Health Care Industry Highlights-2015


Healthcare Industry Highlights-2015

As we move to a close of 2015, the healthcare Industry has seen a lot of ups and down, and changes that although seemed to threaten disruption, but have created just minor ripples. Here is a fleeting glance at the industry

CMS & Reporting requirements

In January 2015, Medicare announced that it would ramp up its timeline for the Transition of fee-for-service (FFS) payments to value-based reimbursement. Necessary, but caused heartburn for many physicians through the year

Physicians had to integrate quality reporting and enable Meaningful initiatives into their Value based purchasing program by the CMS. Physicians who were not meaningful users of certified EHR technology saw a one percent cut in their Medicare Fee Schedule. Further, eligible professionals also saw a reduction in reimbursements for noncompliance with Medicare’s Electronic Prescribing (eRx) Incentive Program and the Physician Quality Reporting System (PQRS)

As part of Medicare’s efforts to improve healthcare, physicians were also required to comply with CMS’s new Value-Based Payment Modifier program, or face penalties. The Value-Based Modifier program calculated Medicare’s payments to physicians in group practices based on annual cost and quality measures

Billing Requirements

With the October 01 deadline that loomed and the number of codes that needed to be introduced, given its complexity, some good news for physicians who were feeling the heat financially, CMS allowed for a new procedural terminology (CPT) code, 99490, which enabled then to bill CMS $41.92 per month for providing remote chronic care management to qualifying patients. Further, more states under Medicaid and commercial payers added telemedicine to their reimbursement fee schedule, which allowed physicians to bill for these services too, thus helping their medical billing revenue cycles

Technology requirements

Integrating updated technology into their workflow has hit the physicians the most. Many payers have insisted on Electronic Health Records, the shift from paperless to digitizing, has costed many a disruption to physicians. But given the changing in coding and payment models, this shift was essential and beneficial to both providers as well as the healthcare industry in the long run. However, Interoperability of EHRs will soon become essential and need to be addressed by physicians who attempt to successfully participate in the advanced stages of meaningful use.

Patient Care & Payment models

Patient care, due to Obamacare reforms took precedence. The use and deployment of social media by many hospitals, and physicians saw more usage of different social media platforms for keeping the footfalls and focus on patient the underlying theme. Increase in the prevalence of ACOs also evidenced a shift to patient care alongside the shift with payment models

Switch from ICD-09 to ICD-10

This switch took centre stage prior to October 01, 2015. However, the heat that was generated before that was tremendous. But, when the switchover happened, the ripple was hardly felt and it was a seamless process, hardly a whimper. The preparations across websites for small clinics, physicians, hospitals, etc. was probably one of the factors that made the switch seamless, besides the earlier delay probably helped physicians prepare, knowing that no further delays would be entertained.

Open Enrollment Period (OEP)

The Open Enrollment period for Obamacare health insurance in 2016 was November 1, 2015 to January 31, 2016 where citizens could enrol for 2016 coverage and a chance to change their health plans. And if you don’t enroll in Obamacare in 2016, you’ll be fined 2.5% of your income or $695 per adult, whichever is higher. When compared to 2015 when total enrollments were down 13 percent, the present saw 1.65 million enrollments during the initials months itself.

Thus, both hospitals as well as physicians have had to make tremendous changes in their workflows, right from upgradation of systems to training their staff and themselves. As they say change is inevitable, but necessary for healthcare to bring forth change in its overall system and stop wastage of expenses given the high healthcare expenses, nearly 21 percent of the GDP.


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