Western Pennsylvania Healthcare News

Covering healthcare news in the Pittsburgh region and beyond.

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3 Ways Your Hospital is Leaving Money on the Table

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seanaudleyphoto (2)Maximizing Revenue from Workers’ Compensation in Pennsylvania

By Sean P. Audley

Hospital administrators are always challenged to find ways to generate revenue from their hospital. Nearly every function in your facility can generate revenue, yet many are leaving money on the table, particularly when you’re dealing with workers’ compensation. Whether you outsource your workers’ compensation accounts to a vendor or handle them in house, it’s highly likely you are missing out on significant revenue from these accounts.

The payment of work-related medical bills is controlled by the Pennsylvania Workers’ Compensation Act and regulations are enacted under its authority. While most claims are not complicated to resolve, some pose roadblocks to payment. These outlier claims are often high dollar accounts and are often contested by employers. They can take months to resolve, tying up valuable staff time. Not understanding the intricacies of the law regulating these claims can result in missed deadlines or lost opportunities for payment.

As a result, your facility may be writing off accounts or settling for a reimbursement amount that is less than what you are entitled to receive. One way you can be more proactive in trying to maximize the revenue from these accounts is to partner with an experienced attorney well versed in workers’ compensation. This will not only increase your recoveries on these cases, but allow your staff to devote their time to less complicated claims, thereby increasing revenue on those as well. [Read more…]

Collecting Bad Debt: Working with a Debt Collection Agency

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By Daniel Casciato

As a patient’s account ages, the chances of collecting on it decrease dramatically. It’s expensive to carry accounts that you will not be able to collect using the methods at your disposal.

“It’s often a better use of your office’s time and resources to concentrate on other aspects of your business,” says Michelle Dunn, Plymouth, NH-based author of Starting a Collection Agency, How to Make Money Collecting Money.  “A professional collection service can assist you in collecting accounts that remain delinquent.”

Debt collectors have a vast knowledge of collection techniques, technology and compliance issues. Using a professional collection service will save time and likely yield better results.

“Collection agencies should be used as a partnership between the medical practice and the agency,” says Tom Corson-Knowles, president and CEO of American Asset Solutions, LLC, based in Granger, IN. “It should also be viewed as a long-term relationship because if you have delinquent accounts today, you’ll likely have them in the future as well.”

It’s a good rule of thumb to not hire an outside agency to collect until at least six months of nonpayment. If you send the account to an agency just 30 days after nonpayment, your patients may be put off.

[Read more…]

How to Double or Triple the Size of Your Urgent Care Practice

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By Luis de la Prida

You probably got into medicine because you wanted to make a difference in the world.  You recognized that urgent care fills a gap in the healthcare market.  You get to interact with a diverse range of patients, fulfilling your own vision of how healthcare should be done.

Now that you’ve been up and running for a while, the administrative burden is keeping you from what you love: practicing medicine.  It’s time to decide whether to hold and maintain or grow. How do you take your practice to the next level?

Growth takes risk and thinking strategically. If you find yourself at the point of wanting to grow, but not quite sure how to do it, then you’ll want to read further.

Current Landscape for Urgent Care Practices

Before figuring out how to create a growth plan or implementing an acquisition strategy, it is important to know the lay of the land.  Knowing who’s buying and why is an important step toward effective negotiating.  Knowing why practices are selling can position you to make an attractive offer that beats out your larger competitors. [Read more…]

Help Along the Wealth Continuum for Health Care professionals

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By Casey Robinson, CFP®

Whether you are an entrepreneur, a corporate executive or a health care professional, there are likely similar stops along the growth path of the wealth continuum. Struggle and sacrifice in the early portion of the journey, followed by earnings growth and the new challenges of financial planning, and then a period of material success and evolving estate planning as one nears the end of the continuum. But for those in the health care field, there are some challenges unique to their industry. Chief among them are the commitment of time it takes to start earning the wages people associate with being a doctor, and the significant cost of the education it takes to get there.

People who wish to become doctors are often fueled by a desire to help others. As they advance in their careers, the assistance they will require to manage their finances will likely grow as well. [Read more…]

What is Wealth Management and How Do I Know if I Need It?

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Wealth management is primarily a professional package for affluent individuals or entities. A person attains advice on their finances and possible investments, taxes requirements, legal planning, accounting, estate planning in the case where there’s property, and ultimately get retirement options. A wealth manager, the person who manages one’s wealth, does not work alone. There sought input from experts in the industry, including accountants, attorneys and insurance professionals, who are often those the client has hired.  Their purpose is to both maintain and increase their client’s wealth.

The notion of hiring a wealth manager may appear extravagant though, but their usefulness is understated. These managers also offer financial advice on every facet of an individual’s financial life. Their existence is for convenience as a person does not have to consolidate input from the various persons involved in their finances and then to task themselves with finding the best way forward. It often takes a professional to interpret the data and chart the best next steps. It essentially tasks a single person to undertake a person’s financial matters to ease their headache. An individual is therefore only tasked with making decisions on anything ranging from what investments to take and what happens to their assets after their passing. [Read more…]

Commercial Payers Embrace Bundled Pricing for Cost Containment, Better Outcomes

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Shane Wolverto is Senior Vice President of Corporate Development for QuantrosBy Shane Wolverton

As commercial payers seek strategies to lower costs and improve care quality, they are paying closer attention to bundled payments.  While many payers express concerns about the impact of recent regulatory reversals that removed mandatory requirements for bundled payments, the benefits of bundled pricing still resonate strongly throughout the commercial marketplace. 

