Hospitals expand to attract well-insured patients despite pressures of healthcare reforms

Several hospitals are looking for well-insured patients beyond traditional market boundaries, both in prosperous suburbs and in nearby areas with growing, well-insured populations. According to a study by the Center for Studying Health System Change (HSC) hospitals seeking a competitive edge in the marketplace are targeting geographic expansion into new markets which are well-insured.

The study based on HSC’s visits to 12 nationally representative metropolitan communities, depicted that hospitals are expanding despite the pressures of the healthcare reform. Hospital strategies mainly include – building full-service hospitals, establishing freestanding emergency departments and other outpatient services, acquiring physician practices, and operating medical transport systems with several hospitals building near major highways to be accessible.

Hospitals expansions survey findings

• In all 12 markets surveyed results depicted that hospitals are looking for full-service hospitals or freestanding emergency departments, buying or establishing physician practices and developing a regional presence through emergency medical transport systems
• Recession rather than diminishing has heightened the drive among hospitals to pursue well-insured patients beyond traditional hospital market boundaries
• Expansion appears more frequent where large hospital systems were pursuing significant employment of physicians and where service-line strategies, such as cardiac or cancer care, were well entrenched

Impact on Hospitals & Independent physicians

The overall impact of hospitals’ geographic expansions is still to be observed, there are conflicting views within the industry regarding these new hospital competitive strategies, if they will increase costs, improve care or both. Hospitals are of the view that the expansions will increase efficiency, increase access and improve the quality of patient care, while payers and competitors argue such strategies will lead to elevated costs.

Also Independent Physicians in most markets due to health reforms who are faced with financial pressures along with difficulty in hiring younger physicians, who often prefer employment in larger organizations, are actively seeking the stability and security of employment in larger physician-owned or hospital-owned groups. According to the HSC study in fast growing and well insured Greer, SC, there are no more independent primary-care practices left.

Revenue cycle management amidst hospital expansion and reforms

Hospitals backing expansions as necessary countering that even though there are costs increases, their efforts provide increased high-quality care; will need to cater to higher patient influx and increased medical billing. Hence in this scenario along with the growing pressure of health care reforms, services of skilled service providers possessing the requisite credentials can be availed by hospitals and practitioners to maintain favorable revenue cycles management.

Medicalbillersandcoders.com the largest ‘Consortium of Medical Billers and Coders, servicing over 50 specialty US physicians, are constantly updated with the requisites of the industry and healthcare reforms are the right choice for hospitals and practices. Medicalbillersandcoders.com has in-depth knowledge and expertise in the delivering the best quality services to hospitalists. Hospital employment will affect patients, hospitals and doctors – as healthcare will require greater coordination, greater use of clinical data and collaborative provider teams — which MBC is best positioned to deliver.

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The primary care physician shortage in California

State of California is facing an increased shortage of primary care physicians especially – with a rise in the number of elderly population in the State leading to increase in health coverage under Federal Health care reforms. Additionally 30% of primary care physicians in the state are nearing retirement being above 60 or older- the highest percentage in any state.

However compared to the shortage, the State has not significantly increased the number of primary care physicians trained. HHS’s Council on Graduate Medical Education recommends 60 to 80 primary care physicians per 100,000 people to adequately serve a population. Statistics show in fast-growing regions of California such as the Inland Empire there are only 40, whereas in low-income rural communities where care for 25% patients is paid by Med-Cal, there are only 45 primary care physicians.

Even though medical school applications have been high in California, with a high proportion of U.S. medical school graduates filling all of the 2011 family medicine slots, state and federal policy decisions too need to be on the same lines. However the State of California is trying to reduce physician fees by 10% in the Medicaid Program, putting physician payment at risk. According to the California Academy of Family Physicians (CAFP) a comprehensive state and nationwide effort would be able to effectively solve this shortage.

Tackling the shortage issue

Increase the number of medical school – The State and federal policies need to encourage funding for higher education and primary care residency programs. Absence of this funding may lead to students pushed to choose non-primary care specialties or to train in medical schools and residency programs in other states. To provide for increasing needs high quality primary care residency programs are the need of the hour to fill vacancies left by retiring physicians.

