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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

Bundled payments for joint replacement could save hospitals $2 billion

A study in JAMA Internal Medicine found hospitals can save an average of 8 percent without impacting quality in Medicare’s bundled payment for joint replacement.

Donations to U.S. nonprofit hospitals up slightly in 2016

Gifts, pledges and grants to nonprofit hospitals in the United States went by 0.2 percent in 2016, totaling $9.6 billion, according to a report from the Association for Healthcare Philanthropy (AHP).

Allergan to acquire LifeCell for $2.9 billion

Biopharmaceutical company Allergan is acquiring Acelity’s LifeCell, a regenerative medicine unit, for $2.9 billion, according to a news release.

CMS expands opportunities for 5% APM bonus in 2018

Practices and payers which want a chance to earn the 5 percent incentive payment offered under CMS’s Advanced Alternative Payment Models (APMs) will have a chance to apply for two qualifying models for 2018.

How Medicare will be impacted by ACA repeal

A full repeal of the Affordable Care Act (ACA) would mean increased payments to hospitals, providers and Medicare Advantage plans, while likely increasing premiums, deductibles and other costs paid for by beneficiaries.

UPenn Health System expanding into New Jersey

Princeton Healthcare System (PCHS) will join the University of Pennsylvania Health System (UPHS), marking the latter’s first expansion beyond Pennsylvania’s borders.

MedPAC recommends higher pay for docs, hospitals in 2018, but not for ASCs

Medicare payments to physicians and hospitals should increase in 2018, but a planned payment bump for ambulatory surgical centers (ASCs) should be scrapped, according to the Medicare Payment Advisory Commission (MedPAC).

Humana to write off $591 million owed in risk corridor payments

Humana indicated it doesn’t expect to receive the $591 million its owed by the federal government under the risk corridor program of the Affordable Care Act (ACA).

Texas hospital employees seek donations after facility can't make payroll

Weimar Medical Center (WMC) in Texas has been closed since Nov. 26 when it didn’t have enough money to pay its employees. Several weeks later, workers are still waiting on checks.

Nonprofit hospitals maintain stable outlook in Moody’s report

Moody’s Investor Service projects nonprofit hospitals and health systems will remain stable in 2017, despite uncertainty caused by the results of the presidential and congressional elections.

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