What the Hill? The Latest in Healthcare News from Capitol Hill

Posted on May 16, 2012 by Linda Ringquist

Here are some of the latest stories from Capitol Hill according to The Hill. The original stories may be found by accessing http://thehill.com/blogs/healthwatch/.

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Obama administration announces plan to fight Alzheimer’s Released from the Health and Human Services Department (HHS), there is a plan for the prevention and treatment of Alzheimer’s which will encompass clinical trials and training for doctors. The release date is 2025. “This is a national plan, not a federal one, because reducing the burden of Alzheimer’s will require the active engagement of both the public and private sectors”, according to HHS Secretary Kathleen Sebelius.

Sequestered cuts keep K Street on high alert According to lobbying disclosure records, several interests lobbied on the budget sequestration last quarter. Defense contractors as well as healthcare groups were closely monitoring the budget cuts proposed for next year. The proposed budget cuts include a reduction of $123 billion in payments to Medicare providers. According to Ken Raske, president and CEO of the Greater New York Hospital Association, “the budget cuts will add to the financial burden on the healthcare system. This could be a compounded horror show for the hospitals The spending cuts could hinder hospitals providing care to patients.

Nurse practitioners push for bigger role as coverage expands Nurse practitioners are pushing to expand their role in healthcare. The American Academy of Nurse Practitioners (AANP) states their role should become more important as Obama’s healthcare law pushes through. The new law will provide coverage to millions of people which will increase the importance of nurse practitioners.

Senator Leahy hopeful that John Roberts will vote to uphold health law Before the court heard arguments in the healthcare case, Supreme Court Chief Justice John Roberts was mentioned as a potential swing vote. “I thought I saw a chief justice who understands the importance of this case to all Americans, including those millions who would otherwise continue without health care insurance and access to affordable health care”, Senate Judiciary Committee Chairman Patrick Leahy said in a floor speech. The court is supposed to make a decision next month whether the healthcare law, which requires everyone to purchase insurance, is constitutional or not. If the mandate is nixed, the court will have to decide whether the entire law will be nixed or if the rest will pass.

Study: Insurers to lose $1 trillion if health law struck down According to the Bloomberg Government, at stake in the Supreme Court’s decision on healthcare reform is nearly $1 trillion of the insurance industry’s total revenue through 2020. “It’s a confirmation of, one, how much money we’re spending as a nation on healthcare, and two, how much is riding on this court case and the Supreme Court’s decision”, according to Matt Barry. “You’re talking about an amount of money here that can affect the economy, not just an industry. The revenue would come from both the expansion of Medicaid and from additional subsidies to individuals purchasing insurance. The Supreme Court is expected to issue a decision by the end of June 2012.

The financial management of health care and healthcare financial analysis are important topics of discussion. If you don’t want to see the same things happen to your company as are proposed for our nation, please review BHM Healthcare Solution’s financial improvement page and/or contact BHM Healthcare Solutions at 1-888-831-1171. Following are a few of our many financial improvement services offered: healthcare financial analysis, revenue cycle, cost variance analysis, and consolidations and mergers. BHM is a one of the top healthcare management consulting firms with a large array of services provided.

Consumer-Driven Health Plans – What Should You Consider When Choosing?

Posted on May 15, 2012 by Linda Ringquist

According to the Bureau of Labor Statistics, the combination of a pretax payment account with a high-deductible health plan is what is commonly referred to as a consumer-driven health plan (CDHP).⁷ In terms of payment methods, CDHPs are composed of a three tier payment system

A savings account
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Out-of-pocket payments
Insurance plan.

The first tier is a pretax account that allows employees to pay for services using pretax dollars. The account may be funded by the employer or the employee, depending on the type of account. The funds from this account can be used to satisfy the insurance plan deductible. The second tier is the difference, or the “coverage gap,” between the amount of money in the individual’s pretax account and the deductible. The amount that is not covered by the pretax account must be covered by the insured. If health care expenses exceed the deductible amount, then the third tier, the high-deductible health insurance plan, kicks in.

In an article from the URAC website, there are ten things to be considered when evaluating and choosing consumer-driven health plans and products.

Is the information regarding the consumer health driven plan available in a variety of formats and media? Is the information available in different languages as applicable? Is the information written in such a way that it can be understood easily, including to those who may have mental or physical impairments or disabilities?
Are all of the costs laid out in a manner in which deductibles, out-of pocket expenses, tax consequences and benefits are clear?
Does the information indicate clearly the details of the plan, including benefits and coverage, customer satisfaction results, and a directory of providers?
Is wellness and prevention data readily available and easily accessible?
Do you have access to a Health Risk Assessment which is evidence-based, reviewed by the organization’s top clinical staff, and provide feedback as to the health status and any recommendations to improve the current health status?
Does the plan provide data explaining the enrollees role and responsibility for making their own decisions for health care? Are there additional expert resources available to the enrollee to help answer any additional questions.
Are there specific instructions as to how to access assistance on a 24/7 basis through different media such as phone, email, and in person?
Is there a method for requesting a detail of the cost and quality for each provider?
Does the health plan provide assistance in making financial decisions about coverage gaps, managed care or review processes necessary for coverage and how to seek care once the personal health account has been exhausted?
Does the health plan reach out to those with chronic diseases to educate them about how to most effectively manage their health care?

