At the Margins

Winter blues, bipartisan agreement, and a novel way to pay less (there's a catch): The rev cycle April reading list

by Anita Mago

Revenue cycle leaders, it's been a busy few months since we last shared our list, but rest assured, we've got some noteworthy news to share—from how the seasons impact revenue cycle, to … brace yourselves … bipartisan agreement! So without further ado, here's our Spring 2019 reading list!

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Even the revenue cycle gets the winter blues

Seasons have material impact on hospital revenue cycle performanceRevenue Cycle Intelligence, April 2019

In a recent analysis of more than 1,000 hospitals, Crowe Consulting found that revenue cycle performance fluctuates in step with the seasons. Using data from Crowe Revenue Cycle Analytics software, the report found that days in A/R, claim denial rates, and bad debt transfer fluctuate on a quarterly basis. The time to overhaul your budgeting process is now, the report cautions, as "the impact of seasonality likely will become more extreme as consumerism and out-of-pocket payments continue to increase."

Brain MRIs: The new frontier for bargain-hunters

Transparent hospital pricing exposes wild fluctuation even within milesKaiser Health News, February 2019

Kaiser Health News examined the chargemasters of the largest acute care hospitals in several large cities and found that prices varied widely. The list price on a liter of basic saline solution ranged from $56 to $472.50, and a brain MRI with contrast was priced from $1,720 to $8,800. Even hospitals within a few miles of each other sometimes charged more than twice as much as their neighbor.

Hospitals penalized, call foul

Medicare trims payments to 800 hospitals citing patient safety incidentsKaiser Health News, March 2019

In 2019, 800 hospitals will be penalized because of high rates of infections and patient injuries. This is the highest number since the Hospital Acquired Conditions (HAC) Reduction Program was created five years ago. The hospital industry protested the HAC penalties, citing an arbitrary cutoff and misaligned incentives that punish better testing.

Novel ways to pay less: First the airlines, now health insurance

Some 'cheaper' health plans have surprising costs—NPR's "Shots," March 2019

The latest efforts to reduce the cost of coverage are yielding an array of innovative products. One health plan from a well-known insurer promises lower premiums, but warns that consumers may need to file their own claims and negotiate over charges from hospitals and doctors. Another policy limits reimbursement to 40% above what Medicare would pay, but has no specific network of doctors and hospitals. According to one expert, "Traditional health plans have not been able to stem high cost increases, so people are tearing down the model and trying something different."

Surprise! Congress agrees on something

Fixing surprise medical bill problem shouldn't fall to consumers, panel toldKaiser Health News, April 2019

During a recent House subcommittee hearing, one point drew clear agreement: when it comes to solving the problem of surprise medical bills, "it is the providers and insurers, not patients, who should bear the burden." Instead of forcing a situation in which patients must negotiate a payment plan after receiving a surprise bill, witnesses testifying before the panel were firm that any answer needed to be worked out between providers and insurers. Although experts offered a few policy solutions, the search continues...

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