Client News Coverage

Our nation’s response to the COVID-19 pandemic has taught us, among other things, that systemic racism doesn’t just lead to disparities in food and housing, but in healthcare as well.

Any conversation that includes the identification and elimination of barriers to health needs to include race, especially since it goes hand-in-hand with social determinants of health. Ignoring or glossing over these challenges is the equivalent of putting bandages on a broken bone.

It’s reactive and ineffective. A proactive approach is required.

Fierce Healthcare»

Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020.

Holiday travel is downright dangerous this year. Earlier this week, the CDC warned Americans to stay home this Thanksgiving. All across the country, people are scrapping their itineraries and making a U-turn.

And for good reason. Some holiday travel errors could land you in the hospital — or worse.

New COVID-19 cases shattering records, as my FORBES colleague Suzanne Kelleher recently noted. Many health experts are warning against all nonessential travel. But if you go — and I'm not saying you should — there are other errors you have to avoid. Because some holiday travel mistakes could kill you.

Forbes»

The fundamental problem with healthcare can be summed up in one sentence: We expect healthcare services that cater to our individual needs, yet the health care system operates under a one-size-fits-all, trial-and-error model. It is a model that results in missed diagnoses, protracted illnesses, and even premature death and wastes $765 billion annually.

The financial toll of this outmoded approach pales in comparison to the human toll. More than 128,000 people in the U.S. die each year from taking medications as prescribed—four times the number of people killed by prescription painkillers and heroin combined, as reported by the Centers for Disease Control and Prevention.

As the healthcare delivery system continues on its journey from a fee-for-service to value-based care reimbursement model, the realization of moving from a traditional “sick care” system that has driven the healthcare industry to date to one that provides more affordable, personalized and preventive care, will be critical to achieving success in this movement.

Many industry leaders believe that the tools needed to reimagine and change how to treat illness, and to establish healthy behaviors in patients by focusing on personal details—such as their unique biology, traits, and environmental factors—are already in place, and the next steps needed to shift the paradigm will be around culture, mindset and operational transformation.

The healthcare industry continues to see an uptick in oversight of federal healthcare payments. In late 2019, HHS’s Office of the Inspector General (OIG) reported that Medicare made $54.4 million in improper payments to acute care hospitals due to incorrectly coded claims. It also recommended that CMS direct its contractors to recover the lost money.

Enter 2020 and the introduction of COVID-19 incentive payments, and today’s C-Suite can expect a continuation of this trajectory in terms of increased scrutiny. In fact, the OIG recently announced its audit plans related to hospital payments covering COVID-19 discharges under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

Healthcare Business Today»

The last few years have ushered in significant progress on the opioid crisis containment front. Acknowledging decades-long misinformation shortfalls, negligence, and improper prescribing patterns, the healthcare industry took important steps on national and state levels to get out in front of devastating statistics.

A March 2020 report suggested the needle was finally pointing in the right direction. The Centers for Disease Control and Prevention (CDC) reported a 13.5% decrease in opioid overdose deaths from 2017 to 2018.

Unfortunately, that report was quickly overshadowed by the global pandemic that brought the nation to its knees. Opioid misuse, like many other critical healthcare priorities, took a back seat to COVID-19. The fallout is notable. A recent analysis points to a spike in opioid overdose cases by 18% since the start of the pandemic.

Health care is realizing the promise of artificial intelligence (AI) across a broad and seemingly endless range of use cases. The opportunities for using advanced technologies to accelerate labor-intensive processes touch everything from research and operations to supply chain and point-of-care decision making.

Data-hungry revenue integrity and billing compliance functions are no exception. AI tools such as machine learning, natural language search, and anomaly detection are fueling new and expanded insights into revenue integrity, billing compliance, and quality assurance to advance process improvement initiatives. And not surprisingly, the value proposition of these tools is growing rapidly amid COVID-19 as health care organizations try to maximize reimbursements against notable challenges such as revenue shortfalls and rapidly changing regulations.

