Financial Sustainability Report: July 2021
The July 2021 issue of the Financial Sustainability Report, sponsored by Kaufman Hall, includes an account of how one health system assessed the benefits and risk associated with moving its 340B covered-entity pharmacy enterprise to a Limited Liability Company. The issue also includes a commentary on CMS’s new Acute Hospital Care at Home program and a discussion of a new metric, equivalent net patient revenue (ENPR), which organizations can use to assess the relative value of proposed investments in alternative revenue sources.
Hospital care at home signifies an important innovation in acute care delivery
Although the CMS Acute Hospital Care at Home program is still early in its development in the U.S., early adopters show evidence of the program’s exciting promise, including positive impacts on health outcomes, an improved patient and provider experience, reduced cost of care and overall healthcare savings.
In 2022 OPPS rule, CMS plans to reinstate policies pertaining to the inpatient-only and ASC covered-procedures lists
The 2022 proposed rule for the Outpatient Prospective Payment System would reverse 2021 policies that began to phase out the inpatient-only list of procedures and expand the covered-procedures list for ambulatory surgical centers.
Moving a 340B covered entity’s pharmacy enterprise to an LLC may prove beneficial, but it requires a feasibility study
University of Utah Hospitals and Clinics (UUHC) in Salt Lake City performed research to assess the feasibility of moving its 340B covered-entity pharmacy enterprise to a Limited Liability Corporation (LLC), with a focus on risks that should be factored into the decision. Other organizations that are considering such a move could benefit from adopting UUHC’s assessment approach.
CMS is preparing to make noncompliance with price transparency requirements much more expensive
A hospital with at least 550 beds would owe more than $2 million in penalties for a year of noncompliance with new price transparency requirements, according to a proposed rule.
Surveys show rates of uninsured increased, underinsured remains significant
HFMA's Chad Mulvany says healthcare organizations should ensure their self-pay revenue cycle process follows best practices as it’s likely with more people uninsured there will be increased scrutiny of these processes.
CMS’s 2022 Medicare Physician Fee Schedule proposed rule: A look at telehealth provisions and overall payment rate changes
Clinicians will be able to seek payment for providing mental health visits to Medicare beneficiaries via audio-only telehealth, according to newly proposed regulations from CMS.
By adopting 4 models for managing risk, healthcare organizations can secure the foundation for value-based payment success
By adopting four models for optimizing costs, care delivery, the continuum of care and contracts under risk-based payment, health systems can create an integrated framework for guiding their value-focused strategy and focusing their efforts in risk-based contracting.
A closer look at the new surprise billing regulations: How cost sharing will be calculated
The qualifying payment amount that establishes a patient's cost sharing for out-of-network care also is intended to factor into negotiations between providers and health plans regarding payment.
Healthcare News of Note: Few consumers are using publicly posted negotiated prices to comparison shop for healthcare services
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Little use of price transparency information to comparison shop for healthcare services, the nursing shortage being felt throughout the U.S., and cash payers being charged more for the same services than patients with insurance.