Back Door Reimbursement Cuts for Docs?

The federal government is concerned about the incidence of Medicare re-admissions.

Typical scenario: an elderly patient is admitted to the hospital for pneumonia and related distress. After a four day stay the patient is discharged to a long-term care facility.

A week later the patient is re-admitted with acute distress, after the nurse requests orders from the patient’s physician. After several days the patient is again discharged to the nursing home.

This cycle is very costly to Medicare, and the feds would like to see it slow down.

(Based on conversations with long-term care nurses and reviews of Minimum Data Set (MDS) summaries, the patients are usually very old, very frail, but not at death’s door quite yet.)

One solution is to ‘train” physicians and families not to be so quick to send the patient back to the hospital. This is tough on families, who often pressure the physician to readmit. Sometimes the patient demands readmission, it is easy for the physician to say yes. This situation can also be tough on the nursing home, where higher acuities are colliding with the nursing shortage.

A proposed solution is bundling. President Obama mentioned it in his 6/15 speech to the AMA. How does it work? The hospital gets a flat fee per incidence and then has to pay the physician, nursing home, ambulance/transport company, physical therapist, etc.

This requires a lot of administrative work and some intense negotiations, and puts the hospital at risk, and creates tension between physicians and the hospital.

Could this work? Maybe. Good for patients? Unknown. Good for physicians? Probably not.

Briefing Paper: Email and electronic communications

The first in a series of briefing papers on administrative topics:

http://www.scribd.com/doc/16018098/Email-Briefing-Paper-Health-Care

Selling Health Care Reform

President Obama is selling health care reform with the argument that we need to fix health care in order to fix the overall economy.

Economic advisor Christina Romer distributed an op-ed piece today explaining how health care reform would 1) improve family incomes, 2) enhanced GDP, 3) lower budget deficits, 4) lower unemployment, 5) provide greater health care coverage (of course) and a 6) better labor market.

Wow. This is quite a claim.

Full report: http://www.whitehouse.gov/assets/documents/CEA_Health_Care_report.pdf

Denial Management

Denial management (whether the denials are based on substance, stalling or practice error) is a key part of revenue cycle management. Some quick tips:

1) every denial should be logged in

2) every denial should have an answer date assigned

3) there should be clear responsibility for answering the denials

4) denials should be compiled for trend analysis, especially practice errors and denials by payer

5) prompt pay laws should be used when applicable (although be careful about starting wars with payers)

6) summaries should be prepared monthly and reviewed for management action


If a practice is behind on denial management, create a strategy to catch up, focusing on the most probable collections and the highest value claims.