The following resources are dated between June 2, 2014, and June 27, 2014. Click on the links below to go to specific resources on this page:
HFMA Resources & Updates
Federal Reports, Statements, Etc.
Other Healthcare Finance News & Trends
HFMA Resources & Updates
Value-Focused Acquisition & Affiliation Strategies
The latest report from HFMA's Value project looks at the new wave of acquisition and affiliation activity in health care
ANI 2014 Coverage
Highlights from ANI.
Value-Based Reimbursement Resource
This has been updated to reflect the proposed changes contained in the FY15 IPPS proposed rule.
HFMA Overview: FY15 IPPS Proposed Rule
CMS issued a proposed rule updating payment rates under the Medicare IPPS for operating and capital-related costs of acute care hospitals in FY15.
CMS Proposed Rule: Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs
Among other issues addressed in the rule, most current enrollees will be automatically re-enrolled unless they select new coverage in November.
Federal Reports, Statements, Etc.
21st Century Cures Roundtable: Digital Health Care
The House Energy & Commerce Committee hosted its second 21st Century Cures roundtable on June 24, 2014, to discuss what steps Congress can take to advance digital and personalized health care.
June 2014 MedPAC Report to Congress
According to MedPAC Chairman Glenn Hackbarth, “This report represents the beginning of a dialogue within MedPAC about how Medicare’s policies across FFS, MA, and ACOs might evolve and how these differing policies might affect beneficiaries, providers, and taxpayers.”
Annual Report to Congress on Breaches of Unsecured Protected Health Information
Health data breaches nearly doubled, according to HHS report.
From Coverage to Care
CMS’s new Coverage to Care initiative helps people with new healthcare coverage understand their benefits and connect to primary care and the preventive services that are right for them. It includes a downloadable brochure to print out for newly insured patients.
Premium Affordability, Competition, and Choice in the Health Insurance Marketplace, 2014
People who selected plans in the federally-facilitated marketplace with tax credits paid an average 76 percent less than the full premium after the tax credit, with their average premium falling to $82 from $346, according to an HHS report.
HHS to Move Forward Allowing 340B Orphan Drug Discounts
HHS and its Health Resources and Services Administration will continue to allow certain hospitals to purchase “orphan drugs” through the 340B Drug Pricing Program when the drugs are not used to treat the rare conditions for which the orphan drug designation was given, according to a June 19 AHA News article.
Winners of Digital Privacy Notice Challenge
ONC provides links to the winners’ demos.
Senate Finance Committee Letter Requesting Transparency Ideas
The committee is asking healthcare stakeholders for ideas on how to make cost and quality data clearer and more readily available to consumers.
CMS Announces Opportunity to Apply for Navigator Grants in Federally Facilitated and State Partnership Marketplaces
CMS announced the availability of $60 million in funding to support navigators in 2014-15.
CMS: Medicare Program; Additional Extension of the Payment Adjustment for Low-Volume Hospitals and the Medicare-Dependent Hospital Program Under the Hospital IPPS for Acute Care Hospitals for FY14
This announcement extends payment protections to Medicare-dependent, small rural hospitals.
Medicare Provider Utilization and Payment Data: Inpatient
CMS data include hospital-specific charges for the more than 3,000 U.S. hospitals that receive IPPS payments for the top 100 most frequently billed discharges.
Medicare Provider Utilization and Payment Data: Outpatient
CMS data include estimated hospital-specific charges for 30 APC gfroups paid under the Medicare OPPS for CY 2011 and 2012.
The Medicare Chronic Conditions Dashboard
Statistical views of information on the prevalence, utilization and Medicare spending for Medicare beneficiaries with chronic conditions and multiple chronic conditions.
The Medicare Geographic Variation Dashboard
CMS has developed interactive dashboards that present information on state and county level variation in standardized per-capita costs for the Medicare fee-for-service population.
Chronic Conditions Data Warehouse
The CMS Chronic Conditions Data Warehouse provides researchers with Medicare and Medicaid beneficiary, claims, and assessment data linked by beneficiary across the continuum of care.
FDA Adverse Drug Events Database
FDA’s drug adverse event database contains millions of adverse event and medication error reports submitted to FDA covering all regulated drugs. The FDA plans to expand the database to include data on product recalls and labeling.
