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While on a recent vacation in Cabo San Lucas, Mexico, with my family, I got a chance to read The Coming Jobs War by Jim Clifton, the chairman of Gallup, the global research organization. In the book’s chapter on health care, Clifton observes, “Congress has passed legislation on healthcare regarding how it is paid for not how to lower costs.” Clifton continues, “The current administration and Congress are working on how to fund the problem, not how to solve it.”
Clifton’s observations reminded me of two fundamental issues in the ongoing discussion about the cost of health care in the United States.
First, the cost savings that are bandied about on Capitol Hill usually pertain only to federal spending and rarely address the much broader issue of total societal spending on health care. This is an important point, because federal spending on health care, at about $800 billion this year, will account for less than 30 percent of the $2.8 trillion our nation will spend in total on health care in 2013.
Second, with regard to solving the cost problem, at its most basic level, the aggregate annual cost of health care is the product of price times quantity for all the healthcare services utilized over the course of a year. The United States spends two to three times as much as any other developed country on health care, so our prices and/or quantities must be higher. Over the past 20 years, the Dartmouth Atlas of Health Care has brought to light significant disparities in healthcare spending across our nation. But even more fundamentally, as Ezra Klein pointed out in The Washington Post on March 2, 2012, “There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher.”
Now you may be thinking, “It’s much more complicated than that”—and obviously, it is. But in his article, Klein compellingly cited a report issued by the International Federation of Health Plans (IFHP), a global insurance trade association that includes more than 100 insurers in 25 countries. Klein writes: “[IFHP] surveyed its members on the prices paid for 23 medical services and products in different countries, asking after everything from a routine doctor’s visit to a dose of Lipitor to coronary bypass surgery. And in 22 of 23 cases, Americans are paying higher prices than residents of other developed countries. Usually, we’re paying quite a bit more.”
Furthermore, two months later, The Commonwealth Fund issued an analysis of data from the Organization for Economic Cooperation and Development (OECD) and other sources to compare healthcare spending across 13 industrialized countries. The study concluded that the United States has below-average utilization of physicians and hospital beds, but higher prices for a variety of healthcare services and products. Although hospital stays are shorter in the United States than the OECD median, after adjustment for differences in cost of living, on a per-discharge basis, they are almost three times as expensive as the OECD median. Overall prices in the United States for the 30 most commonly prescribed drugs are almost double the average of eight other OECD countries. After adjustment for differences in cost of living, American primary care physicians make over 50 percent more than the average primary care physician across five other OECD nations, while orthopedic physicians in the United States make more than double the average in those same five countries.
In September 2012, the Institute of Medicine issued a 381-page report that concluded that about 30 percent of what is spent on health care—$750 billion out of a total spend of $2.6 trillion in 2010—is waste, of which $210 billion is due to the provision of unnecessary services and $105 billion is due to prices that are too high.
Although we obviously should continue to prevent overutilization of services, let’s not fail to also scrutinize the pricing element of the healthcare cost equation as we look at this important issue through a societal lens.
Ken Perez is senior vice president and director of Healthcare Policy, MedeAnalytics, Inc., Emeryville, Calif.
Publication Date: Tuesday, July 02, 2013
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
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