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Healthcare Research Links


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WEBSITES AND QUOTES

1. Revenue Cycle Ripe for Radical Change by Mike Miliard

http://www.healthcareitnews.com/news/revenue-cycle-ripe-radical-change

  1. "I'm surprised that we continue to see the status quo in revenue cycle management," says Sean Wieland, managing director and senior research analyst at Piper Jaffray.

  2. "Healthcare is the only industry that has a revenue cycle with a designated subsector of companies that manage it," he explains.

  3. Worse, "It costs 20 to 30 cents on the dollar to cross a trade in healthcare – to take the money from the buyer of healthcare, the self-insured employer, and put it into the pockets of the providers of healthcare," says Wieland.

  4. "If any other industry had a revenue cycle like that, we'd all be living like the Amish," he says. "Wall Street crosses a trade for fractions of a penny."

2. Key Trends in Healthcare by JP Morgan

https://www.jpmorgan.com/cm/BlobServer/JPM-KeyTrends-in-HealthcarePatientPayments.pdf?blobkey=id&blobwhere=1320610345938&blobheader=application/pdf&blobheadername1=Cache-Control&blobheadervalue1=private&blobcol=urldata&blobtable=MungoBlobs

  1. Patient Payments

  2. Low utilization of back office processing: Healthcare providers rarely take advantage of lockbox facilities, and even less often utilize remote deposit capabilities.

  3. Lack of payment estimates provided at point of care: A 2009 McKinsey Quarterly survey of retail healthcare consumers showed that

  4. 52 percent of consumers would pay from $200 to $500 or more by credit or debit card when they visit a physician, if an estimate was provided at the point of care.

  5. One key focal point of revenue integrity initiatives must be patient payment optimization.

3. From: Merchant maverick

www.Securenet.com

  1. SecureNet deals with over 17,000 merchants and $15 billion in transactions each year

  2. Merchantoptions.com SecureNet is a registered ISO/MSP of Wells Fargo Bank, N.A., Walnut Creek, California and Eagle Bank, N.A., Bethesda,

4. Securenet Website

www.Securenet.com

  1. Health Summary:

  2. Patient responsibility is increasing dramatically

  3. Patients will pay

  4. Provider organizations have numerous challenges to address patient payment process optimization

5. Revenue Cycle Management: How to Brave the Declining Reimbursement Rates Nightmare by Salvador Lopez

http://www.poweryourpractice.com/practice-profitability-index/brave-declining-reimbursement-rates/

  1. According to a new report released by CareCloud and QuantiaMD,

  2. 65% of physicians see declining reimbursement rates as the top issue negatively affecting practice profitability. Not a surprise, since 2013 hasn’t exactly been a banner year for Medicare reimbursements.

  3. Due to April’s budget sequester, Medicare payments have been slashed by 2% across the board. These cuts are estimated to cost providers $11 billion in Medicare payments each year. This leaves many practices wondering if there are any ways to effectively counter these reductions.

  4. Increase Your Patient Base If you’ll be making less money per patient, a natural solution is to treat additional patients to make up for the loss. Finding patients to treat shouldn’t be a problem as 32 million patients are expected to join the healthcare system in 2014.

6. Spend Less Time Chasing Payments & More Time Caring for Patients

http://www.availity.com/products/revenue-cycle-management/

  1. Delays in collections and outstanding invoices are some of the biggest obstacles healthcare organizations face in providing the highest level of patient care. Our healthcare payment processing solutions improve the efficiencies of your organization’s operations allowing you to allocate more resources to what matters most – enhancing the quality of patient care.

  2. Store multiple methods of payment for each patient and automatically update expired and cancelled credit cards

  3. Save time and cut labor costs with automatic recurring billing and secure credit card storage

  4. Improve accounts receivables and decrease the number of days invoices are outstanding

  5. Intriguingly, the McKinsey study found that 74 percent of insured consumers indicated that they are both able and willing to pay their out-of-pocket medical expenses up to $1,000 per year and 90 percent would pay for medical expenses up to $500 per year.5

7. How do PCI Industry Regulations Impact Health Care Providers

https://www.youtube.com/watch?v=5K-6hh0qvSA

  1. PCI DSS

  2. PHI

  3. EHR

  4. Kereo PCI FAQs

8. Competitor’s software - Accepting Patient Credit Cards Protocol FAQ’s

http://www.kareo.com/gettingpaid/2013/04/patient-payments-credit-cards/

9. Mary Pat Whaley, FACMPE, CPC

Physician Advocate at www.managemypractice.com

Manage My Practice offers provider credentialing, and medical coding and billing audits for compliance and quality assurance, as well as customized webinar training for HIPAA, OSHA and Billing compliance.

