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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

Winners and losers in Trump’s proposed budget for HHS

President Donald Trump’s budget proposal for 2018 would reduce funding to HHS by $15.1 billion, a cut of nearly 18 percent, eliminating millions for education and training programs for healthcare professionals, while cutting $5.8 billion from the National Institutes of Health (NIH) alone.

Utilizing hospitals’ internal cost data could improve accuracy of new payment models

In an attempt to obtain greater accuracy on cost estimates, hospitals have developed their own internal systems to identify services with high and low profit margins and control spending. If what they’ve come up with is more detailed than what CMS uses, shouldn’t CMS be using that data?

Massachusetts hospital blamed for Medicare underpayments in other states

Miscalculations by Nantucket Cottage Hospital in Massachusetts in wages and costs in 2015 resulted in Medicare paying all hospitals in the state $133 million more than it should—creating a chain reaction that resulted in hospitals around the country being underpaid by CMS.

Pinnacle to affiliate with UPMC, buy 4 hospitals

Harrisburg, Pennsylvania-based Pinnacle Health announced it will more than double the number of hospitals within its system while also beginning an affiliation with the state’s largest health system, University of Pittsburgh Medical Center (UPMC). 

Fairview, HealthEast plan merger into 11-hospital system in Minnesota

Fairview Health Service and HealthEast Care System have announced their intention to merge, creating what is likely the largest health system in the Minneapolis-St. Paul area with a combined $5 billion in annual revenue.

Advocate, NorthShore scrap merger plans

A merger between two Illinois hospital systems, Advocate Health Care and NorthShore University Health Care, has been called off after a federal judge granted the Federal Trade Commission (FTC) a preliminary injunction against the deal.

McKesson, Change Healthcare finalize new IT company

The creation of a new data and analytics company, combining McKesson’s technology solutions unit with Nashville, Tenn.-based Change Healthcare, has been completed. The merger unites “the majority” of McKesson Technology Solutions with substantially all of Change, with the new company retaining the Change Healthcare name and Neil de Crescenzo as CEO.

Healthcare spending projected to make up almost 20% of U.S. economy by 2026

Health expenditures in the U.S. are expected to grow by an average of 5.6 percent annually through 2025, driven by rising medical prices that won’t be offset by slower growth in other areas.

Dueling lawsuits: Cigna wants $15 billion from Anthem; Anthem claims ‘sabotage’ of $54 billion merger

After their proposed merger was blocked by a federal judge, insurers Anthem and Cigna now have new opponents in court: each other.

Humana exiting ACA exchanges, individual market in 2018

Humana will be leaving all Affordable Care Act (ACA) exchanges and withdraw all its business from the individual insurance market in 2018, becoming the first major insurer to make a full exit amid uncertainty about the law’s future. 

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