Bundled Payments Yielding Good Results

bundled-paymentsIn a previous newsletter, we discussed bundling introduced by Medicare which focuses on orthopedic and cardiac procedures. Through the mandatory initiative for comprehensive care for joint replacements (CJR), which became policy in 2016, some 800 hospitals are participating in the program.

While some sources report the results of bundling as mixed, Medicare reports that joint replacement payments increased by approximately 5% nationally, but decreased 8% for BPCI participants. One large health system achieved a 20.8% episode decrease and another reported a significantly shorter prolonged length of stay – a sign of fewer complications resulting from surgery.

Providers, both acute and post-acute, shared in the savings and indications are that post-acute savings were achieved because their care was bundled, placing these providers at risk. Even though efforts to repeal and replace or modify the Affordable Care Act are on hold, more healthcare providers and payers can be expected to embrace bundling going forward.


Cost-Conscious Consumers Are Driving Health Care Transparency

The out-of-pocket thresholds of high-deductible health plans are leading consumers to ask questions about their care, demanding higher quality and lower cost.

Source: Future of Health Care, Media Planet

Born out of necessity, a new breed of health care consumers is demanding transparency about the true price of office visits, lab tests, procedures, prescriptions and hospitalizations. Clinicians and billing staff should be paying close attention to this trend and working with patients who are balancing the cost of care with its effectiveness.

One-third of Americans

It’s been a slow move from indemnity plans with minimal deductibles before generous copays kicked in, but nearly one-third of American workers are now covered by a high-deductible health plan (HDHP) of some sort, according to 2016 data from the Kaiser Family Foundation. Nineteen percent of American workers have an HDHP with a Health Saving Account and another nine percent have an HDHP with a more restrictive Health Reimbursement Arrangement.

With a high-deductible plan, consumers pay the insurance-adjusted rate of a visit, test or procedure out of pocket until the deductible kicks in. This means most routine care will be paid by the patient, leaving insurance for more intensive illnesses and injuries. It also means patients are asking more questions about the true cost of care and the value of a particular test or scan and the information it can give a clinician versus the cost of knowing.

“Channeling patients to high-quality, low-cost providers saves money, which the plan or the company can share with the patient.”

With only three out of ten workers and their families covered by HDHPs, clinicians might be lulled into believing the transparency issue can be put off for future discussion. But health plans and companies with self-insured plans already are looking closely at the cost and quality of the care they are paying for. Claims data provides a wealth of information about care episodes, the total cost and the outcomes.

Understanding the new consumerism

Narrow network plans incentivize patients to use particular providers, often with price and quality as common selection criteria. Even among wider provider networks, patients are increasingly receiving higher reimbursements or co-pays to use certain providers or provider/facility combinations for such procedures as hip replacements or cardiac procedures where a total common cost can be calculated. Channeling patients to high-quality, low-cost providers saves money, which the plan or the company can share with the patient.

Clinicians must be aware of the cost of the care they are providing, as well as such associated costs as support staff, billing and technology. Increasingly, providers are helping patients who have high-deductible plans by taking less payment than the full retail price of that visit. The new consumerism means that registration and collections staff must do more on the front end to collect money from the patient at the time care is given. And it also means providers are being asked more questions about generic medications, the need for a lab test or scan and alternative treatment plans that respect costs and individual preferences.

Consumerism hasn’t reached the mainstream — yet — but the tide is turning toward greater transparency in the pricing of medical visits and procedures. Consumerism represents a paradigm shift in the doctor and patient dynamic, and providers ignore this trend at their own peril.

Article written by: Steve Rasnick, President, Self Insured Plans & President, Health Care Administrators Association (HCAA). Article published on Media Planet, Future of Health Care


Protecting Your Health Information

Medical documentsWhile health information is protected in doctors’ offices, hospitals and other healthcare institutions, that simply isn’t the case in the online world. The Department of Health and Human Services warns that HIPAA privacy regulations do not apply to information you reveal on social media, in emails and web searches or when using health apps. The unfortunate fact is that information you provide when using these applications is fair game, often being gathered by data aggregators for sale to insurers, employers and others.

Another problem is that the privacy policies included by websites contain pages of small print and are seldom read. Too many people just assume their information is protected, click “accept” and move on. In 2014, the State of California adopted a law that extends HIPAA-like protection to online medical information, requiring medical apps to meet the same standards of confidentiality required by healthcare providers. Many believe that with more and more medical information moving online, it’s time for other states to follow.


Preventing Sickness When Flying

Ever wondered what causes so many people to get sick after flying? Is it the air quality on the plane, people around you or what? The airlines say that the ventilation systems on airplanes are vastly improved, so the recirculation of germs throughout the cabin may not be the issue.

Germs are everywhere. If you think about the experience – people standing in line could be sick, containers you use to go through security – these are great places for germs to gather. Doctors say to stay away from airplane restrooms if you can, stay hydrated, keep the air on at your seat to help blow germs away from you and bring sanitary wipes or hand sanitizer with you. Use it after you touch armrests, latches on overhead bins, etc.


Alexa Has Health Answers

alexaIn the race to bring health-related information to your digital world, Amazon is certainly not falling behind. Beginning in early March, Amazon enabled “Alexa” users to obtain answers to medical questions. According to a press release, with help from WebMD, Alexa devices will respond to medical questions with physician-reviewed, medically appropriate answers in plain, understandable language. Answers to questions such as how to treat a sore throat or the side effects of certain substances can also be sent in text form to those using the Alexa app.