ForTheRecord»

Finding new revenue opportunities and avoiding claims denials has taken on greater urgency as hospitals and other healthcare organizations face growing reimbursement shortfalls in the wake of the COVID-19 pandemic.

It is why Hayes, makers of the industry’s leading integrated compliance and revenue integrity platform for the nation’s premier healthcare organizations, has launched Revenue Optimizer to equip healthcare organizations with actionable insights that help eliminate barriers to revenue integrity and manage overall financial performance.

THE CORONAVIRUS pandemic has underscored that the field of epidemiology, which focuses on discovering the causes of disease outbreaks and tracing the spread of illness, is an academic discipline with real-world relevance. When policymakers propose solutions to the COVID-19 outbreak, they often base their recommendations on advice from epidemiologist.

Epidemiologists, sometimes referred to as "disease detectives," are trained to recognize, control and mitigate the proliferation of disease within a population and often work in academia, government or the nonprofit sector. They also sometimes work for corporations that require guidance on occupational and environmental health and safety measures. 

U.S. News and World Reports»

Little by little, we’re working towards a National Patient Identifier.  For those not familiar with the topic, the US government in a section of the federal budget has banned HHS from even working with the private sector to develop a national patient identifier.  However, the House of Representatives thanks to leadership from Representative Bill Foster (D-IL) and Representative Mike Kelly (R-PA) have passed a bill to remove this ban.

“On behalf of our patients and caregivers, Intermountain Healthcare applauds House passage of the Foster-Kelly Amendment and looks forward to a future in which patients can accurately, safely, and consistently be matched to their health data across the care continuum,” said Ryan Smith, Vice President and Chief Information Officer at Intermountain Healthcare.

Reimbursement is becoming increasingly complex for today’s providers. And while it is fair to say that a certain amount of missed revenue has always been part of the bottom-line equation, healthcare organizations simply cannot afford to leave money on the table in the current market climate.

Already operating within razor-thin margins, today’s hospitals and health systems must now address current and future reimbursement and revenue risks introduced by the COVID-19 pandemic. In a recent study, Strata Decision Technology estimated that 97% of health systems will lose an average of $1,200 per coronavirus case, or as high as $8,000 in some instances—even with the 2% Medicare payment increase.

Carrot believes in enabling a future where each of us has no barriers to leading our healthiest lives. Unfortunately, health in this country is distributed very inequitably. In the Twin Cities we have communities with a 30-year gap in mortality: Medina at ~90 years, Frogtown in St. Paul at ~60 years.

That distribution is often based on lines drawn by racism. Take food insecurity. Those who struggle to get enough to eat report the highest levels of poor health – exacerbating nearly every medical condition.

In Minnesota, the ‘average’ person has much better access to food than the national average – only 75% of the national risk. Until we look at the data by race – in North Minneapolis, a family has 1.6x the likelihood of food insecurity, compared to the nation as a whole.

Medical Alley»

Saying that telehealth has moved front and center amid the COVID-19 pandemic is an understatement. With the Centers for Medicare and Medicaid Services (CMS) now reimbursing for remote care models, adoption of telehealth is rapidly advancing as physicians strive to overcome barriers to continuity of care and maintain operations amid stay-at-home orders.

Notably, one analysis found that from March 14 to April 1, daily telehealth claims for upper respiratory infections using ICD-10 diagnosis codes from private insurance increased nearly 12 times from the daily average over the previous month. In this case, upper respiratory infections were chosen to reflect COVID-19-related illnesses prior to the introduction of a diagnosis code for COVID-19.

Physicians Practice»

While the introduction of new COVID-19 reimbursement rules and regulations have brought on their share of confusion, there is one certainty healthcare organizations can bank on: oversight of incentive dollars will be a regulatory priority. In fact, federal watchdogs are not wasting any time, as reports suggest monitoring of billing and claims data is already underway to ensure that hospitals are not upcoding to take advantage of higher COVID-19 reimbursement rates.

RACmonitor»