Medicaid reimbursements – With Medicaid rates in California being 20% lower than the national Medicaid rate and among the lowest in the U.S, Californians face a severe shortage of physicians willing to cater to them, conversely the California Legislature passed a budget in June reducing Medi-Cal physician payments by 10 %, among other reductions.  This could provide further incentive for students to choose specialties other than primary care. Patient access to care could be hampered as well if practicing physicians opt out of the Medi-Cal program because of the cuts. The state legislature and family physicians needs to work together to remedy reimbursement issues.

California family physicians need a coordinated effort of various entities to remedy this shortage of primary care physicians. In this scenario where primary care physicians need to tackle increased number of patients, cater to shortage issues, physicians may be short of time to give complete justice to their reimbursement strategy and medical billing and coding practices which hampers a steady flow of revenue for smooth running of their practice. Medical billers and coders can not only efficiently interact with insurance providers and increase claims generation but also keep up with health care IT reforms and comply with HIPAA and other guidelines.

Primary care physicians in California need to gear up and face the shortage challenge; moreover they can join a consortium of experts who can provide relevant revenue management services. Medicalbillersandcoders.com  is one of the largest consortiums of Medical Billers and Coders in the United States, our billers and coders in all the major cities of California including Los Angeles, San Diego, San Jose, San Francisco, Fresno can help you settle your requirements through services including- tracking and follow-up on unpaid claims, preparing patient statements and payment posting, customizing billing reports and primary and secondary insurance claims filing.

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Uninsured population rate percentage vs. Physician’s density ration in Texas, Mississippi & Oklahoma

Physicians work scope is expected to change with millions of Americans to gain health insurance through the Affordable Care Act in 2014. On the upside Physicians especially primary-care provider will experience higher demand transforming to higher reimbursements and job security. However, on the  other hand other healthcare reform initiatives would require better quality patient care at subsidized costs and hence the pressure of catering to a larger number of patients along with quality and cost targets will build up for physicians.

Physicians in certain locations are likely to face a tougher time compared to others, most probable providers in states currently facing physician shortages, will face the biggest challenge fitting in new patients into their busy schedules. Moreover states currently possessing the highest number of uninsured individuals will experience the highest increase of new patients.

According to 2011 Reports including rankings of states based on physician density and the 2011 insured population data:

Four states with the worst density/uninsured combination are:

State	Uninsured population rate %	Least physician-dense
Texas	27.2%	One of the least physician – dense State
Mississippi	24.5%	Third least physician-dense State
Oklahoma	22.5%	Second least physician-dense State
Arkansas	21.0%	Seventh least physician-dense State

The physicians in these states are likely to struggle the most in 2014 due to a high influx of patients and shortage of doctors with healthcare reforms demanding quality and cost benefits.

States with the most favorable density /uninsured combination:

State	Uninsured population rate %	Most physician-dense
Massachusetts	5.3 %	One of the most physician-dense State
Maryland	11.4%	Second most physician-dense State
Connecticut	10.3 %	Fourth most physician-dense State
Vermont	9.2 %	Sixth most physician-dense State

Physicians tackling the patient influx:

Even though the Obama administration has relaxed rules limiting the use of nurse practitioners and physician assistants, Physicians need to gear up for the expected patient influx especially in the states facing a physician shortage. Higher reimbursements and incentive may drive physicians to take on more patients; conversely insuring maximum claim generation while trying to maintain quality of care, dealing with new standards like HIPAA 5010, ICD-10, etc and government and private payers could seem as an insurmountable task to most of the Physician practices. However, services of skilled service providers possessing the requisite credentials can be availed by hospitals and medical practitioners.

Medicalbillersandcoders.com experts being constantly updated with the requisites of the industry and healthcare reforms are the right choice for physicians. Our team trained on ARRA 2009, ICD 9, ICD -10, HIPAA 5010 and handling Revenue Management Cycle for various clients, are highly motivated to provide you with the right course of action to take in the current challenging healthcare industry – right from EHR selection, increased data management, increased patient registration right up to denial claims management. 

Maximizing your office’s efficiency and cutting your costs are some of the priorities of medical billing and coding specialists located in Texas, Mississippi, and Oklahoma we also serve across the other 47 states in US.