  1. Physicians have been extending credit to patients almost since the beginning of time. Any time a patient receives healthcare services, has a financial responsibility and does not pay their portion at time of service, they are in essence receiving credit from the physician. Typically, medical practices have extended credit to patients without interest added, and usually on a schedule that patients can handle. Physicians have created payment plans for patients, or allowed them to carry a balance as long as the patient made a payment every month.

  2. Exchanges and employer-sponsored plans carry higher deductibles in 2014.

  3. Things are different now because the dynamics of healthcare reimbursement have changed radically. Ten years ago most patients had a small amount for a co-pay or co-insurance due each time they visited their physician. Deductibles, the amount patients have to pay in full before their insurance plan will start to pay, were anywhere between $250 and $750 per year.

  4. Today, deductibles are soaring as employers struggle to keep benefits budget-neutral and insurance companies reveal new plans on the exchanges. Patients are now footing much more of the bill, averaging between 20 and 35% of each dollar owed. Deductibles on the health insurance exchanges are ranging from $1,000 to $6,350 for individuals.

  5. Medical practices and other healthcare entities are ramping up for 2014 by determining how to make the collection of deductibles manageable, both for the patient and for the practice. For some practices, especially primary care, collecting at the time of service is the only way to ensure the payment gets collected at all. Collecting deductibles and co-pays are one large factor in the balance between a practice surviving and one having to close its doors. With patient payment responsibility increasing at a rate of 5% to 6% each year, physicians and managers are looking for solutions.

10. Congress research service – What’s MLR? (I feel this is important to understanding why collecting the initial deductible is so important to Doctors now.)

http://www.fas.org/sgp/crs/misc/R42735.pdf

  1. The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires certain health insurers to provide rebates to their customers for each year that the insurers do not meet a set financial target called a medical loss ratio (MLR). At its most basic, a MLR measures the share of a health care premium dollar spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if total premiums collected are $100,000, and $85,000 is spent on medical care, the MLR would be 85%. The ACA sets the minimum required MLR at 80% for the individual and small group markets and at 85% for the large group market. In general, the higher the MLR, the more value a policyholder receives for his or her premium payment. Congress imposed the MLR in an effort to provide “greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care.” Insurers that fail to meet these minimum standards must provide rebates to policyholders.

11. First Data HealthCare Data Reform -

http://files.firstdata.com/downloads/thought-leadership/fd_health_care_pymts_wp.pdf

  1. Key Takeaways For the purpose of clarity, let’s define what is meant by “health care payment processing reform.” By this we mean the redesign and automation of the process for assessing a patient’s eligibility for a health service under his insurance or government payment plan; estimating the cost of the services rendered; adjudicating the payment for the services; determining a patient’s responsibility for payment; and electronically processing the patient’s payment at the time service is rendered. End to end, this process currently takes weeks and, occasionally, months. We believe it can be redesigned such that, with the application of the appropriate health information technology, as well as full participation of providers and payers, the process can take place in real time while the patient is in the provider’s facility. The end result is that the patient can know the total cost of the service rendered before he walks out the door, and the provider can be compensated—at least partially if not wholly—within 24 to 48 hours

12. ETA White Paper – Best Practices: Merchant Retention

https://www.spsprocessing.net/sites/default/files/education/ETA%20MerchantRetention.pdf

  1. Executive Summary

  • While a modest economic recovery appears to be underway among merchants, merchant attrition remains a concern for many companies in the acquiring industry. Effective merchant retention strategies and best practices are an important and cost-effective tool to minimize attrition and stabilize portfolios.

  • The Best Practices Committee has researched and published this White Paper to identify some of the causes of avoidable merchant attrition and highlight industry best practices that target merchant retention.

  1. Attrition and It’s Causes

  • Some merchant attrition is unavoidable, caused by an economic downturn, shifts in consumer preferences or poor business management on the part of merchants. Avoidable merchant attrition, on the other hand, is related directly to the relationship between merchant and acquirer. In the latter instances, the leading causes of attrition are customer service issues and price.

  1. Addressing Attrition Before It’s Too Late

  • At the strategic level, the key to effective merchant retention is to identify potential portfolio defections before the merchant actually switches service providers. It’s often easy to see the signs of a discontented merchant after the fact. Noticing these signs – and taking effective action before the merchant takes his business elsewhere – requires a sensitive set of alarm bells and a willingness to listen to what they are saying.

