Providers push arbitration approaches used in some state surprise-bill laws
What should Congress learn from states’ experiences with laws attempting to curtail surprise healthcare bills?
Medicare Advantage plans accelerating their move into SDOH, advocate says
Medicare health plans have increasing authority to grapple with the social determinants of health, and more are pursuing such initiatives.
Get creative with technology to drive your managed care programs
Technological innovations can help healthcare organizations improve their managed care programs.
Ask the Experts: SSI percentage and eligibility
Rolling averages are one way to benchmark patient SSI eligibility percentages.
Ask the Experts: Contract performance
My organization recently transitioned to its first Ambulatory Payment Classifications (APC)/DRG-based contract with a commercial plan. We are struggling with determining how to monitor the contract’s performance and, in particular, with the primary focus on the APC payment. Are there recommended key performance indicators (KPIs) used to track this performance? Answer: It is likely that your organization…
Earning a 4-start patient-experience rating takes dedication
Main article: Why optimizing the patient experience should be on every C-suite leader’s radar Under Maryland’s hospital rate-setting system, 1% of hospital payment from all payers is based on an organization’s performance on the HCAHPS inpatient survey. “It can be millions of dollars for organizations that can be lost or gained,” says Lisa Allen, PhD,…
Why optimizing the patient experience should be on every C-suite leader’s radar
Jason Wolf, president and CEO of The Beryl Institute, knows from personal experience how easily a healthcare organization can lose a customer. A few years ago, his wife was mistakenly billed for a $25 copay that she already paid, and then the account was fast-tracked into collections. Despite receiving excellent clinical care, his wife vowed…
Timing, details unclear for executive order on price transparency
An expected executive order on healthcare price transparency continues to change, even as its release has been delayed, say policy watchers.
CMS cardiac procedure changes could cost hospital cardiac programs $700 million
In a move that could have profound financial implications for hospitals, the 2019 Outpatient Prospective Payment System final rule adds 17 cardiac procedures to the list of procedures approved by CMS to be performed in ambulatory surgery centers.
How physician-finance partnerships pave the way to higher-value care
Physician leaders and finance leaders can use their respective strengths to complement each other and help each other thrive in a value-based environment.