2016: A year of change for healthcare finance

March 29, 2016
By Karen England, Revenue Cycle Consultant, Ingenious Med

It’s safe to say the ICD-10 transition occupied the minds of many throughout 2015, dominating the conversation among healthcare finance professionals. While the buzz around ICD-10 has begun to settle down, other topics in healthcare finance are on the rise.

Medicare is enforcing payment revisions and shifting its reimbursement model, and some of the largest commercial payers are questioning their participation in Affordable Care Act exchanges. And analyzing data has become increasingly necessary as many healthcare organizations struggle to improve revenues. While the impact of ICD-10 is still playing out, more changes are on the way, and health organizations will begin to uncover new areas to improve overall efficiencies and quality of care in 2016.

Medicare gets ‘hip’

One area of significant change involves Medicare making mandatory payment revisions for hip and knee replacements, moving toward a bundled payments model. Since knee and hip replacements are among the most common – and costly – procedures Medicare pays for, the service is starting with these and planning to expand to other operations in the future.

This impacts the facility, the surgeon, and any person responsible for the patient’s care within a 90-day period after the surgery. Providers and facilities must start advancing the way they coordinate to improve patient care in order to operate in this new healthcare arena, and these mandatory bundled payments are a big step closer to a pay-for-performance reimbursement model.

The ACA: Will it be OK?

Additionally, as UnitedHealthcare, the largest commercial payer in the country, talks about plans to pull back on its offerings through the public Affordable Care Act exchanges, it opens up several questions for the rest of the industry.

To which providers will the hundreds of thousands of affected UnitedHealthcare customers move? What if they don’t seek coverage elsewhere? How will the volume of other vendors be affected? These types of inquiries led to an initial drop in stock prices. Should other payers follow United’s lead, there may be negative, long-term financial impacts to providers, patients, and stockholders of insurance exchange companies.

Data = Reduced costs and improved quality

Also in 2016, healthcare professionals will become more data driven as a direct result of the ICD-10 transition. It’s never been more important for healthcare professionals to keep their sights set on data to optimize financial performance by reducing care costs and improving care quality. Looking further ahead into 2016, healthcare professionals should compare patterns and volumes before ICD-10 with current analytics.
Healthcare providers must leverage this information to make data actionable and increase revenue. They need to compare the length of time it takes to process charges and get claims out the door to get reimbursements back into the system.

Additionally, improving physician documentation will help greatly with improving the financial performance and care quality of the organization by reducing readmissions, length of stay, and other facets of the patient encounter. If all continues to go smoothly, the remainder of 2016 will give way to improvements in revenue and patient care due to changes in the healthcare landscape.

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