Tag Archives: Hospital

ACA repeal makes hospitals more vulnerable to closure

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http://www.fiercehealthcare.com/healthcare/hospital-closures-aca-repeal-makes-organizations-more-vulnerable?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiTldOaE1tUXlaRFUxTlRrMyIsInQiOiJVUFpNQ0tIKzF1c1pzU0gzbVpuaTNMdE8wbHUxY09LWW1mN1hoaHJ4QnVtVzdOWUExOXNqUXhPZkxTaUUwcFpHWW9ib21QdkRxanU1TzhRMXltUUNZN2dFdVdhSnpJWWpKbTVhMGkzSmlWT3R5UDVhMTJQUXhwSlF3eXNKT1VsRyJ9

hospital hallway

Millions of insured Americans could lose health insurance coverage if Congress and the new White House administration make good on their threat to repeal the Affordable Care Act. But they aren’t the only victims.

Many hospitals could also close as a result of the legislative action and the loss of government funds and increase in uninsured Americans who need care.

And these potential closures only add to the growing problem of vanishing hospital beds, according to a Bloomberg report. Indeed, more hospitals have shifted their focus from inpatient to outpatient care for financial reasons, acquiring or opening stand-alone facilities, physician practices and retail clinics.

“It’s been a very tough environment for hospitals,” Jason McGorman, a Bloomberg Intelligence analyst, said in the piece. “They have to get into other areas and businesses to free up cash and generate better margins than inpatient care, which has become a slow-growth business.

Drug companies to face fines for overcharging 340B hospitals: 4 things to know

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http://www.beckershospitalreview.com/finance/drug-companies-to-face-fines-for-overcharging-340b-hospitals-4-things-to-know.html

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HHS’ Health Resources and Services Administration has finalized a rule that sets civil monetary penalties for drug manufactures that overcharge healthcare organizations that are part of the 340B Drug Pricing Program.

Here are four things to know about the final rule.

1. The final rule requires drug manufacturers to calculate the 340B ceiling price on a quarterly basis. The rule includes the methodology manufacturers must use when estimating the ceiling price for a newly covered outpatient drug.

2. Under the final rule, drug manufacturers that intentionally overcharge a covered hospital will face civil monetary penalties. HRSA can fine a manufacturer up to $5,000 for knowingly and intentionally overcharging a 340B hospital for drugs purchased through the program.

3. HRSA clarified that a drug manufacturer that overcharges a hospital for drugs purchased through the 340B program would not face penalties if the manufacturer made an “inadvertent, unintentional or unrecognized error in calculating the ceiling price.” A manufacturer would also be deemed not to have the requisite intent if it “acted on a reasonable interpretation of agency guidance,” or “has established alternative allocation procedures where there is an inadequate supply of product to meet market demand, as long as covered entities are able to purchase on the same terms as all other similarly situated non-340B covered entities.”

4. The final rule is effective March 6. Since the effective date falls in the middle of a quarter, HRSA said it plans to begin enforcing the requirements of the final rule at the start of the next quarter, which begins April 1.

Hospital uncompensated care costs fall to lowest level in 26 years: 4 things to know

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http://www.beckershospitalreview.com/finance/hospital-uncompensated-care-costs-fall-to-lowest-level-in-26-years-4-things-to-know.html

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From 1990 through 2015, U.S. hospitals’ uncompensated care costs totaled $704.7 billion, according to a recent American Hospital Association report.

To calculate a hospital’s uncompensated care costs, the AHA combined the hospital’s bad debt and financial assistance costs. The uncompensated care figure does not factor in Medicare or Medicaid underpayments or other contractual allowances.

Using that formula, the AHA has calculated national uncompensated care costs from 1990 through 2015.

Here are four things to know about hospital uncompensated care costs, according to the AHA report.

1. In 1990, total uncompensated care costs were $12.1 billion, representing 6 percent of total hospital expenses.

2. Although total uncompensated care costs steadily increased from 1990 to 2000, the costs consistently represented about 6 percent of total expenses. During that period, uncompensated care costs represented the smallest percent of total expenses in 1992 at 5.9 percent and the largest percent in 1999 at 6.2 percent.

3. From 2000 to 2015, national uncompensated care costs fluctuated, reaching a high of $45.9 billion in 2012, which represented 6.1 percent of total expenses.

4. In 2015, total uncompensated care costs were $35.7 billion, representing 4.2 percent of total expenses — the lowest level in 26 years.

