to the old ways of doing business.”

OTHER KEY FINDINGS

The report also provides other details:

  • Financial loss is the largest barrier to assuming risk. Nearly 25% of respondents cited financial loss as the biggest challenge for adapting to models based on risk. Other roadblocks include challenges related to changing the culture. In addition, policy uncertainty at the federal level also may contribute to hesitancy. “The cancellation of several mandatory bundled pricing programs in favor of voluntary versions has raised questions about the future of value-based care, just as many administrators were beginning to accept it as inevitable,” according to a news release.
  • Smaller organizations are behind. The survey indicates 90% of large hospitals had at least one contract based on risk, compared to the 71% of smaller organizations.
  • Despite some progress, cost and quality management is lacking. When asked about management in cost variation, 61% of respondents rated their organization as average or worse than average. This reflects an improvement of only 8% over three years.

“Healthcare is an industry in transition, but the resistance to necessary change is deeply entrenched,” said Numerof President Rita Numerof, PhD in the release. “Rather than embracing new models that they perceive as risky and difficult to manage, providers are trying to muddle their way through as long as possible.”

METHODOLOGY

Numerof’s fourth annual State of Population Health survey report summarizes online responses gathered between August to October 2018 from more than 500 executives in urban, suburban, and rural locations across the United States. Open-ended interviews with select executives provided deeper insights. Participants include physician group executives and vice presidents, as well as individuals working in U.S. provider organizations including healthcare systems, hospitals, and academic medical centers. Respondents represent a wide range of delivery organizations, including standalone facilities, small systems, and IDNs; for-profit, not-for-profit and government institutions; and academic and community facilities.

 

 

 

4 hospitals file for bankruptcy in Oklahoma, Kansas

https://www.beckershospitalreview.com/finance/4-hospitals-file-for-bankruptcy-in-oklahoma-kansas.html?origin=rcme&utm_source=rcme

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Four hospitals in Oklahoma and Kansas, all owned by affiliates of EmpowerHMS, filed for Chapter 11 bankruptcy on March 17.

Three of the four hospitals that filed for bankruptcy are in Oklahoma. According to the bankruptcy petitions for Fairfax (Okla.) Community Hospital, Drumright (Okla.) Regional Hospital and Haskell County Community Hospital in Stigler, each hospital entered bankruptcy with less than $50,000 in assets and at least $1 million in liabilities. Drumright Regional has upward of $10 million in estimated liabilities.

Oswego (Kan.) Community Hospital, which abruptly closed Feb. 14, also entered bankruptcy on March 17. It is the third hospital in Kansas owned by Kansas City, Mo.-based EmpowerHMS that has filed for bankruptcy in recent weeks. Hillsboro (Kan.) Community Hospital and Horton (Kan.) Community Hospital entered Chapter 11 bankruptcy earlier this month.

Two other hospitals owned by EmpowerHMS — Lauderdale Community Hospital in Ripley, Tenn., and Washington County Hospital in Plymouth, N.C. — have entered bankruptcy since late February.