The Changing Landscape of Healthcare Reimbursement in 2012

“As the projection for 2012 forecasts an unprecedented increase in patient population, physicians will have a hard time balancing their time resources between quality medical care and adhering to imposing compliance regimen promulgated by the Federal Healthcare Reforms. Therefore, it becomes crucial that practitioners seek strategic alliance with medical billing advisories that can ease their burden off the compliance regimen, and help elevate their quality of medical service.”

While the dawn of a new year brings forth a renewed optimism about offering enhanced quality medical care and accelerated revenue generation, there also seems to be an undercurrent of apprehensions about complying with the ensuing medical reforms that are going to be effective very soon – the Affordable Care Organization Concept, the undecided fate of Sustainable Growth Rate (SGR) fix, the mandatory transition to exhaustive ICD-10 and HIPAA 5010 medical coding and reporting compliance, and the last but not the least,  the revised ABN (Advanced Beneficiary Notice of Non-coverage), Form CMS-R-131.

The imminent weight of these factors is sure going to press all the stakeholders – physicians, medical billing companies, and medical billing software providers – for realigning their resources and competencies to address the change-scenario prompted by these radical reforms.

Foremost, as the CMS (Centre for Medicare Services) has made it obligatory that physicians form suitable cartels among themselves to be eligible for incentives from savings out of Affordable Care Organization concept, a considerable time and resource is going to be spent on arriving at judicious decision on joining the cartel that best suits the concerned practitioners’ business model.

Though, CMS has given an extra leeway of 90 days more for complying with HIPAA 5010, the obligation to report all Medicare related transactions still remains unchanged. As the ICD-10 and HIPAA 5010 are soon going to be effective, physicians will require upgrading their clinical and operational management, and outsourcing those medical billing companies’ services that have a proactive outlook to embrace newer practices through logistically formed alliances with medical billing and EHR software manufacturers.

Although, with the postponement of SGR fix, physicians have been given a breather, yet, they cannot take it for granted as the threat of cumulatively accumulated figure (of about 25%) always looms large. Therefore, while being assured of 2% hike annually, they need to be vigilant about their operational and capital expenditure, and be prepared for any eventuality.

Adding to the imminent list is the use of the revised ABN form (Advanced Beneficiary Notice of Non-coverage), which is going to be mandatory starting January 1, 2012. And failure to upgrade to this revised form of for disclosure beneficiary notice of non-coverage) will eventually invite hurdles while being audited.

As the projection for 2012 forecasts an unprecedented increase in patient population, physicians will have a hard time balancing their time resources between quality medical care and adhering to imposing compliance regimen promulgated by the Federal Healthcare Reforms. Therefore, it becomes crucial that practitioners seek strategic alliance with medical billing advisories that can ease their burden off the compliance regimen, and help elevate their quality of medical service.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – whose credentials have, time and again, come to the fore in successfully aiding physicians comply by healthcare regulations – should be your preferential alliance partner for complying by the imminent healthcare reforms. Our close association with Medicare and Medicaid, leading private insurance carriers, Federal Healthcare Agencies, and leading technology providers lends us the requisite edge in addressing and solving physicians’ apprehensions.

Meaningful Use’ Compliant EHR Technology Implementation – specialists’ perspective

“While specialist practitioners, such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. can claim exemptions and exclusion of certain objectives set out in the Meaningful Use Clause by CMS, they are not treated preferentially as far as documenting clinical processes using approved and compliant EHR software is concerned:  their responsibility for reporting clinical data using Certified EHR Technology and EHR modules remains as mandatory as for general practitioners.”

There has hardly been anything that has got as much an attention as the CMS’ Meaningful Use criterion for medical practitioners – a program for eligible practitioners to be able to qualify for Medicare incentives upon meeting a certain set of core objectives set out in the Meaningful Use Clause under the ARRA. Although CMS has laid down guidelines for general practitioners, who serve the bulk of Medicare beneficiaries, yet their specialist colleagues – such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. – are not out of the CMS’ Meaningful Use ambit; after all they too are indispensable to CMS’ initiative towards an efficient healthcare environment. But, because their service-composition and documenting varies from general practitioners, specialists’ requisite compliance with core objectives set out in the Meaningful Use Clause under the ARRA gets a little different.