13. Mobile Devices for work in the Medical field

http://www.manhattanresearch.com/News-and-Events/Press-Releases/physician-smartphones-2012 http://www.manhattanresearch.com/News-and-Events/Press-Releases/physician-iphone-ipad-adoption

  1. Physician Cell phone Adoption 81% Acceptance Rate in 2012

  2. 75 Percent of U.S. Physicians own some form of apple device according to new Manhattan research study

14. New Taking the Pulse® U.S. v11.0 study of physician digital trends indicates iPhone and iPad driving steep mobile device adoption in the U.S. physician market

15. STUDY: 102.3 MILLION PATIENTS ONLINE FOR PRESCRIPTION DRUG INFORMATION, DOUBLED IN PAST FOUR YEARS –

You can find more studies like this at:

http://www.manhattanresearch.com/Search.aspx?searchtext=health+care+payment+processing+reform&searchmode=anyword

16. HBMA Healthcare Billing & Management Association

http://www.hbma.org/news/public-news/n_succeeding-in-an-evolving-industry-a-look-at-the-most-influential-trends-in-healthcare-payments

17. Succeeding in an Evolving Industry – A look at the Most Influential Trends in Healthcare Payments www.instamed.com/wp-content/uploads/healthcare-payments-white-paper-providers.pdf

18. Healthcare Payments White Paper for Providers

Industry Approaches to Healthcare Payments

Leading Practices for Patients Payments

Managing Healthcare Payment Complexity

Achieving Financial Assurance with Patient Payments

http://www.plunkettresearch.com/health-care-medical-market-research/industry-trends

19. Health Expenditures Globally and in OECD Developed Nations:

A comprehensive study published by the OECD (Organization for Economic Cooperation & Development) covering more than 30 nations including the majority of the world’s most developed economies (excluding Brazil, Russia, India or China), found stark contrasts between health costs in the United States and those of other nations. In 2011 (the latest complete data available), the average of a list that includes, for example, the UK, France, Germany, Mexico, Canada, South Korea, Japan, Australia and the U.S., spent 9.3% of GDP on health care. The highest figures were in America at 17.7% of GDP, The Netherlands at 11.9%, France at 11.6%, Germany at 11.3%, Denmark at 10.9% Canada at 11.2% and Switzerland at 11.0%.

20. The Kaiser Family Foundation estimated that in 2013 an employer’s premium to cover a typical family was $16,351 per year (a 103% increase since 2002), with the typical worker paying 28% ($4,565) of that premium. Employer-provided health care insurance for single coverage cost an average of $9,068, with the employee paying $2,412 of that premium

21. About TransFirst Health Services - http://www.transfirst.com/solutions/health

http://www.paymentsnews.com/2008/02/availity-transf.html

http://www.availity.com/documents/Availity_CareCollect_Brochure.pdf

http://www.qsidentalweb.com/transfirst.html

http://www.gatewayedi.com/payments/

http://www.aces-abes.org/transfirst.htm

https://www.youtube.com/watch?v=Ar4j1saQzGo

http://www.dentalvisionenterprise.com/partners/transfirst.aspx

http://www.quicdoc.com/docs/GettingStartedTransFirst.pdf

http://www.orthodonticproductsonline.com/2006/09/transfirst-and-new-horizons-software-sign-partnership-to-provide-fully-integrated-payment-processing-2006-09-25-01/

http://www.aae.org/welcome/transfirst_0912.html

Serves approximately 200,000 merchants, financial institutions and ISO/ISA sales partners

Annual transaction volume run rate of approximately $48 billion

Privately owned; equity partner is Welsh, Carson, Anderson & Stowe

More than 1,000 employees

Headquartered in Hauppauge, New York, with additional operations facilities in Dallas,Texas; Broomfield, Colorado; Aurora, Colorado; Omaha, Nebraska; Overland Park, Kansas; Franklin, Tennessee; and Cypress, California

22. 1/15/2016 Patient responsibility for specialty therapies - DRG

https://decisionresourcesgroup.com/drg-blog/patient-out-of-pocket-responsibility-for-specialty-medications-is-a-local-matter/40.5% of plan designs in our study have an out-of-pocket maximum of $6000 or higher

23. For a number of years, our clients have asked us to analyze benefit plan designs to determine regional variances in patient responsibility for Specialty therapies. Inspired by our clients, DRG recently completed a detailed study of 700 of the nation’s largest Commercial benefit plan designs to determine the wide spectrum of patient out-of-pocket costs for Specialty medications. Here’s what we learned, in part: 40.5% of plan designs in our study have an out-of-pocket maximum of $6000 or higher

