Tag: CMS

Hospital Credit Rating

Hospitals private or public have been relying on many different sources of income to continue operation. Many hospitals rely on bond funding for their development and the procure of new apparatus.  Revenue that is created by the hospital is then used to pay back the bondholders.  The risk to bondholders is that they are generally paid after the hospital pays its operational expenses.  Therefore, if the hospital is less profitable than expected (or not profitable at all), bondholders assume the financial risk.

Low-rated hospitals before have used strategies such as merging with higher-rated hospitals, diversifying payer mix, recruiting doctors, and opening new service lines in order to boost their credit ratings.  But these tactics may not always work in a system that rewards value rather than volume. Therefore a stable source of financial capital must be develop in order to increase the quality of healthcare services.

The CMS quality measures being tied more and more to hospital reimbursement CRAs are looking at ways to apply quality metrics to their hospital investment grade ratings.  These savvy agencies recognize the basic tenet that hospitals which give a higher level of quality care tend to be more profitable.  In the move from fee-for-service to value-based payment models in health care, it’s not surprising that CRAs are looking at different quality metrics when assessing investment risk.

The factors they are looking into include Medicare reimbursement rates publicly available quality scores, HCAPS scores, and commitment to establishing a culture of safety.  Some CRAs are also planning to highlight IT investments such as EHRs and data analytics platforms.They also looking at meaningful use and ICD-10 readiness.

The ultimate ability to change quality of care lies in the hands of the front-line health care providers. Tying these quality factors to hospital credit ratings and subsequent bond funding available should help to bring quality even more front and center in c-suite and hospital board meetings.  With the bottom-line becoming increasingly tied to quality and patient safety, hospital administrators need to work closer than ever with physicians and other constituents of the health care team to help them with the resources they need for institutional conversion.

Hospitals needs to be focusing on improving their eminence of care in advance of these changes. Those institutions that wait for the CRAs to act first may find themselves in an increasingly difficult place to receive bond financial support.  With the recognized inverse relationship between health care quality and expenditure, it would make sense to assume that those hospitals who might need bond funding the most may be the ones in worse shape to begin with.

Medicare Hospital Issues

The House Ways & Means health subcommittee held a hearing last May 20 on hot-button Medicare hospital issues, specifically focusing on CMS’ two-midnights inpatient admissions policy, brief in-patient stays, out-patient observation stays, auditing and appeals, subcommittee Chair Kevin Brady (R-TX) said. Inside Health Policy said that the hearing was in the works. The hearing also will look at appeals trapped at the third level of the system, Brady says in a hearing statement.

In introducing the hearing, Brady says, “There are a number of problems associated with brief hospital stays and the way medical centers are audited. The Ways and Means Board battled hard to ensure that sufferers are getting the proper care they need and that Insurance coverage is properly paying medical centers for the care they offer. While we were able to offer some relief last March, it was only a short-term fix. We must work on a lasting solution. We don’t want suppliers needlessly looking over their shoulder area for auditors. We want medical centers to be perfectly refunded so that they can focus all of their time on providing the right type of care to sufferers.”

Brady is making reference to Congress’ decision, as part of the short-term doctor payment patch passed in March, to put on hold until March 31, 2015 Restoration Audit Contractor audits on most brief hospital stays related to medical requirement during an elongated transition to the two-midnights plan. A representative for the American Coalition for Healthcare Claims Integrity, which symbolizes RACs, says that the coalition facilitates continuous developments to the RAC system. “We hope this hearing will light up the impressive volume of waste in Medicare and the value of the RAC system to recipients, tax payers and the Medicare Trust Fund,” the representative says. Recent quarterly reviews from CMS show that the RACs’ recoveries have dropped since the two-midnights plan and other changes to the system were applied.

Goal Oriented Patient Care

The largest U.S. health insurance provider, the Centers for Medicare and Medicaid Services (CMS), has set a multiple aim: better care for patients, better health for communities, and lower costs. At the same time, major efforts have been released to make healthcare more patient-centered, defined as “respectful of and aware of individual patient choices, needs, and principles, and ensuring that individual principles guide all clinical choices.”Attention to patient-centered actions and results will be particularly important as CMS moves increasingly to link medical healthcare providers’ compensation to their performance on selected actions.

 

So far, tests of quality of patient care and wellness results have not incorporated patient-centeredness. Rather, amount of quality has resolved preventive and disease-specific wellness care processes (e.g., smoking-cessation guidance and start of appropriate medications after myocardial infarction). Similarly, results measurement has focused on condition-specific signs, both short-term (e.g., glycated hemoglobin levels and high blood pressure control) and longer-term (e.g., disease-free survival), as well as overall death rate.

Though these process and results measures work well for relatively healthy sufferers with single illnesses, they may be unsuitable for sufferers with several circumstances, serious impairment, or short life expectancy. For such sufferers, the overall quality of health care is determined by more than just disease-specific health care procedures. Furthermore, disease-specific results may not effectively indicate treatment effects in sufferers with several coexisting illnesses. Adopting of more worldwide results, such as efficient position, would not ensure patient-centeredness unless they were regarded within the perspective of individual patients’ objectives and choices in the face of trade-offs.

Perhaps the most important hurdle to goal-oriented patient care is that remedies are greatly based in a disease-outcome–based model. Rather than asking what sufferers want, the culture has respected handling each condition as well as possible according to recommendations and inhabitants’ goals.

Ultimately, good remedies are about doing right for the affected person. For sufferers with several serious illnesses, serious impairment, or limited life expectancy, any bookkeeping of how well we’re following in providing health care must above all consider patients’ recommended results.