Recognizing the diverse nature of specialists, CMS has allowed for certain exceptions and exemptions from complying with certain objectives that does not owe allegiance to these specialist practices. Therefore, of the 20 mandatory objectives to be met out a possible list of 25, specialist practitioners can still seek exemptions on the ground of being unique fields of medicine. Consequently, their mandatory objective-list ultimately becomes less than 20; while CPOE, eRx, Vital Signs, Smoking Status, Electronic Copy of Health Information, and Clinical Summaries are usually allowed exemptions from Meaningful Use objectives, the following exclusions may still be claimed under substantiated evidence: Drug Formulary Checks, Clinical Lab Test Results, Patients Reminders, Patient Electronic Access, Medication Reconciliation, Summary Care Record, Immunization Registries Data Submission, and Syndromic Surveillance Data Submission.

While specialist practitioners, such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. can claim exemptions and exclusion of certain objectives set out in the Meaningful Use Clause by CMS, they are not treated preferentially as far as documenting clinical processes using approved and compliant EHR software is concerned:  their responsibility for reporting clinical data using Certified EHR Technology and EHR modules remains as mandatory as for general practitioners. Thus, everything points towards sourcing and implementing EHR software’s that best serve unique needs of diverse practices while also being compliant with the CMS mandate on Certified EHR Technology for achieving Meaningful Use criterion bench-mark.

Despite the market being replete with numerous EHR software – a prior advisory on judicious selection is always advisable as any hasty selection can have multiple repercussions: adverse impact on clinical documenting, practice management, and revenue generation. Given the prevailing scenario, Medicalbillersandcoders.com proven credentials in advising and implementing certified EHR software platforms –  Medisoft , Misys Tiger, Eclinicalworks, Advanced MD, Office Ally, Sage Medical Manager, GE centricity, Lytec, Altapoint, Dentrix being some its leading names in an exhaustive portfolio innovative and futuristic models – for diverse clients comprising Allergy, Anesthesiology, Cardiology, Dermatology, ENT, Endocrinology, Family Med, GI, Geriatrics, Internal Medicine, Long-Term Care, Multi-Specialty, Neurology, Neurosurgery, OB/Gynecology, Occupational Medicine, Ophthalmology, Optometry, Orthopedics, Pediatrics, Plastic Surgery, Podiatry, Psychiatry, Psychology, Pulmonology, Rheumatology, Surgery, SurgicalCenter, Urgent Care, Urology, and the rest.

About Medicalbillersandcoders.com (www.medicalbillersandcoders.com)

Medicalbillersandcoders.com has been a leading source for comprehensive medical billing revenue cycle management. A talent-pool of qualified and competent medical billing professionals with diverse skills specific to unique needs of multiple medical disciplines has been instrumental in our being a leading consortium for medical billing management.

CMS encouraging physicians for health care reform innovation: grants offered

At last someone is looking to cut healthcare cost innovatively- The Health Care Innovation Challenge program, announced on 14^th November, last year is the most recent federal effort by the Center for Medicare and Medicaid Innovation (CMMI) to support health care innovations. The program is aimed at awarding grants to physicians and other health professionals, payers, local governments, to improve care and reduce costs for patients with public coverage.

The center will provide grants of $1 million to $30 million, which is to come from the $10 billion the center is receiving from the health system reform law. With applications for the innovation challenge grants due on 27^th January, 2012, the innovation center expects to notify awardees by 30^th March, 2012. Additionally CMMI – part of the Centers for Medicare & Medicaid Services (CMS), is managing several similar programs designed to improve health care by providers.

Priority Areas for Proposals for the Health Care Innovation Challenge program include:

• Workforce Development and Deployment of health care workers in new, innovative ways
• All proposed models must be operational or capable of rapid expansion within six months
• All proposals are expected to define a clear pathway to sustainability

The Health Care Innovation Center recognizes that new types of infrastructure activity are critical for implementation of the recent program like: data intermediaries for quality reporting and information sharing; transparency initiatives; preventive care models; medication reconciliation systems, etc. Physicians to cater to the likely increase in administrative burdens can utilize professional healthcare services.

Medicalbillerandcoders.com has been advocating the use of new workflows and innovative ideas of practice management to cut healthcare costs since a decade now. MBC has been offering innovative but ethical means like work-specialization, training and implementing simple technology to reduce tedious administrative jobs. MBC is a well-entrenched association of highly experienced medical billers and coders who can provide services to ensure a healthy revenue returns for healthcare providers, and assist them in solely looking at improving healthcare for the aging US population.

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