Browse by Topic
More than 40,000 members value HFMA's thought leadership and practical strategies. HFMA is where you need to be.
Get acquainted with the
healthcare finance industry's leading professional association. Find out why our
members rely on HFMA as their go-to source for insight and
Members have many
options for helping them advance their careers. Conferences, seminars,
eLearning, certification, and more -- our education and events will keep you
Connect the dots on today's big issues, explore collaborations, get career-boosting tips, and network with colleagues nationwide at the leading finance conference. Save $100 off the full conference rate when you register by May 8.
Real-time presentations with nationally recognized experts, networking opportunities, and industry solutions—no travel required!
Learn about timely healthcare finance topics and earn CPEs. Most live webinars are free for HFMA members and $99 for non-members. View the latest schedule.
If you're a subscriber to any of our three newsletters, you have access to online education. Learn more or subscribe.
Get the perspectives of leading healthcare finance professionals on today's hottest issues.
Information about leading vendors helps your buying decisions.
Forum members can network during live webinars or access a library of past webinars on topics such as bundled payment, charity care, and ICD-10.
An ever-expanding collection of spreadsheets, policies, job
descriptions, checklists, and more that you can adopt and adapt.
Forum members can submit vexing questions to a panel of experts
using our Ask the Expert service.
Your source for employment solutions.
Find new employment opportunities or
reach out to qualified candidates.
Distinguish yourself as a
leader among your peers and advance your career by earning certification in our
healthcare finance programs.
Get an objective third-party evaluation of products and services used in the healthcare finance workplace.
MAP App is a web-based application that helps organizations improve revenue cycle performance based on industry-standard metrics called MAP Keys.
Find suppliers and products in this comprehensive vendor directory for healthcare finance professionals.
Guidance for understanding and communicating about the price of health care.
Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
Amid the increasing financial pressures resulting from the ongoing implementation of the Affordable Care Act, hospitals face a growing concern: They must cope with insurer companies’ use highly restrictive networks for the plans that they sell.
Many insurance companies are responding to intense regulatory and competitive pressures by creating more restrictive provider networks and attempting to reduce the amounts that they pay for covered services.
This national trend has been the subject of much discussion in the media.a Hospitals and organized systems of care must decide how much to reduce their charges and whether to sign on with more restrictive networks that will place all charges under intense scrutiny.
Across the country, some hospitals are choosing to redesign their cost and care structures to “opt in,” while others are “drawing a line” and refusing to cut charges beyond a certain point.
The result will be difficult for both patients and providers. Many patients will lose access to the hospitals that they prefer. Hospitals may have to adapt to reducing charges or serving fewer patients.
This change is emerging for 2014, and is likely to accelerate in 2015 as more employers reduce the amounts that they are willing to pay for health insurance.
As a result of financial pressures on individuals and employers, and therefore on insurance companies, hospitals are likely to struggle with determining how extensively they should make financial and operational changes.
This challenge may be an issue for many years. So how should hospitals respond?
Certainly, more efficient operations are part of the answer, but these changes can go only so far.
At what point will hospitals choose to say “no,” and what price will they pay for doing so? And what will happen to relationships within the hospital community, as some hospitals accept new insurance demands while others refuse these demands?
Hospitals will need to make fundamental decisions about their purposes and missions. Each hospital must decide how it wants to adapt, and how it will cope with financial pressures from regulators and insurance companies.
Clearly, such important and complex decisions should not be made lightly. Rather, as part of a deeply deliberative process, hospitals should develop and apply a protocol for evaluating network proposals and guiding responses. This protocol should be clearly understood by leadership throughout the organization to help prevent internal conflict and misunderstanding. The protocol should be designed to guide evaluations of network relationships and define the strategies the hospital will pursue based in its decisions, whether positive or negative.
A protocol strategy can start with the financial circumstances of a hospital. The "income budget" at present may be modified to show the results with and without a new network commitment—which can be estimated based on increased or decreased patient-days. "Expense budget" options may then be prepared for the current situation and for circumstances with or without the new network, taking into account changes in staffing, services, and capital investment required to meet operational targets.
Community impact can be estimated in terms of increased or decreased numbers of patients, how physicians are likely to respond, and how relationships within the larger community will be affected. Then, hospital preferences for relationships with all providers, large and small employers, and dominant insurance companies should all be evaluated. Finally, hospital values may be considered: How does the organization see itself evolving in the future, and which relationships are essential to achieve this future?
a. See, for example, Hancock, J., Kaiser Health News; and Landen, R., Modern Healthcare.
Ferd H. Mitchell is an attorney, Mitchell Law Office, Spokane, Wash., and a member of HFMA’s Washington-Alaska Chapter.
Cheryl Mitchell is an attorney, Mitchell Law Office, Spokane, Wash.
Publication Date: Monday, December 09, 2013
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
©2015 Copyright Healthcare Financial Management Association
HFMA.org is best viewed using IE9 or the latest versions of Chrome, Firefox, and Safari.
Join HFMA today and enjoy: