There are two things in particular, which are on the rise in United States, one is the rising dissent with the current federal governments healthcare policies, and second is the rising outpatient payment, both of which are denting the healthcare industry. In fact the speed of healthcare costs rising is two to three times faster than the current rate of inflation. And to all of you working in this line of business and industry, this trajectory is not sustainable and something is going to have to give.
We often hear about rate pressures on hospitals and the risk these pressures pose for their future. With healthcare reform up on the cards, the burden of rising hospital costs is now shifting from payers to providers. However, do we always take in the true meaning of that warning? Does it become just another indication of doom and gloom that we can brush off? How will the healthcare units survive, what can be said about the solo practitioners, ASCs, outpatients facilities, and medical billing and coding companies? Let's be abreast, before the storm hits the shores!!

What Do The Numbers Say?

  • A recent research or study conducted on, Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 6th Edition, came out with a conclusion that that states with percent-of-charge-based fee regulations had substantially higher hospital outpatient payments per surgical procedures, than states with a fixed-amount fee schedules, which is 37 to 151 percent higher than the median of the studied states with fixed-amount fee schedules in 2015.
  • States with no fee schedules also had higher hospital outpatient payments per procedure, which is 44 to 136 percent higher than the median of the studied states with fixed-amount fee schedules in 2015.
  • The research report also found out that hospital outpatient payments per treatment in most states with percent-of-charge-based fee regulations or no fee schedules grew faster than in states with fixed-amount fee schedules.

How Was It Done?

  • To put these reimbursement rates in perspective, the research provides a comparison between workers' compensation hospital outpatient payments and Medicare rates for the most common group of surgical treatments across states.
  • Medicare rates captured payments to hospital outpatient providers for similar services by a large payer other than workers' compensation.
  • The variation in the difference between average workers' compensation payments and Medicare rates for a common group of arthroscopic procedures across states was incredible ranging from below It projected that Medicare levels in Nevada, New York, and Massachusetts were high as 527 percent (or $9,927) above Medicare in Alabama.

Also discussed in the research report was an analysis of major policy changes in Connecticut, Florida, and North Carolina, the states with recent fee schedule reforms. For instance, Connecticut adopted a fee schedule for hospital and ambulatory surgery center services, with the hospital outpatient reimbursement rate set at 210 percent of the Medicare rate.

Following this Ambulatory Payment Classification (APC) based fee schedule, the normal hospital outpatient payment per surgical episode decreased in Connecticut about 14 percent from 2014 to 2015.

The 35 states that were included in this deep and through study are Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wisconsin.

The study states were chosen for a reason as they are geographically diverse and represent a wide range of industries and a variety of regulation choices for hospital payments. Experts opine that rising hospital costs have been a focus for federal policymakers and industry stakeholders in recent policy debates in many states. The new developments surrounding the healthcare bill will help policymakers and stakeholders conduct more meaningful comparisons of hospital payments across states, as well as keep a tab on the rising hospital payment trends in relation to reforms of hospital outpatient reimbursement regulations.

Why Medical Billers and Coders (MBC)?

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Published By - Medical Billers and Coders
Published Date - Jan-09-2018 Back

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