What Healthcare Providers Can Expect
By Morgan Atkins
Vice President, Product and Innovation
On July 1, 2021, the Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management issued an interim final rule to implement fundamental parts of the No Surprises Act (NSA). Despite the disarming title, the No Surprises Act will lead to many surprises, around lack of parity in reimbursements within a market. In upcoming years, payers and providers will be forced to evaluate their value proposition, market positioning, customer/patient transparency, and data analytics.
The NSA contains key protections to hold consumers harmless from the cost of unanticipated out-of-network medical bills. According to the Kaiser Family Foundation, “surprise bills lead the list of affordability concerns for many families; 2 in 3 adults say they worry about unexpected medical bills, more than the number worried about affording other health care or household expenses. Surprise bills can number in the millions each year.”
While the major implications of the NSA will benefit consumers, the severity of impact that this legislation will have on payers and providers will depend on how they react. In this post, we’ve worked to summarize this new law and discuss some of the ways that both providers and payers can be prepared to act.
UnitedHealth Group released its quarterly earnings report earlier this month and several changes in coverage caught our attention, particularly as they pertained to outpatient services.
United is to begin denying claims for certain types of services performed in hospital outpatient departments (HOPDs). They are the first major payer to do so. This will inevitably lead to an increase in care at other outpatient settings, such as Ambulatory Surgery Centers (ASCs).
This post will discuss why this should be of concern to HOPD invested health systems and how they can prepare to mitigate their risk. We’ll also consider how ASC management companies can take advantage of this opportunity for growth.
When talking to clients in the midst of scaling operations in a new market, the question of how to establish attractive market rates often comes up. Entering a new market with rates too high can be a deterrent for growth and setting the right rates can be challenging.
The right data, insights, and tools are key to identifying the sweet spot when setting rates and planning for payer negotiations.
Often, payer negotiations are driven by a team’s working knowledge of the market rates, or based on insufficient input from outside consultants. In this post, we’ll discuss how to use reimbursement data effectively when entering new markets and preparing for negotiations.
We’ll discuss what data is needed, what new insights can be found, and how the right data can help your organization grow more successfully.
When entering payer/provider reimbursement negotiations, the need for data to back your position is critical. The right insights can show how your payer contracts compare to the market, how payer rates have changed over time from facility to facility, and highlight financial opportunity. This intelligence can equip you to more successfully navigate payer negotiations and leave with more favorable reimbursement rates.
The infographic below highlights a particularly helpful data-based insight called Fair Market Reimbursement. This is a reasonable range of reimbursement rates that all providers within a local market receive from a commercial insurer or payer. Created by our partner Ancore Health, the infographic below explains Fair Market Reimbursement in more detail, by answering several common questions.
The trials of 2020 have left many in the healthcare industry searching for ways to diversify their income. Due to COVID-19, hospitals across the nation are estimated to lose $200 billion between March 1 and June 30, according to a report from the American Hospital Association. This current financial strain and shaky future prospects are pushing healthcare institutions to find creative ways to keep revenue flowing while still maintaining high-quality care.
Becker’s Hospital Review cites the reimbursement landscape challenges and dwindling patient volumes as two main factors leading at least 29 hospitals across the U.S. to file for bankruptcy this year. In this post, we’ll consider how hospital leaders can turn these leading indicators of distress into golden opportunities for growth.
There’s a discussion across healthcare about the need for greater price transparency. The talk is about whether or not patients should know the hard costs of medical procedures and how much they can expect to pay out of pocket for medical services. Armed with this information, they can shop around for care that fits their quality standards as well as their budget.
At Stratasan, we feel there’s another layer of healthcare price transparency that’s needed—transparency that can level the playing field in provider-payer reimbursement negotiations. Both providers and payers are in need of more data to inform their negotiating position.
In survey research1, a confidence level is applied to express how confident a researcher is in the data obtained from a population sample. A confidence level lets someone know if they can trust the research data to make decisions.
Similarly, a confidence level (or score), when applied to all-payer claims data (APCD), indicates the trustworthiness of this data for making healthcare decisions. It’s a metric that ensures integrity and can empower a provider to use this data with greater assurance.
Greater data confidence can be useful when pursuing a number of healthcare planning initiatives. In this post, we’ll discuss specifically how an adjustable confidence-scoring system is valuable when preparing for provider-payer reimbursement negotiations. Equipped with this tool, providers can:
Let's get started discussing each of these factors in more detail.
Hospitals and caregivers across the country have pivoted to virtual care in response to COVID-19. It's opened the door for telehealth growth in ways we've never seen before. We’ve witnessed a rapid shift from a previously deliberate adoption path to a record pace of uptake.
“Telehealth is bridging the gap between people, physicians, and health systems, enabling everyone, especially symptomatic patients, to stay at home and communicate with physicians through virtual channels, helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines,” said Dedi Gilad, CEO, and co-founder of Tyto Care, a telehealth technology company, in this Healthcare IT News article.
It's likely that this adoption to virtual care is here to stay, as patients will expect it to continue to be an option for care delivery in the future. So, how can hospital planners prepare for a change in strategy in light of our collective embrace of virtual technologies?