Value-Based Care, Price Transparency Rule Top Stories of 2018

December 10, 2018 - 2018 has kept healthcare revenue cycle management and finance leaders on their toes. The healthcare industry continued its slow, but steady transition to value-based care and purchasing all while navigating the new landscape of healthcare consumerism and consolidation.

Hospitals, medical groups, and practices alike are facing a significantly different market compared to a decade, or even a couple of years, ago.

Approximately one-third of healthcare payments are now tied to alternative payment models, up five percentage points compared to two years ago. And providers and payers are starting to see the benefits of value-based care and reimbursement, including lower costs and higher care quality.

At the same time, value-based care and new entrants to the healthcare industry are changing how healthcare organizations look. Hospitals and practices are becoming closer than ever as healthcare organizations increasingly consider mergers and acquisitions.

How healthcare looks and feels, especially for patients, significantly shifted in 2018. And no one felt it more than those in charge of revenue cycle management and finance departments.

READ MORE: Best Practices for Value-Based Purchasing Implementation

Based on the reading habits of RevCycleIntelligence.com readers, revenue cycle management and finance leaders explored not only the trends that impacted healthcare business, but also best practices and strategies to manage healthcare consumerism, value-based care, and other top trends.

With that, RevCycleIntelligence.com presents the list of the top ten stories of 2018.

10. Top 10 Enterprise Resource Planning (ERP) Vendors By Hospital Use

Enterprise Resource Planning (ERP) solutions are key tools for healthcare revenue cycle management. The solutions integrate human resources, payroll, materials management, accounts payable, general ledger, supply chain management, and other business applications into one system to automate back office functions.

Now that providers are largely done with EHR implementation projects, healthcare leaders are setting their sights on improving financial systems. About 38.4 percent of hospitals now have an ERP solution, and another 46 percent expressed a strong interest in implementing a solution in the near future, a recent HIMSS Analytics report showed.

“Top 10 Enterprise Resource Planning (ERP) Vendors By Hospital Use” explores the ERP solution market, identifying the top vendors and what they offer in terms of ERP systems.

READ MORE: 4 Strategies for Providers to Improve Hospital Price Transparency

Infor, Intacct, Oracle, and SAP are among the most commonly used ERP vendors by hospitals.

9. The Difference Between Medicare and Medicaid Reimbursement

Medicare and Medicaid are the largest payers in the US, accounting for 37 percent of all healthcare spending in 2017.

Many healthcare organizations depend on revenue from the public health insurers to keep their doors open, so it is no surprise that readers want to explore the nuances of Medicare and Medicaid reimbursement.

The article dives into the differences between the two public healthcare programs, such as enrollment eligibility requirements and financing structures. Readers can also learn how Medicare and Medicaid pay providers for covered services and how the public health insurers plan to innovate in the near future.

8. 6 Major Hospital Merger Deals Making Headlines in 2018

The healthcare industry is undergoing rapid consolidation as hospitals and practices engage in robust merger and acquisition (M&A) activity. While healthcare merger and acquisitions are occurring across different types of organizations and markets, some M&A deals made a bigger splash than others.

READ MORE: Investing in Primary Care Delivers Value-Based Care Results

Six of the major hospital merger deals popping up in headlines in 2018 included the deals between Advocate Health Care and Aurora Health Care, Beth Israel Deaconess Medical Center and Lahey Health, and Carolinas Healthcare System and UNC Health Care.

The health systems announced the top six hospital merger deals in 2017 and continued the merger process well into 2018, while other deals fell apart.

For example, the Massachusetts Attorney General recently approved the merger between Beth Israel and Lahey Health. However, the new Beth Israel Lahey Health System will have to abide by a seven-year price cap, as well as care access requirements.

On the other hand, the rumored merger between Providence St. Joseph Health and Ascension Health will not happen, according to news sources.

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

Healthcare fraud and abuse allegations and convictions can significantly cost healthcare organizations. Avoiding major fraud and abuse schemes may seem like a no-brainer, but the regulatory complexity involved with Medicare and Medicaid can make preventing fraud and abuse difficult.

For example, the healthcare industry is pushing value-based care implementation. But certain arrangements that support care coordination can violate the anti-kickback statute or physician self-referral law if specific waivers are not granted.

RevCycleIntelligence.com readers learned about specific healthcare fraud and abuse laws, as well as how to create strong compliance programs to avoid fraud and abuse allegations.

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

The hospital chargemaster is the backbone of revenue capture. The chargemaster is a list of all the billable services and items hospitals deliver or furnish to a patient and/or the patient’s health insurance provider.

Maintaining an updated hospital chargemaster is key to accurately capturing the costs of each procedure, service, supply, prescription drug, and diagnostic test provided at the organization, as well as any fees associated with healthcare delivery.

The hospital chargemaster was the top of mind for many revenue cycle management and finance leaders in 2018. New healthcare price transparency requirements and the push to empower patients as consumers is driving hospitals to make their chargemasters more accessible to patients.

As the industry aims to lower healthcare costs, exploring hospital prices and reimbursement rates will continue to be a trend. Hospitals should prepare to have their chargemasters take center stage in the healthcare price transparency efforts.

5. CMS Clarifies Healthcare Price Transparency Rules for Hospitals

In a similar vein, RevCycleIntelligence.com readers clamored to stories about new hospital price transparency requirements from CMS.

CMS finalized a new requirement in August 2018 that will require hospitals to publish a list of their standard charges online in a machine-readable format. Hospitals must comply with the new requirement by Jan 1., 2019.

Healthcare organizations are sprinting to comply with the hospital price transparency rule. The article unpacks the specific requirements within the hospital price transparency rule, such as what constitutes machine-readable and how hospitals can incorporate quality information.

4. 3 Strategies to Reduce Hospital Readmission Rates, Costs

Reducing costly hospital readmissions was a top priority for RevCycleIntelligence.com readers in 2018.

Hospital readmissions cost organizations $41.3 billion when patients return to the hospital within 30 days, according to the latest data from the Agency for Healthcare Research and Quality. Preventable readmissions can also impact value-based reimbursement for hospitals.

Understanding how to effectively reduce hospital admissions is key to decreasing hospital costs and maximizing value-based reimbursement.

3. Understanding the Basics of Bundled Payments in Healthcare

Healthcare payments are increasingly moving to alternative payment models, and bundled payments continue to be a popular option for providers.

Under bundled payment models, providers receive a single payment for a suite of related healthcare services for a specific time period. If the care episode’s costs are less than the bundled payment amount, then the provider shares in the savings. However, care costs exceeding the bundled payment means providers must repay payers.

Bundled payments have cut costs and improved care quality while transitioning providers to value-based reimbursement and two-sided financial risk arrangements.

2. Exploring the Role of Supply Chain Management in Healthcare

The healthcare supply chain is a major cost center for organizations, coming in as the second largest expense for providers. As healthcare organizations look to cut costs and optimize care delivery, leaders are exploring strategies to add value to the healthcare supply chain.

Understanding the role of supply chain management in healthcare is the first step to maximizing labor and supply savings, as well as improving outcomes through lean supply chain management.

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

Value-based care and reimbursement were popular topics on RevCycleIntelligence.com in 2018. The industry is slowly, but surely transitioning away from fee-for-service. Approximately 34 percent of healthcare payments are now tied to an alternative payment model.

How the transition will impact providers and their revenue is a top concern for the industry. Understanding what value-based care is, what models are currently available, and how to prepare and implement the models are key questions for providers as they continue with the transition.