Successful Results from CMS ICD-10 Acknowledgement Testing Week
This past March, the Centers for Medicare & Medicaid Services (CMS) conducted a successful ICD-10 testing week. Testers submitted more than 127,000 claims with ICD-10 codes to the Medicare Fee-for-service (FFS) claims systems and received electronic acknowledgements confirming that their claims were accepted.
CMS Establishes a Provider Relations Coordinator
Although providers should continue to take questions about specific claims directly to the Recovery Auditor or Medicare Administrative Contractor who conducted the review, providers can raise larger process issues to Coordinator.
A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure
The National Coordinator for Health Information Technology proposes a broad framework and 10-year vision for achieving an interoperable health IT infrastructure.
Medicaid & CHIP: April 2014 Monthly Applications
As of April, more than 6 million additional individuals enrolled in Medicaid and CHIP since open enrollment began in October 2013.
Accelerating Improvement Through Systems Engineering
The President’s Council of Advisors on Science and Technology proposes enhancing health care through greater use of systems engineering.
Other Healthcare Finance News & Trends
The Forum editors pulled together the following articles and resources that may be helpful to healthcare finance leaders.
See also: HFMA News for additional breaking news.
Trade Groups, ACOs Push Telemedicine Reg Changes
Industry groups, trade groups, and ACOs have sent a series of letters to the new HHS Secretary pushing for potential changes to the ACO program to better accommodate telehealth and remote patient monitoring, according to a June 10 Modern Healthcare article.
Building a Data Analytics Infrastructure for ACO Development: Two Industry Expert Perspectives
One of the biggest challenges to population health management is to get the right analytics in place, according to a June 7, Healthcare Informatics article.
Bundled Payment & Other Value-Based Payment Models
Hospitals Push Bundled Care as the Billing Plan of the Future
Proponents say bundled payments, unlike fee-for-service billing, provide strong incentives for doctors and hospitals to work together to keep costs low and complications down, according to a June 8 Wall Street Journal article.
The State of Value-Based Reimbursement and the Transition from Volume to Value in 2014
Most payers and providers expect value-based reimbursement to overtake fee-for-service by the year 2020, according to a McKesson Corporation report.
Do Those With Consumer-Driven Health Plans (CDHPs) Understand Them?
The answer appears to be “yes,” according to the 2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS), which found that three-quarters (77 percent) of those with a CDHP were extremely, very, or somewhat familiar with it.
Cost Containment & Performance Improvement
More Than 750 Hospitals Face Medicare Crackdown on Patient Injuries
A quarter of the nation’s hospitals—those with the worst rates—will lose 1 percent of every Medicare payment for a year starting in October, according to a June 22 Kaiser Health News article.
15 Top Health Systems Deliver Better Quality, Healthier Finances
Even as hospitals face issues of declining reimbursements and increasing costs, some health systems have found a way to balance and excel at two fundamental goals—financial success and quality improvement, according to a June 7 Modern Healthcare article.
Disproportionate Share Hospitals
Provider Reimbursement Review Board Issues 60 Day Deadline to Supplement Record in All DSH Medicaid Eligible Days Appeals
On May 23, 2014, the CMS Office of Hearings released Alert 10, notifying providers of an important new 60-day deadline concerning certain appeals before the Provider Reimbursement Review Board.
Disproportionate-Share Hospital Payment Reductions May Threaten the Financial Stability of Safety-Net Hospitals
California’s safety net hospitals could face more than $1 billion in residual uncompensated care costs and Medicaid shortfalls in 2019, if proposed DSH cuts are implemented, according to a June Health Affairs study.
Health Insurers Pressing Down on Drug Prices
More health prescription plans are refusing to cover certain drugs unless the companies charge less for them, according to a June 20 New York Times article.
Financial Metrics (Volumes, Prices, and Other Ratios)
Healthcare Prices Continue to Rise Slowly
Healthcare prices continued to rise exceptionally slowly in the first quarter, growing at an annual rate of just 0.5 percent, while utilization (real healthcare spending) fell 1.4 percent at an annual rate, leading to an outright decline in nominal spending in 2014:Q1, according to a White House blog piece.
U.S. Health Spending Versus Global Spending
Over the past 20 years, the U.S. and OECD median rates of excess growth have tracked each other quite closely, according to a June 26 JAMA study. Furthermore, in recent years, rates of excess healthcare spending in the United States and OECD have declined below their historical norms; in 2010 and 2011 (and 2012 for countries with available data), excess spending was either negligible or negative.
