Más contenido relacionado La actualidad más candente (20) Similar a Rising Healthcare Costs: Why We Have to Change (20) Más de Health Catalyst (20) Rising Healthcare Costs: Why We Have to Change2. Rising Costs Driving Down Margins
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The burden of rising healthcare
costs is shifting from payers to
providers.
A recent study by an industry
group determined the following
sobering fact:
Hospitals that keep operating
according to business as usual
will have a negative 15.8%
margin by 2021.
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3. Burden of Rising Healthcare Costs
Family Premiums, 1999 to 2013 Family, Worker Contributions, 1999 to 2013 Kaiser Family Foundation
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Healthcare costs in the United States
are rising two to three times faster
than the rate of inflation.
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4. Burden of Rising Healthcare Costs
The graph clearly illustrates
the steady—and steep—rise
in healthcare premiums.
Fifteen years ago, the
average yearly insurance
premium was less than
$6,000. Today, it is more than
$16,000—a 167% increase.
Employers have shifted costs to their workers through growing
deductibles and coinsurance. Health insurance is the fastest
increasing expenditures for large companies who are rapidly
becoming less willing to sustain these increases.
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5. 2013 2014 2015 2016 2017
HAC Re-Admit VBP MU
Some programs are penalty-only such as Readmission and
Hospital-Acquired Conditions (HAC). Under the Medicare
Shared Savings Program (MSSP) and through Value-Based
Purchasing (VBP) hospitals earn incentives or are penalized.
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Pressure on Payers
Government payers normally
pay at low levels. In 2014,
the Medicare inpatient
payment increase was .5%,
and the outpatient payment
increase was 1.8%.
During 2013, sequestration
brought a 2% payment cut.
Medicare $ At Risk
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6. The change in demographics
only exacerbates the problem.
As baby boomers age and
become Medicare beneficiaries,
the payer mix worsens.
With more population moving
into the unprofitable government-payer
category, fewer patients
have commercial plans to carry
the cost burden.
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Pressure on Payers
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7. Hospitals Can Survive And Thrive
This all sounds pretty dire, right? Here
are four things hospitals can do to face
these issues:
Capture all available revenue in current VBP agreements (ex:
meet readmission targets and disease management quality
scores).
Ensure clinical documentation and billing records accurately
reflect the care provided. Many organizations miss billing
opportunities due to incomplete or insufficient documentation.
Increase revenue by negotiating shared savings agreements
with payers.
Eliminate waste and increase efficiency to reduce operating
costs.
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8. Hospitals Can Survive And Thrive
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Getting hospital data assets
together to form one picture for
data analysis is a challenge.
A single source of truth requires
a healthcare enterprise data
warehouse (EDW) that can
aggregate clinical, financial, and
patient satisfaction data to help
hospitals understand and
improve their business.
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9. Hospitals Can Survive And Thrive
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A hospital’s success will depend
on ability and willingness to
creatively collaborate with payers.
It will also require efficient
operations and an in-depth
understanding of relationships
between clinical quality and
operational costs.
An EDW gives hospitals the data
foundation required to
successfully plan, prioritize,
measure, and sustain these
improvements.
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Link to original article for a more in-depth discussion.
Rising Healthcare Costs: Why We Have to Change
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For more information:
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12. Other Clinical Quality Improvement Resources
Jared Crapo joined Health Catalyst in February 2013 as a Vice President.
Prior to coming to Catalyst, he worked for Medicity as the Chief of Staff to
the CEO. During his tenure at Medicity, he was also the Director of Product
Management and the Director of Product Strategy. Jared co-founded
Allviant, a spin-out of Medicity, that created consumer health management
tools. In his early career, he developed physician accounting systems and health claims
payment systems.
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Click to read additional information at www.healthcatalyst.com
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