BHM Healthcare Solutions specializes in URAC accreditation and URAC consulting. For more information regarding URAC accreditation assistance, please visit the URAC page of our website or call for a fee consultation call BHM at 1-888-831-1171 today!

Questions to Ask Before Having a Radiology Test

Posted on March 6, 2012 by Annie Evans

With the state of our economy and the rising cost of health care, medical scans such as MRIs, PETs, or CT scans can seem particularly expensive. Policymakers claim that physicians who prescribe these tests often do so just to make money. However, these types of scans have also greatly improved the quality of health care we receive today.

If your physician prescribes any type of radiology test, it’s natural to feel concerned and overwhelmed about both the procedure and the cost. Before you have any such test done, there are a few questions you should ask your doctor to make sure that it is absolutely necessary and safe.

1. Why do I need this test?

Don’t be afraid to ask your physician why you must have a certain test done. Ask what information it will provide and how the results may affect your treatment. Advanced medical imaging scans can provide excellent information, but they should not simply be a replacement for a physical exam.

2. What are the risks and side effects of this test?

It’s important to know the risks of the radiology test your physician prescribes, so that they can be compared with the potential benefits of having such a test.

The main risk of advanced medical imaging is exposure to electromagnetic energy, which varies depending of the type of scan.

- Magnetic Resonance Imaging scans (MRIs) use a magnetic field which is safe to most patients. However, if a patient has a pacemaker, automatic defibrillator, or other metallic articles in their body, an MRI is not safe.

- Computed Tornography (CT) scans use high levels of ionizing radiation at about 300 times more than the exposure of an x-ray. Although they are still relatively safe, pregnant women should avoid these types of scans.

- Positron Emission Tornography (PET) scans are performed with a nuclear source but are considered safe for most patients

Another risk is an allergic reaction to a substance called contrast, which is a dye injected into the veins to produce a clearer image. Allergic reactions are very rare, but may be more likely if you have a history of diabetes or kidney problems.

Thirdly, advanced imaging techniques can expose other abnormalities in the body that may or may not be a health problem. A physician may recommend further testing to ensure that there is not a problem, which will result in more scans and increased costs.

3. How much will this test cost? Are there any low-cost alternatives?

While prices of imaging tests vary, CTs generally cost less that MRIs or PET scans. In some cases, less expensive imaging options like an x-ray or ultrasound can provide your physician with enough information. Other times, the results of blood tests or other tests will offset the need for radiology testing.

4. Where should I have this test done?

Not all medical imaging facilities are alike. Some may have newer equipment that produces better images, or they may have a staff with more experience. You should go to a center that employs certified or licensed technicians and a board certified radiologist. The equipment should be up to date and FDA approved. The center should also take proper measures to ensure safety from radiation and magnetic fields. Most importantly, the center should be known for producing quality results.

5. How soon do I need to have this test performed?

Most radiology tests do not need to be performed immediately. Consult your physician and consider how long your health problem has been present and if it has improved. Many problems should be treated a fair amount of time before medical imaging is performed.

Annie Evans has been working as a certified radiologist in hospitals for over 15 years. Her site, Become an X-Ray Technician, is a resource for students who want to start a career in medical imaging.

Bracing for Reform Impact- Encounter Data and Claims (1)

Posted on August 15, 2011 by Danyell Jones

As we gear up to hit on some hot healthcare reform topics this month we will begin with the monumental changes which will be taking place with regard to Encounter Data and Claims under a new Center for Medicare and Medicaid Services (CMS) requirement. Though few organizations seem to have this requirement on their radar, the impact could prove to be very costly for any organization which finds itself unprepared once the new requirement goes into effect in Jan. 2012.

What is Encounter Data and Claims

Before we dig into the topic at hand, we will begin with a brief overview of what Encounter Data and Claims is. Encounter Data and Claims is all information related to the services provided by a States capitated Medicaid Managed Care Program, and the primary record of services for enrolled beneficiaries. This information allows CMS to know which medicaid services enrolled beneficiaries in managed care are receiving, what services Medicaid is paying for via capitated rates, and whether or not capitated rates paid to Managed Care Organizations and Local Management Entities are fair and set accordingly.

