Pa­tients and price

HFMA looks at costs, trans­parency

Modern Healthcare - - THE WEEK IN HEALTHCARE - Beth Kutscher

Health­care’s fi­nan­cial man­agers will in­creas­ingly do busi­ness in a world where pa­tients are on the hook for sig­nif­i­cant shares of their med­i­cal bills, prices are pub­li­cized and re­im­burse­ment is tied to qual­ity. Against that back­drop, the Health­care Fi­nan­cial Man­age­ment As­so­ci­a­tion in­tro­duced two ini­tia­tives re­lated to fi­nan­cial in­ter­ac­tions with pa­tients and pric­ing trans­parency.

In a brief talk last week open­ing the as­so­ci­a­tion’s an­nual con­fer­ence in Or­lando, Fla., HFMA Pres­i­dent and CEO Joe Fifer un­veiled draft guide­lines for con­ver­sa­tions providers have with pa­tients in­side and out­side the emer­gency depart­ment as well as be­fore they are treated. The guide­lines ad­dress points such as when and where it’s ap­pro­pri­ate to ini­ti­ate a fi­nan­cial dis­cus­sion, who should con­duct the con­ver­sa­tion, how to pro­ceed when a pa­tient has an out­stand­ing bal­ance and how to mea­sure com­pli­ance.

The group is ac­cept­ing pub­lic com­ments through July 31, and hopes health­care providers will adopt the vol­un­tary prac­tices be­gin­ning in the fall. The rec­om­men­da­tions build on pre­vi­ous stan­dards set by HFMA and the Amer­i­can Hos­pi­tal As­so­ci­a­tion about a decade ago, and Fifer said they add a new level of speci­ficity.

They also come about a year af­ter Min­nesota At­tor­ney Gen­eral Lori Swan­son cast a harsh light on Ac­cre­tive Health, a pub­licly traded rev­enue-cy­cle man­age­ment firm. Swan­son al­leged the com­pany vi­o­lated pa­tient pri­vacy and con­sumer pro­tec­tion laws while pur­su­ing pa­tients for debt they owed sev­eral hos­pi­tals in the state. A set­tle­ment agree­ment bars Ac­cre­tive from op­er­at­ing in the state for up to six years.

Ac­cre­tive said in May 2012 that it would fund a panel to draft pa­tient col­lec­tion stan­dards but had not yet se­lected a part­ner to de­velop the guide­lines. Co-founder and for­mer CEO Mary Tolan served on the steer­ing com­mit­tee for the HFMA ini­tia­tive along with 14 other rep­re­sen­ta­tives from provider or­ga­ni­za­tions, pa­tient ad­vo­cacy and in­dus­try groups.

Fifer said the HFMA is also es­tab­lish­ing a task force on price trans­parency, work­ing with the Med­i­cal Group Man­age­ment As­so­ci­a­tion, the Leapfrog Group and Amer­ica’s Health In­sur­ance Plans, among oth­ers.

Through­out the four-day meet­ing, at­ten­dees wres­tled with the del­i­cate bal­ance be­tween in­creas­ing col­lec­tions and work­ing with pa­tients who are pay­ing a greater share of their bal­ances.

Ti­mothy Reiner, vice pres­i­dent of rev­enue man­age­ment at Ad­ven­tist Health Sys­tem, Al­ta­monte Springs, Fla., opened a ses­sion on how to se­lect col­lec­tion agency part­ners by not­ing that con­sumers’ out-of-pocket costs are grow­ing and ex­pected to ac­cel­er­ate un­der health in­sur­ance ex­changes, where the most af­ford­able plans come with sig­nif­i­cant cost-shar­ing.

“It’s sort of like the Olympics—you can get the gold medal, the sil­ver medal or the bronze medal,” he said. Peo­ple least able to af­ford health­care are likely to choose the “bronze” in­sur­ance plans, where they may be re­spon­si­ble for up to 40% of their health­care costs (see story, p. 6). “They prob­a­bly don’t have the $5,000 to $6,000 out of pocket to pay us,” Reiner said.

Ven­dors also in­tro­duced prod­ucts aimed at eas­ing the col­lec­tion process. Cit­i­group, the fi­nan­cial ser­vices gi­ant, last week un­veiled Money2

for Health, a tool de­scribed as a health­care “wallet” that ag­gre­gates ex­pla­na­tions of ben­e­fits for pa­tients, and al­lows them to make on­line pay­ments to par­tic­i­pat­ing providers. Its char­ter mem­bers in­clude Aetna and Par­al­lon Busi­ness So­lu­tions, the rev­enue-cy­cle man­age­ment arm of hos­pi­tal gi­ant HCA, which is pi­lot­ing the tech­nol­ogy in two mar­kets.

Providers also are look­ing at a smaller spike in in­sur­ance cov­er­age than they were ex­pect­ing, cau­tioned An­drew Bressler, man­ag­ing di­rec­tor at Bank of Amer­ica Mer­rill Lynch. The Con­gres­sional Bud­get Of­fice re­vised its 10-year es­ti­mate down to 25 mil­lion, which rep­re­sents some “leak­age” of em­ploy­ees who lose in­sur­ance at work and don’t pick up cov­er­age on an ex­change, he said. Em­ployer cov­er­age is ex­pected to de­crease by 7 mil­lion.

While the fi­nan­cial mar­kets have cheered health­care re­form by boost­ing the share prices of in­vestor-owned chains, Bressler noted that the es­ti­mated $37 bil­lion net pos­i­tive im­pact will be shared un­evenly among 5,000 hos­pi­tals over 10 years. “It’s not go­ing to be as big a win as first thought,” he said. “You have to be cau­tious about that.”

Bressler and oth­ers also em­pha­sized that the Af­ford­able Care Act in­cludes many pro­vi­sions that mean lower Medi­care re­im­burse­ment, and that providers could see more Medi­care cuts as law­mak­ers ad­dress the fed­eral deficit.

But Dr. Don­ald Ber­wick, a key­note speaker, told the at­ten­dees that they should able to do much bet­ter with a lot less. About a third of what the U.S. spends on health­care is waste, the for­mer CMS ad­min­is­tra­tor said, cit­ing a study he pub­lished last year with RAND Corp.’s An­drew Hack­barth.

“If you’re only play­ing the old game, you’ll have the (old) re­sults, and they’re not go­ing to be good enough,” he said. “The only way to pro­duce value is to meet the needs in front of you and re­duce waste.”

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