According to a Healthcare Financial Management Association’s (HFMA) Pulse Survey, several hospitals and health systems rely on multiple vendors to simplify diverse facets of revenue cycle management. Around thirty percent of healthcare finance executives have been surveyed and almost twenty percent of those respondents use two suppliers with one performing various aspects of the automation process. Around five percent use a trio of suppliers who each work with a different part, and five percent use four or more suppliers to completely control the automation of the revenue cycle.

For all automation phases in the sales cycle, nearly forty percent of respondents stated they rely on a sole vendor and just over thirty percent have an inner team concentrating solely on revenue cycle management automation.

Small organizations showed a reduced likelihood of having an internal staff committed to revenue cycle automation (34% with net patient income under $500 million and 26% with a net patient income of $500 million and $1 billion); they are more likely to rely on multiple vendors. Interestingly, there were no mid-size hospitals or health departments using at least three vendors or more.

For the healthcare sector, revenue cycle automation has had its challenges. A June 2019 study showed that only one-fifth of hospitals and health facilities had completely digitized or streamlined more than a quarter of their organization’s financial and revenue cycle activities.

To read more, please visit https://revcycleintelligence.com/news/30-of-hospitals-use-two-or-more-revenue-cycle-management-vendors/.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

President Joe Biden is quickly launching his health roadmap, starting with addressing the pandemic. He has also stated that during his term, he intends to dip into qualifying for Medicare and Medicaid, unexpected billing, prescription costs, value-based treatment, and more.

The bulk of the job will be handled by the regulation of HHS and CMS, which means that in 2021, providers are in for a range of regulatory shifts that are expected to have a major effect on operations. Policies that influence current value-based pricing mechanisms and potential chances for the new administration and vendors themselves to move away from fee-for-service are likely to be shared priorities.

During the health crisis, the fact fee-for-service was not the perfect healthcare funding model was revealed. Along with neighborhoods shutting down, many providers were forced to do the same, resulting in income declines of fifty percent and more. Value-based contract providers were better able to cope with the drop in patient numbers and build new, even original, pathways of treatment, telehealth, for instance.

Value-based arrangements do not depend on the number of people served or facilities delivered, ensuring that even though volumes might be minimal or hospitals moved to virtual treatment methods, providers still get their reimbursements.

Leaders are liable to take a greater interest in value-based contracts and the versatility they provide to create stronger organizations going forward. With the introduction of novel value-based pricing frameworks for suppliers to try, the existing administration will likely provide full support.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Earlier this month, the federal government announced via email that it plans to extend the Home Health Value-Based Purchase Model (HHVBP) through rulemaking starting no earlier than January of next year. The model is now being applied in nine states and has led to an overall increase of nearly five percent in service ratings for home health providers and more than $140 million in annual savings from Medicare.

The HHVBP model has been part of the broader, ongoing transition from volume to value-based care by the federal government. CMS launched the initiative in 2016 to incentivize home health providers to better the quality of care and decrease spending on Medicare.

HHVBP is compulsory in select states where incentives are adjusted based on quality results compared to peers in the state for Medicare-certified home health agencies. Florida, Iowa, Maryland, North Carolina, Tennessee, and Washington are among these states.

For example, in 2018, home health providers involved in the model achieved a median of three percent Medicare rate change (up and down) based on average results across 20 quality measures, including hospital-free utilization of emergency rooms, oral medication management, and urgent care hospitalizations during the first 60 days of home health care.

The maximal positive and negative payout adjustment has been raised by CMS each year, with the peak adjustment at six percent for the most recent performance period. Next year, the department plans to lift to eight percent the maximum positive and negative adjustment.

To read more, visit https://revcycleintelligence.com/news/cms-to-expand-home-health-value-based-purchasing-model.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

In healthcare, time-driven costing is a technique that measures the cost of resources spent as a patient progresses through the continuum of treatment. Along with the need to manage increasing costs and scarce resources, such as nurses, the approach has gained traction among hospital leaders, particularly in the face of new value-based reimbursement models.