The #1 thing you need to know from the 2017 JP Morgan Healthcare Conference: Follow the money

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http://www.beckershospitalreview.com/hospital-management-administration/the-1-thing-you-need-to-know-from-the-2017-jp-morgan-healthcare-conference-follow-the-money.html

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If you want to understand the future of the $3 trillion U.S. healthcare industry, the lesson of the past is to ‘follow the money.’ And no one would argue that the place to do that is the infamous JP Morgan Healthcare Conference taking place this week in San Francisco.

While there are an estimated 4,000 people attending the conference, there’s roughly another 20,000 here for ‘off the grid’ meetings in every nook and cranny you can find. It is a surreal atmosphere in the form of the top executives from more than 450 private and public companies in biotech, pharmaceutical, medical device and technology, as well as healthcare providers, payers, private equity and venture capital firms and investment banks. Simply stated, this is where medicine’s flow happens.

With that said, roughly $1 trillion or one-third of annual U.S. healthcare spend flows through hospitals and healthcare delivery systems. So, if you want to understand what’s happening now and what will happen in the future, a good place to start is in the nonprofit healthcare provider track, where CEOs and CFOs of over 20 of our nation’s largest healthcare delivery systems presented their strategic plans in rapid fire 25-minute presentations.

Together these organizations represent over $100 billion or 10 percent of that $1 trillion spend. Incredible. The average organization presenting had over $6 billion in annual revenue, 15 hospitals, close to 30,000 employees and thousands of physicians on staff. Many of the name brands in healthcare including Downers Grove, Ill.-based Advocate Health Care, Irving, Texas-based CHRISTUS Health, Cleveland Clinic, Detroit-based Henry Ford Health System, Salt Lake City-based Intermountain Healthcare, Indianapolis-based IU Health, Oakland-based Kaiser Permanente, Cincinnati-based Mercy Health, New York-Presbyterian, Chicago-based Northwestern Medicine, Northwell Health in Great Neck, N.Y., and Robert Wood Johnson Barnabas Health based in West Orange, N.J., presented along with leading children’s hospitals such as Children’s Hospital of Philadelphia and innovative physician focused models such as Marshfield Clinic in Wisconsin and Geisinger Health System in Danville, Pa.

This provided an incredibly important snapshot of both the ground level view of what’s happening in the real world today as well as the bets being placed for the future. What follows is a high-level perspective of what was shared by these prominent provider organizations.

So, follow the money…and here’s the Top 10 Trends shaping how that money is flowing:

5 health systems with strong finances

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http://www.beckershospitalreview.com/finance/5-health-systems-with-strong-finances-011117.html

Market Power

Here are five hospitals and health systems with strong operational metrics and solid financial positions according to recent reports from Moody’s Investors Service, Fitch Ratings and S&P Global Ratings.

Note: This is not an exhaustive list. Hospital and health system names were compiled from recent credit rating reports and are listed in alphabetical order.

1. Minneapolis-based Allina Health has an “AA-” rating and stable outlook with Fitch and an “Aa3” rating and stable outlook with Moody’s. The health system has stable operating cash flow and favorable balance sheet metrics, according to Moody’s.

2. Coral Gables-based Baptist Health South Florida has an “AA-” rating and stable outlook with S&P. The system has maintained key balance sheet metrics and generated better-than-projected financial results in fiscal year 2016, according to S&P.

3. Christiana Care Health Services has an “Aa2” rating and stable outlook with Moody’s. The Newark, Del.-based system has solid liquidity and a history of above average financial performance, according to Moody’s.

4. Springfield, Ill.-based Hospital Sisters Health System has an “AA-” rating and stable outlook with S&P. The system successfully implemented a strategic plan, which helped it maintain a strong balance sheet while improving operations, according to S&P.

5. Madison-based University of Wisconsin Hospital and Clinics has an “Aa3” rating and stable outlook with Moody’s. The system has strong balance sheet resources and established clinical and academic market positions, according to Moody’s

Study: In healthcare price negotiation, insurer size matters

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http://www.fiercehealthcare.com/payer/study-when-negotiating-healthcare-prices-insurer-size-matters?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiWmpCaVl6YzNZVGMzWW1VMSIsInQiOiJFOWcxQXlNRFltbXIzc2FocWNwREJpRnp6dEpLbmZORTVIb29WaTRtQ2lrYzVwQ1hjOW4rS1RMUDlNOEE1RVRJdEJoMjJYeEpNWUFjbnBiRUQ0WGhoSGpkUDQyWkQxZE1UQ3NBbFU1bjVwVm5ITjBTVUxRbmNWQ3JcLytnMlM0bnAifQ%3D%3D

Handshake

Larger health insurers are able to negotiate lower prices with providers, according to a new study. But that doesn’t necessarily mean payer consolidation is the answer to keeping healthcare costs in check.

