Value-Based Care, Hospital Chargemasters Dominated 2019 Headlines

December 19, 2019 - A lot can change in a year. From innovative technologies and value-based care to hospital mergers and acquisitions and new competitors, the healthcare industry has undergone yet another year of immense change.

While the reading habits of RevCycleIntelligence.com followers reflected that, with top stories from this year detailing the struggles and triumphs of trends like hospital mergers and acquisitions and the opioid crisis, industry experts also reconnected with the basics.

The healthcare industry is nearly a decade into the value-based care journey, yet readers were still interested in unpacking the fundamentals of new care delivery and payment models. They were also interested in exploring the pillars holding up healthcare, like medical billing and coding and hospital chargemaster management.

The healthcare industry is constantly in a state of flux as new policies and regulations dictate how providers should deliver care but at the same time leaders are always trying to deliver the highest quality care at the lowest possible cost to their organization and, most importantly, their patients.

In its annual list of the top read stories from the past year, RevCycleIntelligence.com breaks down the new healthcare finance and revenue cycle management trends piquing the interest of industry leaders, as well as the topics that have had staying power in 2019.

10.  Medicare, Medicaid Reimbursement $76.8B Under Hospital Costs

Kicking off the list of top read stories from 2019 is a report highlighting the financial challenges facing healthcare organizations. The American Hospital Association (AHA) reported in January 2019 that Medicare and Medicaid reimbursement was $76.8 billion short of actual costs of care in 2017, the most recent year for which the association had data. Specifically, Medicare reimbursement was $53.9 billion short of actual hospital costs, while Medicaid underpaid hospitals by about $22.9 billion.

With the aging population rapidly growing, Medicare and Medicaid underpayments represent a serious issue for providers who are responsible for caring for these patients. Some private payers also use Medicare reimbursement rates as a starting point for negotiations, which would spell trouble for providers.

9. Opioid Overdose Care Totals $1.94B in Annual Hospital Costs

The Trump administration declared the opioid crisis a public health emergency in 2017 after approximately 42,000 Americans died from an opioid overdose the year before. In 2019, the country is still facing an opioid crisis, and healthcare providers were certainly interested in how they could make a difference.

One of the top read stories in 2019 highlighted a Premier analysis that found hospitals spent nearly $2 billion between 2017 and 2018 on treating opioid overdoses. Out of nearly 430,000 total emergency department, inpatient, and other care setting visits during the survey period, emergency department care for opioid overdose patients equaled over $632 million in hospital costs. And about 40 percent of patients admitted saw organ failure, which increased the cost to $20,500 for intensive care, the analysis found.

The data highlighted the impact the opioid crisis is having not only on patients, but also on their providers. Federal and state policymakers are actively pursuing new rules to halt opioid use disorder and overdose rates, but providers have recently found that a strategy they are already pursuing could help: value-based reimbursement.

8. 4 Hospital Business Models for Consumer-Centric Healthcare

High-deductible health plans continue to push patient financial responsibility higher, causing patients to increasingly consider the value of care provided. This new age of healthcare consumerism is impacting providers and not always for the better.

The traditional healthcare business model in which providers rely on payers for revenue will not cut in in a more consumer-centric industry, Gupreet Singh, a health services leader at PricewaterhouseCoopers (PwC) explained to RevCycleIntelligence.com in one of the most-read stories of 2019. Singh and his colleagues at PwC’s Health Research Institute (HRI) uncovered four new hospital business models that will enable the organizations to adjust to the changing landscape.

7. How Addressing Social Determinants of Health Cuts Healthcare Costs

"Social determinants of health" was one of the top buzzwords of 2019, and even healthcare finance and revenue cycle management leaders were talking about the social risk factors influencing their patients’ outcomes and costs.

“How Addressing Social Determinants of Health Cuts Healthcare Costs” provides healthcare finance experts with best practices and strategies for implementing more holistic care into their business models. The article highlights examples of providers who saw significant financial benefits by implementing efforts like a nutrition program, housing partnership, and ridesharing app.

6. CMS Clarifies Healthcare Price Transparency Rules for Hospitals

If social determinants of health topped the list of buzzwords in 2019, then healthcare price transparency wasn't too far behind. This year, the Trump administration made healthcare price transparency a priority by finalizing new rules that required hospitals to publish what is considered proprietary information: their charges.

