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Finance

 

An ever-changing world of reimbursement can be frustrating for those involved in revenue cycle management (RCM). Being too set in your ways to change, however, is one of the most common strategic mistakes seen by Nicole Rogas, MBA, senior vice president of sales at Experian Health.

Whether Republicans’ version of an Affordable Care Act repeal-and-replace bill looks like the House-passed American Health Care Act (AHCA) or the Senate’s Better Care Reconciliation Act (BCRA), it would have a negative impact on the credit ratings of nonprofit hospitals, according to Fitch Ratings.

Transitioning to value-based care and taking on risk is often cited as one of the drivers of the consolidation trend throughout healthcare. Some systems, however, are beginning to look at partnerships more “holistically,” according to Kaufman Hall managing director Anu Singh, MBA, by pursuing creative affiliations to enhance their capabilities rather than a merger or acquisition.

In a year with new payment tracks for Medicare, additional bumps in the road on the path to value-based care and—potentially—an overhaul of health insurance coverage coming through Congress, what are healthcare finance leaders going to be focused on at this year’s conference?

Predictive modeling has been shown to help providers assess patient risk for a variety of conditions—which is how the vast majority of hospitals and health systems have been utilizing it.

 

Recent Headlines

Uncompensated Care: Sharp Healthcare Turns ED Losses into Gains

In 2009, the recession was in full swing, unemployment rates were high, and health care facilities were providing more than $39 billion a year in uncompensated care for the uninsured. Instead of riding out the recession with uncertainty and accruing more debt, Sharp HealthCare (San Diego, California) joined forces with the nonprofit Foundation for Health Coverage Education (FHCE) (San Mateo, California) to meet the problem head on. Sharp leveraged a Web-based eligibility software program and took on a strong patient advocacy role to provide uninsured patients with much-needed eligibility assistance.

Analyst Forecasts Continuing Headwinds in Health-care Financial Markets

Consolidation, the implementation of the Patient Protection and Affordable Care Act (PPACA), and efforts to use capitation for Medicare patients will all have an impact on health-related stocks, over then next few years.

Serving Low-income Patients Inland Empire Health Plan’s PPACA Strategy

One of the most contentious issues associated with the Patient Protection and Affordable Care Act (PPACA) has been the creation of health insurance exchanges (HIEs), which must be composed entirely of private health insurers. While many states have resisted participation, others, like California, have begun building an exchange.

M&A Part II: Practical Considerations of the Deal

In the hospital space, as in other markets, mergers and acquisitions (M&A) can be fraught with emotion. However, setting feelings aside and concentrating on practical matters—especially unique challenges that are inherent in merging with or acquiring a particular type of institution—are essential to deal-making success.

Vetting a Partnership: When to Consider a Merger or Acquisition

Health care reform has catalyzed providers—especially independent hospitals—to consider the business models and structures within which they will operate going forward. As such, many will contemplate mergers or acquisitions, but there is much to consider before pursuing such a path.

WellPoint Founder: Health Reform Law Is Not Enough

Leonard Schaeffer, founding CEO and former chairman of WellPoint insurance company, gave a sobering opinion on the ability of the federal reform legislation to bend the health care cost curve at The 8th Annual American Health Care Congress and Exhibition.

Hospital Employment: What Hospitals and Physicians Should Know

American physicians are again rushing to become employed by hospitals—and hospitals are responding in kind, says D. Louis Glaser, JD, partner with Katten Muchin Rosenman LLP in Chicago, Illinois. "The trend is being driven by the uncertainty of the future," he says. "Physicians and hospitals are wondering how reimbursement is going to change,

OhioHealth: Creating a High-performance Revenue Cycle

When Jane Berkebile, vice president of revenue cycle for OhioHealth (Columbus, Ohio), joined the organization five years ago, she was already impressed by its revenue cycle performance. “The triad for success, as I call it, was up and running when I came here: patient access, medical records, and business office activities were all reporting to the

Leadership and Succession Planning for Health Care

Multiple factors stand to shake up health care organizations' leadership structures in the coming years, says Will Powley, senior consulting leader with GE Healthcare's Performance Solutions group: economic recovery, health care reform, and, perhaps with the most impact, the impending retirement of the Baby Boomer generation. Combined, these three

Improving Financial Performance Through Employee Engagement: BHS Case Study

By early 2007, Birmingham, Alabama-based Baptist Health System (BHS) was facing significant systemic problems with its staff and management—problems that were creating tough-to-surmount financial repercussions. Alan Bradford, chief human resource officer at BHS, clearly recalls the difficulties the organization was facing: "The momentum of the

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