The introduction of time-driven costs in healthcare has been problematic, despite the attraction of efficient assessment and control of costs. Past attempts, such as those in the 1990s, have failed or only partly succeeded due to the significant capital commitment needed and the complexities of the healthcare system.

Recent efforts have been made to introduce a time-driven expense approach backed by data analytics. Extracting information from the electronic health record to combine clinical information with payroll and time-keeping statistics, such as how many cases reached the ED and at what stage of the emergency severity index, creates a time-costing solution.

By executing a staffing-to-demand plan leveraging cumulative knowledge, sufficient ratios of nursing personnel and other providers is assured, and the health system is more effective at managing costs and services.

To read more, please visit https://revcycleintelligence.com/news/how-time-driven-costing-in-healthcare-boosts-staffing-revenue-cycle.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

CMS is evaluating the possibility of including 20 quality measures to a few of Medicare’s quality and value-based payment programs.

To apply, the department said, all but three of the recommended steps would have to be gathered online, either via electronic health reports or staff feedback. The shift to digital measures is following the Meaningful Measures Framework of the Department, an effort initiated in 2017 that focuses on addressing administrative burdens. Performance measurement, while providing little benefit to doctors or patients, has long been criticized for being burdensome on workers.

The 20 recommended initiatives are part of the annual rule-making phase of CMS, where the department chooses a list of measures that are then evaluated by the collaboration of measure applications of the National Consistency Council, a group of health experts providing suggestions about what CMS should pick for its services. CMS receives input on steps they have in the list that goes to NQF from specialty societies and other stakeholders.

Feedback on the proposed steps would be approved by the NQF by the sixth of January.

Ten of the suggested measures are for the Merit-based Incentive Payment System this year. Several of these measures are cost-related, and one is an impact indicator reported by patients.

A trio of the measures, including one that monitors coronavirus vaccination among healthcare workers, are linked to COVID-19.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Humana recently declared an extension of its value-based program expansion with the forthcoming implementation of the Primary Care First (PCF) model. The initiative will expand the availability of coordinated primary care to beneficiaries of some Humana Medicare Advantage services and aims to enhance the quality of treatment and patient safety, minimize the cost of care, and relieve the financial load of primary care agencies.

At the Centers for Medicare & Medicaid Services (CMS) Innovation Center, the PCF model was created to encourage primary care practitioners to migrate to value-based care and to determine whether this new payment model of Original Medicare would improve productivity and minimize costs. Humana will supply a related model for the Humana Medicare Advantage Preferred Provider Organization and Health Maintenance Company policy to participating primary care agencies currently in the network, as a newly approved CMS payer partner and the first insurer in the nation to have its own variant of the PCF model.

The Humana PCF model is scheduled for launch on July 1, 2021. A prospective capitated incentive, which takes into account the achievement of metrics based on quality and results, will be granted to participants every month.

To read more about Humana’s upcoming value-based program, please visit the following link:https://www.businesswire.com/news/home/20201210005023/en/Humana-Announces-New-Primary-Care-Value-Based-Model.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

The COVID-19 pandemic impacted the operations and finances of nearly 97% of medical practices in the U.S. It revealed a stark contrast between the resilience of healthcare providers focused on value-based care versus those who focused on the traditional fee-for-service (FFS) model.

Physician practices still using FFS suffered heavy financial losses when in-person patient volume dropped by 60% on average at the start of the pandemic. The providers that experienced minimal disruption to their operations were the early adopters of the principles and latest technology of value-based care in their long-term business strategy.

Successful implementation of value-based care requires a robust electronic health record (EHR) that supports data collection, clinical decision-making tools, and multidisciplinary care management. Even though the use of EHRs is widespread in the U.S., most EHRs in their current form don’t support value-based care.

EHR optimization is an ongoing process of improvement that affects all aspects of a healthcare organization practicing value-based care. Medical practices that lean into EHR optimization can see more effective patient care plans, decreased physician burnout, and increased ROI. The most common optimizations include:

1. Workflow and business process improvement for more efficiency
2. Clinical decision support to achieve better clinical outcomes and improve quality of care
3. Identification of areas where cost savings are possible

Major stakeholders agree on the role and value of EHRs in transforming the U.S. health system to value-based care. Physicians and patients now feel increased comfort with telehealth and like the safety of virtual engagement during the pandemic. Payers are looking for physician partners who can conduct value-based care with measurable outcomes. EHR optimization is a big step towards realizing industry-wide change.