This is evidenced by a recent announcement from Humana, which expanded a bundled payment model into seven additional states that will cover hip and knee replacements within the Medicare Advantage beneficiary populations. This model is designed to improve outcomes and patient satisfaction during an entire episode of care while reducing their costs. More comprehensive data sharing with providers to evaluate and improve care across the continuum helps both Humana and providers meet quality and profit requirements. [Read more…]

How the Healthcare Industry is Benefiting in a Big Way from Fintech Start-Ups

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The healthcare industry is one that has gone through all kinds of changes over the past decade thanks to innovation and technology. Now it seems the revolution taking place in the industry is being driven by those in the fintech, or financial technology industry. More and more fintech start-ups have their sights set on the healthcare industry with big plans on how they can make their mark.

Giving Patients Easier Ways to Pay

One of the biggest complaints from both patients and those on the administrative side of the healthcare industry is just how confusing and difficult the billing and paying system is. Change is not only welcome, it is needed at this point. Fintech start-ups are now looking at ways they can work to facilitate payments such as offering online billing and bill payments.

There is also the other side to bill payments and that has more to do with offering assistance when it comes to financial planning for patients. We all know that medical care isn’t cheap, and not everyone has insurance coverage. Fintech companies are now looking at products they can offer that help patients to better plan and budget their finances so that they can indeed pay for the medical services. [Read more…]

Spending Your IT Budget More Wisely

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Healthcare IT budget, healthcare finance, revenue cycle management

Stretching information technology (IT) budgets are an ongoing challenge for many medical offices today. In theory, your practice should first determine what IT you need to meet your business objectives, and then budget accordingly. However, because technology is constantly changing, many practices would like to stay ahead of the trends to improve their business operations. But there’s a way to stay current and relevant while stretching those precious IT dollars.

Understand your expenditures

Before you begin to slash away at your IT budget, Bob Merrill, IT strategy expert at PA Consulting Group, says to make sure that your practice understands what you are actually spending on IT. You can do that by simply listing each line item/category, and including IT-like expenditures, which may include items such as phone systems, mobile phones and associated services, voice and data networks, copiers, fax machines, printer/copier/fax supplies, maintenance agreements, as well as allocation of floor-space and associated rent for computer rooms. 

“Many of these expenditure categories are considered office expense, even though they duplicate capabilities available through IT technology,” he points out. “Sort the categories from highest annual expenditures to least, and focus on the costliest expenditures first when looking for opportunities for reduction.”

Donovan Niesen, co-founder of The Tech Outfit in Minneapolis, MN, says to begin with your biggest IT expenditures and work your way down.

“When evaluating ways to reduce your IT spending, it is absolutely critical to do a proper risk assessment to understand any pitfalls that can arise from changes made,” he cautions. [Read more…]

Improve Clinical Communication to Reduce ED Overuse and Control Costs

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Brad Brooks is Co-Founder & Chief Executive Officer of TigerTextBy Brad Brooks

Much has been written recently about the opioid epidemic running rampantly through American cities and towns. The crisis impacts everyone, including hospitals that are being inundated by patients with opioid-related emergencies, often including overdoses of potentially lethal combinations of prescription medications and illegal drugs. 

Concurrently, healthcare organizations are seeing an increase in patients visiting emergency departments (EDs) complaining of pain in order to obtain opioid prescriptions. Drug-seeking patients typically return to the ED several times a year, or visit multiple hospitals in surrounding communities in search of having a prescription filled.

ED overuse, however, is not exclusive to drug addicted patients. It also includes patients with mental illness; with multiple, uncontrolled chronic diseases; or those who believe the ED is their only access to care.

The financial consequences of unnecessary ED utilization are very real. One study estimates that $38 billion in spending each year could be eliminated by diverting care from the ED to a more appropriate setting. Streamlined clinical communication can help hospitals and health systems to reduce some of this overuse, improve patient care through more appropriate actions, and augment reimbursement under value-based payment models through better efficacy.

By aligning communications across multi-disciplinary care teams—not just physicians and nurses—but also social workers and rehabilitation facilities, patients can get the effective, appropriate help they need and organizations can reduce wasteful care spending. [Read more…]

Value-based Purchasing and Reimbursement: The Business Case for Improving Quality and Patient Safety

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By Andy Weissberg

In the increasingly competitive, transparent and value-based healthcare economy, hospitals and health systems in Western PA and throughout the nation are facing increasing financial pressure from healthcare purchasers and payers to improve patient care outcomes. At the center of value-based purchasing and reimbursement, performance against numerous measures of quality and patient safety performance also heighten hospital concerns for reputation and market share. 

Although patient safety and quality have traditionally been regarded as disparate domains of performance measurement in traditional fee-for-service (FFS) models, they are increasingly interconnected in performance-driven, value-based purchasing, payments and reimbursement from both public and private payers, underpinning the business case to improve the quality and safety of health care.

The top and bottom line: only high-performing hospitals that deliver higher quality, safer and more efficient care with measurable and improved clinical outcomes will thrive and financially survive, improving a health system’s reputation and ability to increase market share and encourage patients to use in-network services. [Read more…]