Despite Improving Economy, Hospital Margins Narrow
The average operating margin in 2013 was 3.1 percent, down from 3.6 percent in 2012, according to the analysis, as reported in an article from The Advisory Board Company.
Navigating the Gap Between Volume and Value
In this HPOE guide, hospital executives will find a step-by-step information on the financial planning process and how it can help your organization evaluate the impact of repositioning initiatives as you move toward value-based care and payment.
Healthcare Employment & Compensation
Parkland Health to Boost its Minimum Wage, Funded by Exec Bonus Pool
Parkland Health & Hospital System will raise the minimum wage of system entry-level workers to $10.25 an hour—and initially fund the boost from the bonus checks of executives, according to a June 12 Modern Healthcare article.
Health Insurance Exchanges
Three Million U.S. Employees Enrolled in Private Health Insurance Exchanges
An estimated three million people currently receive employer health benefits through a private exchange, according to new report by Accenture.
Survey of Non-Group Health Insurance Enrollees
Nearly six in 10 (57 percent) of those with exchange coverage were uninsured prior to purchasing their current plan, according to a Kaiser Family Foundation survey.
Premiums Rise at Big Insurers, Fall at Small Rivals Under Health Law
Hundreds of thousands of consumers nationwide who bought insurance plans under the ACA will face a choice this fall: swallow higher premiums to stay in their plan, or save money by switching, according to a June 19 Wall Street Journal article.
Exchange Plans Unaffordable for People in Gap Between Medicaid and Obamacare
On average across the 23 states with a Medicaid/Obamacare Gap, a 30-year-old non-smoker with income below 100 percent federal poverty level would have to pay at least 14 percent of their income to purchase a catastrophic health plan. For older individuals in the gap, the expense increased since premiums increase as age increases, according to a HealthPocket survey.
Insurers Fill Gaps in Health-Law Plans
Health insurers in several states are adding to the choices of doctors and hospitals in their health-law plans amid consumer and state official concerns about access to care, according to a June 9 Wall Street Journal article.
Hospital Networks: Updated National View of Configurations on the Exchanges
Consumer choice of health plan design is expanding, according to a June report from McKinsey & Company.
Exchanges Have Cheaper Metal Plans than Major Off-Exchange Carriers in 35 out of 39 Cities
On average, the least expensive bronze plans offered by the four off-exchange insurers were 45 percent more expensive than the least expensive bronze plans offered on the exchanges, according to a June 5 HealthPocket study.
More Patients Flocking to ERs Under Obamacare
Many hospitals are seeing a surge of newly insured Medicaid patients walking into emergency departments, according to a June 8 USA Today article.
M&As & Other Major Strategic Moves—by Providers
Three-System Merger to Create New Detroit Health Giant
New system will provide 30 percent of Detroit inpatient and outpatient services, according to a June 24 article from The Advisory Board Company.
Boeing Signs Shared Savings Deal with Washington Hospitals
University of Washington (UW) Medicine and Providence Health & Services have contracted directly with Boeing to create "preferred networks"—with a shared savings component—for 27,000 employees of the aerospace giant, according to a June 16 article from The Advisory Board company.
Medicaid & Uninsured
Long Waits Persist for Those Applying for Medicaid Coverage in Many States
While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the ACA, more than 1.7 million more are still waiting for their applications to be processed, according to a June 7 Washington Post article.
Impact of Medicaid Expansion on Hospital Volumes
The Medicaid proportion of patient volume at hospitals in states that expanded Medicaid increased substantially in the first quarter of 2014. At the same time, the proportion of self-pay and overall charity care declined in expansion-state hospitals, according to a paper from the Colorado Hospital Association.
California Probes Obamacare Doctor Networks at Anthem and Blue Shield
California regulators are investigating whether Anthem Blue Cross and Blue Shield of California have violated state law in connection to patients struggling to find doctors under Obamacare, according to a June 20 LA Times article.
Pricing and Transparency
Calif. Court: Hospital Bills Must Charge 'Reasonable Value'
The California Fifth District Court of Appeals ruled that insurers are not required to reimburse hospitals for amounts that are more than the actual value of services.
Staff Development and Productivity
How to Spend the First 10 Minutes of Your Day
“The day is over and I am leaving the office with a tremendous sense of accomplishment. What have I achieved?” This exercise is usually effective at helping people distinguish between tasks that simply feel urgent from those that are truly important, according to a Harvard Business Review blog piece.
Publication Date: Monday, June 30, 2014