Providers and payers staunchly opposed the two rules that required hospitals to first publish their chargemasters then their payer-specific negotiated rates. The rules especially troubled hospitals, which sought clarity on the new requirements according to one of RevCycleIntelligence.com’s top read stories of 2019.

5. How Providers Can Detect, Prevent Healthcare Fraud and Abuse

2019 was a big year for healthcare fraud takedowns. In September alone, the Department of Justice charged dozens of individuals, including several medical professionals, for their involvement in national fraud schemes, including one that cost Medicare more than $2.1 billion.

Engaging in fraud and abuse may not be as cut and dried as providers think. Coordinating care across providers can create compliance issues for providers as evident by HHS’ recent investigation into how current fraud and abuse laws prevent value-based care implementation.

Industry leaders looked for solutions in the name of value-based care in 2019. Meanwhile, readers explored how to detect and prevent a potential healthcare fraud and abuse situation, which could cost organizations more than its reputation to resolve.

4. Major Healthcare Mergers and Acquisitions Making Waves in 2019

Healthcare merger and acquisition (M&A) deals have been gradually increasing year over year, and 2019 proved no different. Value-based reimbursement, shrinking hospital margins, and record-high healthcare spending encouraged providers to collaborate and form new partnerships.

Some of the top deals taking place in 2019 included the Dignity Health-Catholic Health Initiatives merger, which created a $29 billion system called CommonSpirit Health, as well as the Beth Israel-Lahey Health merger, which brought the two Massachusetts health systems together to rival Partners HealthCare.

While these M&A deals were successful in 2019, many others slated to make waves this year were not. In Texas, for example, Baylor Scott & White Health and Memorial Hermann abandoned their deal by February. Partners HealthCare also pulled out of a deal in Rhode Island after state leaders opposed the merger.

The healthcare industry will continue to see more M&A deals in 2020, but if and how those deals unfold will be on center stage as more providers consider the consequences of their purchases and affiliations.

3. 3 Strategies to Reduce Hospital Readmission Rates, Costs

Falling reimbursement rates and value-based care are putting pressure on hospitals to reduce costs. Hospitals are actively trying to reduce one of their biggest avoidable expenses – hospital readmissions – to remain financially healthy, according to RevCycleIntelligence.com’s top stories list.

Among the top strategies for reducing hospital readmission rates were identifying the reasons why patients present back at the hospital, optimizing transitions of care, and improving patient engagement.

2. The Role of the Hospital Chargemaster in Revenue Cycle Management

You can’t talk about hospital price transparency without mentioning the role of the chargemaster. The list of prices for all billable services and items at a hospital was once considered proprietary information, used mainly as a starting point for negotiations with private payers. However, new hospital price transparency requirements are unveiling chargemaster prices to empower consumers to shop around for care.

With chargemasters out in the open, hospital leaders sought to better understand their prices and how they will be viewed by the public. Readers are likely to continue exploring this topic as policymakers seek broader price transparency policies.

1. What Is Value-Based Care, What It Means for Providers?

Value-based care is not a new trend in healthcare, but RevCycleIntelligence.com followers continue to read (and re-read) “What is Value-Based Care, What It Means for Providers.” Topping the 2019 list of most-read stories on the site for the second consecutive year, the article explores the basics of value-based care and strategies for providers to implement and succeed under the new care delivery and payment models.

Providers are still very much in the thick of value-based care implementation.  The latest data from the Health Care Payment Learning & Action Network (HCP LAN) showed that just over one-third (35.8 percent) of healthcare payments 2018 were through an alternative payment model.

The journey from volume to value is a long and steady one. However, providers are still interested in participating in the right alternative payment model in order to improve outcomes for their patients while bringing down unsustainable healthcare costs.

Value-based care, price transparency, fraud and abuse prevention, consumerism, and other trends explored in this list are unlikely to go away in the new year. The reading habits of RevCycleIntelligence.com followers show that these trends are changing how healthcare does business and providers are actively seeking strategies to adapt.

Written with help from Samantha McGrail, news writer at Xtelligent Healthcare Media.