This update is provided by CareOptimize, a healthcare management consulting firm. We offer managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Recently, the Centers for Medicare and Medicaid Services added the finishing touches to its Physician Self-Referral Rule revisions, commonly referred to as the Stark Law. The law forbids a doctor from referring a patient for several forms of services to a provider owned by the doctor, under their employment, or otherwise getting payment from them.

The old federal rules were meant for reimbursing providers on a fee-for-service basis, in which further services were supplied as a financial reward. These federal regulations have weighed down hospitals with increased operating expenses and obstructed the transition towards value-based compensation. The healthcare sector, nevertheless, is proceeding steadily toward financial reimbursement systems related to value.

CMS’ move comes as self-referral does not have the same risks as before since providers are increasingly more responsible for patients’ total cost of care. Lack of clarity in the Stark legislation, however, has caused many providers to stay put, afraid of breaking the law even with favorable agreements, which may have critical and expensive implications.

The law finalizes several of the draft policies from the October 2019 notification of planned rulemaking. All the provisions in the revised Stark law are expected to be in effect within sixty days from the Federal Register display date, unless stated otherwise.

To read more, please visit https://www.healthcarefinancenews.com/news/cms-finalizes-changes-stark-law-hindered-physician-referral.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

In view of the COVID-19 pandemic, more providers are contemplating moving to capitation arrangements. The decision cannot, however, be made lightly; the risks and complexities of lump sum payments need to be carefully addressed by provider organizations before any decision to switch is made.

Organizations need to recognize the effect the restructuring of the healthcare industry would have on capitation payments. There is a strong financial opportunity for physicians to scrutinize hospitalizations and emergency room admissions and offer higher care levels to patients. This could be a challenge for consolidated health networks that involve hospitals and clusters of doctors. To offset fixed and variable costs of inpatient treatment while still financing alternate care facilities, these organizations may have to determine resource distribution.

Specialist benefits under capitation payments continue to be discussed. Organizations aim to place the primary care provider at the forefront of a healthcare team in alternative payment structures, and capitation payments definitely urge organizations to do so. However, under the alternative payment arrangement, specialists do need to be accountable for total care costs.

Under capitation fees, health services would need to consider how to handle financial risk. The success of capitation payments is jeopardized by complications, debilitating illnesses, and other avoidable problems. But with stop-loss insurance and payment allocation for high-cost products, such as specialty medications and equipment, providers can minimize the effects of these problems.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Humana is reaping the rewards of its decision to gamble on value-based primary care, with the national health insurer receiving well over $600 million in additional income, resulting in a third-quarter profit of $1.3 billion. Humana’s venture into better primary care arrives at a time when healthcare prices are increasing, and insurers are searching for ways to cut costs on medical claims.

When more money is allocated initially for primary care, including screenings and preventative care, research has shown long term cost savings. Humana beneficiaries tend to be seniors in Medicare Advantage programs and cost more than younger, healthier patients, so that investment pays off. Better care with better outcomes has also led to more member retention, a key element in creating value.

Instead of paying physicians for each treatment they offer, which is how health plans historically charged for medical care, Humana pays primary-care practices a fixed monthly fee per patient. This practice is becoming more widespread, especially after the coronavirus outbreak stopped patients from accessing regular care and drained income from medical practices. When people stopped visiting their doctors’ offices, several value-based practices still received payments.

Humana’s Medicare Advantage members receiving treatment from physicians in value-based contracts last year could have spent an additional $4 billion in medical costs if they had continued their care from doctors paid the conventional way, according to the current annual value-based care study from Humana. In contrast with standard Medicare, participants of value-based plans have seen thirty percent fewer hospital stays and ten percent fewer ER visits.

To read more, please visit https://www.businessinsider.com/humana-ceo-lays-out-approach-to-primary-care-clinics-2020-11.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.