Healthcare News of Note: Providers in these 10 states may struggle the most to collect claims from payers
Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.
- During the first six months of 2023, healthcare providers in Louisiana were more successful in collecting claims from payers than providers in other states, while those in South Carolina struggled the most.
- Black students had greater than 50% higher odds of leaving MD-PhD training compared with their peers, according to a study of 4,702 enrollees spanning 2004-2012.
- Eight U.S. hospitals led the pack of 330 hospitals ranked by Newsweek and Statista as the World’s Best Smart Hospitals for 2024.
1. The top and bottom states for paying provider claims are detailed in new report
“A connection exists between where a provider operates and how fast and accurately claims are paid,” according to a Crowe RCA benchmarking analysis published in September. Along with location, Crowe examined three domains — getting paid quickly, getting paid what services are worth and getting paid by a single payer — to rank “the 10 best and 10 worst states to operate in for providers collecting healthcare claims.”
The report writers noted, “During the first six months of 2023, healthcare providers in Louisiana were more successful in collecting claims from payors than all other states while those in South Carolina struggled the most.”
“It is alarming that in the worst-performing states for final denials, healthcare claims were more than five times more likely to not get paid at all,” Colleen Hall, managing principal of the healthcare group at Crowe, said in the report. “Final denial rates have been rising nationwide, but this data helps us zero in on the states where payors consistently refused to pay claims during the first half of 2023.”
Top claim-paying states
The best states for collecting payments, according to the report, are:
1. Louisiana
2. Oregon
3. New Mexico
4. Pennsylvania
5. Indiana
6. Wisconsin
7. Iowa
8. Arizona
9. Illinois
10. Ohio
Bottom claim-paying states
The worst states for collecting payments, according to the report, are:
51. South Carolina
50. Mississippi
49. Arkansas
48. North Carolina
47. Missouri
46. Kansas
45. Georgia
44. Kentucky
43. New Jersey
42. Idaho
“This data paints a picture of how payor claims-paying behaviors vary significantly by state and helps us identify trends by region,” Hall said. “It is interesting to see the regional disparity of the data, especially the lowest-ranking states, where seven out of 10 are in the southern part of the country. Providers can utilize this data to have meaningful conversations with payors to correct systemic and chronic problems.”
Report methodology
Under each of the three domains, two KPIs were measured to determine the best and worst states for the following: initial denial rate, AR greater than 90 days, six months’ lagged cash to net revenue, final denials, patient responsibility as a percentage of total allowable, and bad debt as a percentage of gross patient service revenue. The top five and bottom five states for each KPI were reviewed in the report, with Crowe using those scores to produce a top 10 and bottom 10 (see page 10 of the full report for more detail).
2. Significant racial and ethnic disparities in attrition from MD-PhD training are seen in the United States, study shows
“Black students had greater than 50% higher odds of leaving MD-PhD training than their peers [after adjusting for MCAT quartile],” according to a research letter published July 31 in JAMA Internal Medicine. The study reviewed a cohort of 4,702 students enrolled in MD-PhD programs in 2004-2012.
“Compared with a prior study in 1995-2000, the attrition rate from MD-PhD programs for Black students was persistent, despite a decrease in overall attrition,” wrote the study authors.
“Although more Black than White students demonstrate interest in MD-PhD programs, Black medical students report disparate experiences of mistreatment and discrimination, which may lead to depression, burnout, and leaving training.”
Study results
Here are some additional statistics from the study pool:
- 2,724 (57.9%) identified as white
- 1,011 (21.5%) identified as Asian
- 265 (5.6%) identified as Hispanic
- 215 (4.6%) identified as Black
- 9 (0.2%) identified as American Indian/Alaska Native or Hawaiian Native/Pacific
Of those students:
- 3,932 (83.6%) completed MD-PhD training
- 192 (4.1%) left medical school
- 578 (12.3%) graduated with their MD only
Of those who graduated with their MD only:
- 43 (20%) were Black
- 35 (13.2%) were Hispanic
- 337 (12.4%) were white
- 115 (11.4%) were Asian
- 48 (9.8%) were multiracial
The study authors stated in the letter: “The disparity in attrition for Black MD-PhD students could have implications for the racial diversity of the biomedical workforce. The benefits of a diverse workforce are well documented and include improved translational patient care and innovation.”
HFMA insight
- Read “A brief guide to the health-equity journey” by Richard Jackson, Yi-Ling Lin and Munzoor Shaikh, MBA, published June 12.
- Read “10 Steps Toward Health Equity,” a report on key takeaways from HFMA’s 2022 Thought Leadership Retreat.
3. 101 U.S. hospitals ranked among the World’s Best Smart Hospitals 2024, with Mayo Clinic named No. 1
Eight U.S. hospitals led the pack of 330 hospitals ranked by Newsweek and Statista as the World’s Best Smart Hospitals 2024. A total of 101 are U.S. hospitals, with Mayo Clinic’s Rochester, Minnesota, campus in the No. 1 spot, according to an announcement by Newsweek.
The winners hail “from 28 countries that stand out for their use of electronic functionalities, telemedicine, digital imaging, artificial intelligence, and robotics,” Nancy Cooper, global editor in chief for Newsweek, said in the announcement.
Top 8 smart U.S. hospitals
U.S. hospitals took the top eight spots in the rankings:
- Mayo Clinic, Rochester, Minnesota
- Cleveland Clinic
- Massachusetts General Hospital, Boston
- The Johns Hopkins Hospital, Baltimore
- The Mount Sinai Hospital, New York City
- MD Anderson Cancer Center, Houston
- Memorial Sloan Kettering Cancer Center, New York City
- Brigham and Women’s Hospital, Boston
“Medicine and technology are entwined, as some of the most significant medical advances have been made possible only through technological innovation,” Cooper said, adding: “Today, we are seeing the rise of smart technologies that share medical information faster and more accurately while providing improved patient care.”
HFMA insight
HFMA regularly provides content related to smart technology, such as:
Read “AI and machine learning — an intelligent approach to healthcare fraud prevention,” by Ellen Zimiles, JD, and Rod Fontecilla, PhD, published June 9.
HFMA bonus content
- Read the September issue of hfm, including the columns, “Voice of Experience: Richard Silveria says healthcare finance is rife with opportunities,” by Steven Berger, FHFMA, and “The best healthcare finance leaders are also great coaches,” by Jill Geisler.
- Read HFMA’s comments to CMS on a proposed rule for distributing $9 billion in remedy payments to 340B hospitals.
