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Finance

 

68 percent of patients with hospital bills under $500 didn’t pay off the full balance by the end of 2016, according a TransUnion Health study released at the Healthcare Financial Management Association (HFMA) conference in Orlando.

An ever-changing world of reimbursement can be frustrating for those involved in revenue cycle management (RCM). Being too set in your ways to change, however, is one of the most common strategic mistakes seen by Nicole Rogas, MBA, senior vice president of sales at Experian Health.

Whether Republicans’ version of an Affordable Care Act repeal-and-replace bill looks like the House-passed American Health Care Act (AHCA) or the Senate’s Better Care Reconciliation Act (BCRA), it would have a negative impact on the credit ratings of nonprofit hospitals, according to Fitch Ratings.

Transitioning to value-based care and taking on risk is often cited as one of the drivers of the consolidation trend throughout healthcare. Some systems, however, are beginning to look at partnerships more “holistically,” according to Kaufman Hall managing director Anu Singh, MBA, by pursuing creative affiliations to enhance their capabilities rather than a merger or acquisition.

In a year with new payment tracks for Medicare, additional bumps in the road on the path to value-based care and—potentially—an overhaul of health insurance coverage coming through Congress, what are healthcare finance leaders going to be focused on at this year’s conference?

 

Recent Headlines

S&P: ACA markets ‘fragile'—but not in death spiral

Despite claims by President Donald Trump, Republican members of Congress, and some insurance CEOs, the Affordable Care Act (ACA)’s health insurance exchanges aren’t in a death spiral, according to a Standard and Poor’s (S&P) analysis, which predicts the individual market is actually on a path to profitability in 2018.

Cardinal Health nearing $6 billion purchase of Medtronic’s medical supplies unit

Cardinal Health is in exclusive talks to acquire the medical supplies business of Medtronic for $6 billion, sources told Reuters on April 5. 

Hospital chargemaster rates linked to higher payments, but not higher quality care

The list prices for hospital procedures and tests aren’t “inconsequential,” according to economists, and can be associated with higher payments from insurers and patients.

 

Medicare Advantage plans get better than expected rate hike for 2018

Payments to insurers offering Medicare Advantage plans will increase by an average of 0.45 percent, according to the final rate notice issued by CMS, above the 0.25 percent bump in pay the agency had previously proposed.

CMS: Medicaid DSH payments will consider what Medicare, third-party pay

In a final rule issued on March 30, CMS clarified uncompensated care costs for Medicaid patients are limited by what a hospital received from other sources, such as commercial insurers, Medicare or the patients themselves.

ACHE 2017: Creating a provider-sponsored health plan means understanding your market

The lines are blurring between healthcare providers and payors as more providers are sponsoring their own health plans or partnering with payors. Unfortunately for interested providers, that greater prevalence hasn’t come with any one-size-fits-all approach for making these plans succeed.

Anthem likely to leave ACA markets for 2018

Financial analysts are predicting Anthem, one of the nation’s largest health insurers, will be following other national companies in leaving the Affordable Care Act’s exchanges in 2018.

500,000 healthcare jobs added because of ACA

A new analysis from Goldman Sachs said that 500,000 of the jobs added to the healthcare sector since 2012 can be attributed to the Affordable Care Act (ACA)’s increasing of health insurance coverage. 

Cleveland Clinic operating income drops by 71%

Revenues were up at the Cleveland Clinic in 2016, but higher expenses put a damper on operating income, which fell 71 percent from the year before.

Former Anthem lobbyist to be nominated to run DOJ’s antitrust division

The specific division of the U.S. Department of Justice that fought Anthem’s $54 billion acquisition of Cigna—and which the insurers is still pushing to approve the merger over antitrust concerns—could be run by a former Anthem lobbyist.

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