The study, conducted by researchers from Harvard Medical School and published in the January issue of Health Affairs, examined multipayer claims data from 2014 to assess how insurers’ market power affected the rates that they were able to negotiate for office-based physician services.

The researchers found that greater market power did indeed give insurers a leg up at the negotiating table. For example, when examining rates for office visits paid to the same group of providers, they estimated that large insurers—those with market shares of 15% or more—negotiated prices that were 21% lower than prices negotiated by small insurers, or those with market shares of less than 5%.

Looking at providers of different sizes, the study also found evidence that insurers require greater market shares to negotiate lower prices from large provider groups than with smaller ones. And if providers respond to insurer mergers with greater consolidation of their own, that would boost their bargaining power and let them negotiate higher prices, the study said.

S&P issues stable outlook for nonprofit healthcare despite looming ACA repeal

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http://www.beckershospitalreview.com/finance/s-p-issues-stable-outlook-for-nonprofit-healthcare-despite-looming-aca-repeal.html

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S&P Global Ratings‘ outlook on the nonprofit healthcare sector is stable in 2017, despite the sector facing a likely repeal of the ACA.

Although S&P’s ratings and financial medians support its outlook on the sector, the rating agency may change its outlook in the near future.

“…we see a growing potential for credit quality deterioration based on the latest results from some providers, and the possibility the outlook could turn negative after the new administration and Congress are sworn in, given their intention to drastically alter the ACA and many long-term legislative tenets of the overall healthcare delivery system,” said Kevin Holloran, an S&P Global Ratings credit analyst.

Even without any major legislative changes, many hospitals are facing renewed expense, revenue and volume pressures, as the initial positive effects of Medicaid expansion have ended. S&P said there has recently been an increase in the number of providers with weaker financial and operating performance.

“We believe the sector peaked in 2016 from a financial and operating metric perspective, although change is evolving slowly and is based on existing legislative healthcare framework,” said S&P.

The rating agency emphasized that 2017 is not all doom and gloom for the nonprofit healthcare sector.

“Continued implementation of fundamental operational improvement initiatives and strategies…should continue to provide financial flexibility under any type of payment system,” said S&P.

Two other major rating agencies, Moody’s Investors Service and Fitch Ratings, have also issued stable outlooks for the nonprofit healthcare sector in 2017.

M.D. Anderson to eliminate 1,000 jobs

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http://www.healthcaredive.com/news/md-anderson-to-eliminate-1000-jobs/433447/

Dive Brief:

  • M.D. Anderson Cancer Center will eliminate about 1,000 jobs, about 5% of its workforce, Houston Business Journal reported.
  • Regarding the cuts, 800-900 will be eliminated through layoffs while the remainder will be cut via retirement.
  • Out of the total number of workforce reductions, all of which will be in Houston area, about 120 will come from managerial roles, HBJ added.

Foreign nation behind Anthem cyber breach, investigators say

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http://www.healthcarefinancenews.com/news/foreign-nation-behind-anthem-cyber-breach-investigators-say

The cyber attacker who breached more than 78 million Anthem consumer records in 2015 was acting on behalf of a foreign government, according to the California Department of Insurance.

Anthem is paying more than $260 million dollars for security improvements and remedial actions in response to this breach, the department said in releasing the examination findings and settlement agreement Friday.

“In this case, our examination team concluded with a significant degree of confidence that the cyber attacker was acting on behalf of a foreign government,” said Insurance Commissioner Dave Jones, who was among seven insurance commissioners leading the national investigation.

Jones and the department did not name the foreign government nor identity of the attacker.

 

In Through the Out Door: A Comprehensive Look at Surprise Medical Bills

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http://www.realclearhealth.com/articles/2017/01/09/in_through_the_out_door_a_comprehensive_look_at_surprise_medical_bills__110368.html?utm_source=RealClearHealth+Morning+Scan&utm_campaign=79f64f1189-EMAIL_CAMPAIGN_2017_01_09&utm_medium=email&utm_term=0_b4baf6b587-79f64f1189-84752421

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Imagine receiving medical care at an emergency department (ED) you know is in your insurance network only to find out later, after receiving a large medical bill, that the treating emergency physician was not an in-network provider in your health plan. Or diligently shopping for the best in-network hospital and in-network surgeon to perform an elective surgery, after which you find out that an out-of-network physician assisted in the procedure and expects payment for the portion of her bill not covered by your insurance. Imagine needing an ambulance, only to find out there are no ambulances available in your area that are covered by your insurance.