Why the Medicare physician fee schedule is sheer madness
Amid the complexities of U.S. healthcare, there is probably no construct that’s more byzantine than the Medicare Physician Fee Schedule (MPFS) — the program’s elaborate system of paying physicians and other clinicians (including nurse practitioners, physician assistants and clinical psychologists) for more than 10,000 medical services.a In 2022, the schedule drove about $71.2 billion in…
Reimagining charity care: How Monument Health puts patients first with an innovative financial assistance program
Deepak Manmohan Goyal, MD, MBBS, MBA, executive director for revenue cycle and supply chain at Monument Health, remembers the case of a 40-year-old patient with late-stage cancer who sought care at the Rapid City, S.D., health system a few years ago before succumbing to her disease. An earlier and unrelated care episode ideally would have…
How to promote patient loyalty by improving network integrity
To achieve enduring financial stability, health systems must pursue initiatives to improve margins. And a particular priority for them is to focus on improving the integrity of their provider networks, with the goal of building patient loyalty to the larger healthcare organization. The first step in such an effort should be to perform a network…
Robert Rebitzer: How to overcome the disruptive forces that can impede high-value innovation
In the 1980s, two valuable innovations, laparoscopic gallbladder surgery and electronic health records (EHRs), came to market. The former became widely adopted in about three years. The latter took three decades and billions of dollars in federal subsidies. The reasons behind the differing uptakes of health innovation are among the topics in the book Why…
Why U.S. policy needs to focus on pruning the healthcare transaction thicket
Despite its huge disruptive impact, the Change Healthcare cyberattack seems to be fading from the headlines even as the after-effects of this disruption linger. What remains, however, is the unsettling awareness not only that the U.S. healthcare payment “system” is not secure, but also that the hospitals and physicians’ offices we all rely on when…
Andrew Donahue: An open letter to Congress on nonprofit hospital finances
There’s a lot of bad information out there on nonprofit hospital finances. Part of the problem is run-of-the-mill scapegoating — stakeholders with an agenda using our business complexity to muddy the water. Part of the problem is classic misuse of information — good people with good intentions making the wrong assumptions. And part of the…
BESLER provides thorough Transfer DRG revenue recovery services
Hospitals require clear and simple paths through the challenges posed by changing regulations so they can spend more time and dollars focusing on enhancing patient care.
News Briefs: Providers face trying times in the first month after the Change Healthcare cyberattack
Healthcare providers struggled financially and operationally in the first 30 days after a Feb. 21 cyberattack forced the shutdown of Change Healthcare’s claims submission and payment systems, among more than 100 other applications. As of the week of March 18, parent company UnitedHealth Group had restored Change Healthcare’s payment platform and was reporting progress in…
How to keep your balance sheet steady in tumultuous times
The balance sheet contributes significantly to cash flow at most not-for-profit (NFP) hospitals and health systems. Yet few organizations have developed a strategy that reflects the balance sheet’s contributions to financial sustainability. Throughout the operational and financial turmoil of the past few years, many health systems have relied on their balance sheet to compensate for…
How providers can optimize payer contract negotiations
Negotiating payer contracts can be both challenging and frustrating. Payers have significant leverage at the bargaining table, enhanced by payer consolidations and the emergence of dominant local, regional and national plans. But by adopting a transparent data-driven strategy in negotiations with a payer, a provider organization can create an opportunity for building a strong partnership…