While 15% of plan designs have no annual deductible, our study found that 65% of plan designs have an annual deductible set at $2,000 or lower

In roughly 22% of plan designs, patients had an in-network copayment of $50-$200 for a Specialty product, representing an annual patient out-of-pocket responsibility of $650-$2600

In 16% of plan designs, patients had an in-network copayment of 50% for a Specialty product

In our study, New Hampshire had the highest number of plan designs with an out-of-pocket maximum set at $5,000 or higher, confirming our theory that location does matter

This study is part of an annual, syndicated Out-of-Pocket Analysis performed by DRG, which, along with our Out-of-Pocket Tool can be used to inform the out-of-pocket contributions patients will pay within a given state, payer, and benefit design.

24. 2/1/2015 Biz Journals.com http://www.bizjournals.com/portland/blog/health-care-inc/2016/02/3-reasons-why-health-care-should-act-like-expedia.html?

Today, only 9 percent of patient bills are paid within the first 30 days, but with health care e-commerce, providers receive payment in days, not weeks or months.

25. HDHPs is a major contributor to current expectations to grow from $250 billion in 2009 to $420 billion by 2015, a 68 percent increase in five years. http://www.rcmanswers.net/patient-payments-a-shift-in-responsibility-for-revenue-cycle-management/

26. At the April HIMSS 2015 Richard Nagengast, Director at Northwestern Memorial Hospital, in a joint presentation with Paul Bradley, Chief Data Scientist at ZirMed, spoke on “Using Data Analytics for Improving Productivity and Revenue”. He called attention to predictive analytics for the self-pay process, and how important relationships are with your patients, especially satisfaction levels. Many patients now have insurance for the first time. Yet, at the same time there are more patients being sent to collections for the self-pay portion. He discussed the need to push the patient responsibility upfront, to have the patients understand the out-of-pocket expenses before procedures. “Imagine never having to send patients to collections” proclaimed Nagengast, and “data is the way to do it”.

-Healthcare Organizations and PCI Compliance –

http://www.grantthornton.com/~/media/content-page-files/health-care/pdfs/2012/HC-2012-New-Persp-PCI-DSS-New Perspectives Spring 2012.ashx

27. http://www.medigain.com/blog/how-to-get-patients-to-pay-what-they-owe

When patients haven’t paid their bill in several months, you may be tempted to turn those delinquent accounts over to an external collections agency. Unfortunately, the healthcare collection industry recovers only about 22 percent of delinquent funds from medical practices. Collection agencies charge 15 to 35 percent commission, so you’re likely to recover only about 14 percent of what you’re owed. Furthermore, aggressive external patient collection efforts can jeopardize your relationship with your patients, causing your practice to lose patients and referrals.

28. Growing need for interoperability

Healthcare reform is driving a greater need for efficiency, resulting in the formation of Accountable Care Organizations (ACOs) and provider consolidation. As provider organizations using different systems work together, there is a much greater need to integrate heterogeneous environments to achieve system interoperability. However, healthcare information is often not easily exchanged among providers because of paper-based processes or systems that are not compatible. In fact, 71% of providers surveyed said the lack of system interoperability is a major barrier to health information exchange (Bipartisan Policy Center).

29. Instamed

Growing need for interoperability

Healthcare reform is driving a greater need for efficiency, resulting in the formation of Accountable Care Organizations (ACOs) and provider consolidation. As provider organizations using different systems work together, there is a much greater need to integrate heterogeneous environments to achieve system interoperability. However, healthcare information is often not easily exchanged among providers because of paper-based processes or systems that are not compatible. In fact, 71% of providers surveyed said the lack of system interoperability is a major barrier to health information exchange (Bipartisan Policy Center). 74% of insured consumers indicated that they are both willing and able to pay their out-of-pocket medical expense up to $1,000 per year.

30. Currently, only 9% of patient bills are paid within 30days

http://healthaffairs.org/blog/2015/10/07/trouble-ahead-for-high-deductible-health-plans/

PwC’s Health Research Institute found that 44 percent of employers are expected to offer HDHPs as the only benefit option for employees in the next three years, in their continued effort to reduce health care spending. Therefore, more patients who rely on employer-based coverage have to pay significant amounts out of pocket or from a health savings account (HSA) to buy health care services. This trend is supported by a 2014 census report released by America’s Health Insurance Plans (AHIP) illustrating the growing popularity of HSA-eligible insurance plans, which typically have high deductibles. As of January 2014, 17.4 million people were enrolled in these plans, a 74 percent increase over 2010 levels.


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