Why is Encounter Data and Claims Information Important

According to the Office of Inspector General:

Enrollment in Medicaid managed care is increasing

71% of Medicaid beneficiaries receive managed care services
45% of Medicaid beneficiaries are enrolled in comprehensive managed care programs

Expenditures for Medicaid managed care are increasing

2000-2006 State and Federal expenditures increased form $207 to $322 Billion
2008 Total Medicaid spending reached $330 billion
2009-2010 Federal Medicaid budget request increased by $36 billion

What is changing under Healthcare Reform

Historically, Medicaid program evaluations have been based on fee-for-service claims- providers would submit a claim and upon approval be paid for services rendered, however Medicaid is not longer a fee-for-service world and the move has been made toward capitated payments.

Plans will not need to be more focused on submitting patient encounter data to CMS for risk-adjustment purposes. According to AIS Health “this is not only a system-change issue, although many plans seem to be way behind on making those needed modifications. It also affects revenue cycles since plans not collecting and supplying high-quality data reflecting patient ‘encounters’ with providers could receive lower payments from CMS.”

Organizations should begin to make concrete determinations as to whether or not they are prepared for the impending Jan. 2012 changes, and what potential impact this could have on their organization. In our next post we will be looking at some statistics that show how successful, or unsuccessful states have been thus far in regard to Encounter Data Collection and Use. We will also be posting a list of questions that organizations should ask themselves to gauge their current level of preparedness.

We hope you will join us!

If you believe that your organization could benefit from a financial analysis which examines the intricacies of how Encounter Data and Claims is utilized in your business please visit our Financial Improvement page, or contact us at results@bhmpc.com for a free consultation.

It’s Okay To Be Different

Posted on June 13, 2011 by Kathleen Rand

Highlighting Organizational Value

As promised, I am going to present the first part of the series about proposal writing: creating a persuasive value statement. What is a value statement, anyway? It is an assertion that differentiates your company from others, that separates your services, your product from the rest.
Very often, a written proposal is the only means of communication you have with the highest levels of your client’s organization. Time is short, and money is tight; proposals not only have to be straightforward and succinct but, more importantly, relevant and specific.

The value statement is essential in that it tells clients how your solution will offer the greatest rate of return for their organization as well as focus on the benefits your services will provide to them. It should be consistently repeated and built upon throughout your proposals and be substantiated with precise examples, evidence and statistics.
Some points to keep in mind when crafting a value proposition:
Focus on a specific measure of value: be clear on what you can do; don’t promise everything to everybody.
Provide substance/proof that backs up statements such as ‘uniquely qualified’ or ‘industry leading’ – otherwise these phrases become empty, invalid and, quite potentially, disqualifying.
Concentrate on responding to your clients’ needs rather than attacking a competitor. Being aware of the competition’s capabilities is a benefit; exploiting their weaknesses could be perceived as a lack of professionalism.
Present a realistic and accurate description of your organization’s scope of work while simultaneously emphasizing how your outcome will offer the greatest amount of gain to your clients.
Avoid placing too much attention on presenting “the cheapest” option to clients – let your services speak for themselves and your cost-effective resolutions will not be overlooked but will stand out instead.
Choosing the right differentiators to include in your value statement (and that will be further clarified within your proposals) is paramount.

Put simply: determine what is important to your client and build your strategy around it. Only include the differentiators that will best meet your client’s goals and support them with evidence like past performance reports, case studies, customer testimonials, project summaries, and a company history.

Thank you for taking the time to review the relevance of building a persuasive value proposition with me. Next time we will examine essential components of winning proposals and some unnecessary elements to stay away from. We look forward to hearing your questions and comments, and best of luck!

Do You Know What I Mean?

Posted on June 2, 2011 by Kathleen Rand

“The difficulty … is not to write but to write what you mean…” Robert Louis Stevenson
Hi, my name is Kathleen Rand, a Senior Proposal Writer with BHM Healthcare Solutions. I am new to the BHM team but not to writing. After I graduated from college, it was common for people to ask me: ‘What are you going to do with an English degree?’ Well, what I did was write…a lot. For over fifteen years and for various organizations, I wrote just about everything from marketing materials to technical manuals, from educational curriculums and student catalogs to policies and procedures, from training documentation to government grant submissions.
It turns out communicating effectively – writing what you mean – is a marketable skill. Even in today’s digital age of texting and smart phones, a well-written presentation or proposal, one that is clear, concise and accurate, cannot be underestimated. It can translate into the close of a deal, the addition of a new client, the reward of state or government monies.
I plan to present a three part series discussing the impact of writing in the business world, more specifically the significance of solid business proposals. I will share tips on how to create a persuasive value statement that will truly differentiate your organization. Further, I will examine the elements essential to successful proposals, and those that aren’t. Finally, I will evaluate the writing process in whole: from defining the basic steps necessary to organize a proposal to assessing the importance of word choice and sentence structure.
I am excited to jump into the BHM blogosphere and look forward to the journey with you.