2014 was another year big year for healthcare. As we continue to move toward a more patient-centered and transparent healthcare system, so too continue the changes to our payment models, insurance coverage and commitment to patient outcome measures. While there were many changes to keep track of, three things seem to have defined the progress made in the scope of revenue cycle improvement.
Managed care has been around for almost one hundred years, at least in theory. When placed up against fee-for-service payment models, however, it was a hard sell. Traditionally, the way that physicians were compensated for their services was a fairly straight-forward invoicing process: they would bill the patient (or later, the payer) for everything they did in terms of diagnosing or treating the patient. Everything.
Healthcare has become something of a hard science, if the focus on data and numbers is any indication. It would seem that the research, the endless reporting and spreadsheets of healthcare administration, has served to at least shed light on the problems healthcare is currently facing as an industry - but the fix isn’t likely to be in black and white.
As 2014 draws to a close, many of us in the healthcare industry are looking back at the year we’ve had and reflect on what worked, what needs to change and what we can expect for 2015. As an industry, healthcare saw a continued move towards accountable care, shared decision making, value-based purchasing and patient satisfaction measures. Buzzwords abound, there was a lot for everyone - providers, patients and payers - to juggle this year. And it looks like the trend is apt to continue into 2015.
Even though the Accountable Care Act has only been on the scene for many since Obama signed it into law back in 2010, the idea of accountable care vastly predates the law itself. The Clinton Administration had taken a similar model to Congress in the 90s, which was almost immediately denied, in part because the market wasn’t prepared for a payment reformation. Of course, not that it was any more ready come the 2000s, when the United States entered into a period of, in recent decades anyway, unprecedented economic recession. Still, the ACA went ahead and so too did the expectations placed on hospitals, providers and patients within the healthcare market.
Accountable Care Organizations (ACOs) may have an additional three years before penalties would be enforced for poor performance, according to a new proposal by the Federal government. These groups of doctors, hospitals, and providers that care for Medicare patients work jointly as ACOs toward the goal of retaining whatever additional financial resources are left over after completed care. Currently, there are about 330 ACOs in the United States, and together they have saved Medicare more than $700 million in healthcare spending.
We hear a lot about bi-partisanship in politics - but what about healthcare? Sometimes it seems like the payers and the providers, the administrative and the clinical, are across the aisle from one another in more ways than one, and it brings to mind the challenges faced by politicians who just can’t see from the other side’s perspective. While politics shoulders many competing agendas, when it comes to healthcare the bottom line is the same no matter where you are: good health for the best price. This is even true of the patient’s themselves, who are becoming more and more concerned with the cost of the services they receive - and using the internet to find out if there’s a better “bargain” on care somewhere else.
You might be thinking - “Just five challenges?!” and it’s true that the healthcare industry is facing many challenges at the moment. Five of them, however, are most specific to hospitals. We often think of hospitals as the “front lines” of healthcare, and while it may be true that the majority of practicing physicians, nurses and allied health professionals find employment there, new data shows that one vital piece of the hospital picture might be missing: patients.
As part of BHM’s partnership with The Doctor’s Channel, Anthony Grimaldi, BHM’s Senior Vice President Provider/Hospital Division, explains the changes to the way that providers must deliver healthcare.
Five years into the Affordable Care Act, the healthcare climate of the United States has continued to evolve and improve. While there are some long term changes required that have just begun to take shape, many changes brought about by the ACA are immediate gratification. Changes to Medicare and Medicaid have helped many Americans gain coverage that they previously wouldn’t have had access to. While the system is imperfect, there’s plenty of positivity to consider since it launched in 2010.