|Caring for Opioid Use Disorder Patients Costs Hospitals $95B Per Year
By Victoria Bailey | January 25, 2023
Caring for patients with opioid use disorders (OUDs) costs hospitals more than $95 billion per year and accounts for almost 8 percent of all hospital spending, according to data from PINC AI Applied Sciences (PAS).
PAS data scientists used the PINC AI Healthcare Database (PHD) to analyze discharges for emergency department (ED) outpatient visits and inpatient admissions that occurred between 2017 and 2022. They used OUD prevalence and cost estimates from the PHD analysis to determine the cost of care for people with OUDs.
OUD was associated with around 66 million ED outpatient visits and 760,000 inpatient admissions each year, leading to economic challenges for hospitals. On average, patients with an OUD diagnosis had a 32.5 percent higher cost per ED visit and an 8 percent higher cost per inpatient visit compared to those without an OUD diagnosis.
Patients experiencing an opioid overdose in an ED are at high risk for multiple organ failure, hospitalization, and steeper costs due to stays in the intensive care unit and unplanned readmissions after discharge.
The mean total cost of an ED outpatient visit for hospitals was $854 for a patient without OUD and $1,264 for a patient without an OUD diagnosis. The mean inpatient visit cost was $14,510 for a patient without OUD and $15,763 for a patient with OUD.
When applying these cost estimates to all hospital ED and inpatient visits in the country, the total cost of OUD to hospitals was $95.43 billion annually. This makes up 7.86 percent of all hospital expenditures. If the payer mix remained constant, $67 billion of the spending would occur within Medicare and Medicaid.
To read more, to Revcycle Intelligence.
ASA-Endorsed Legislation Included in Year-End Appropriations Package
January 24, 2023
The American Society of Anesthesiologists (ASA) is pleased HR 3259, the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act introduced by Representative Terri Sewell (D-AL-7) and Representative David McKinley (R-WV-1) was signed into law. This bipartisan legislation expands access to non-opioid medication for Medicare patients by addressing barriers to non-opioid pain management.
The NOPAIN Act directs the Centers for Medicare and Medicaid Services (CMS) to provide separate reimbursement under Medicare for non-opioid treatments used for pain management in both the hospital outpatient department (HOPD) and the ambulatory surgery center (ASC) settings. The Senate companion legislation, S. 586, was introduced by Senator Shelley Moore Capito (R-WV) and Senator Jeanne Shaheen (D-NH).
ASA supports a multimodal and interdisciplinary approach to pain treatment and believes this policy encourages the best possible care for patients.
To read more, got to ASA’s website.
What Anesthesiologists Are Paid in the 3 Largest US Cities
By Patsy Newitt | January 23, 2023
Self-employed anesthesiologists regularly out earn their employed counterparts in three major U.S. cities, according to Medscape’s physician salary explorer.
Here are stats on average annual anesthesiologist salaries, grouped by practice setting and experience range, in the three largest U.S. cities by population:
New York City – Employed anesthesiologist salaries by experience range:
1 to 7 years: $337,529
8 to 14 years: $369,379
15 to 21 years: $407,360
22 to 28 years: $423,519
29 to 35 years: $433,029
36+ years: $406,733
Chicago – Employed anesthesiologist salaries by experience range:
1 to 7 years: $354,606
8 to 14 years: $389,233
15 to 21 years: $422,371
22 to 28 years: $434,309
29 to 35 years: $436,886
36+ years: $393,792
Los Angeles – Employed anesthesiologist salaries by experience range:
1 to 7 years: $348,364
8 to 14 years: $373,361
15 to 21 years: $411,129
22 to 28 years: $429,267
29 to 35 years: $425,969
36+ years: $399,075
To read more, go to Becker’s ASC.
2023 Set to be Big Year for Denials Management
By Amanda Norris | January 17, 2023
Healthcare organizations are on the verge of stepping up their denials management strategies in 2023 as rate cuts are expected to impact revenue.
On the delivery side, most practices plan to continue their telehealth operations in the new year, according to the 2023 Part B News Predictions Survey conducted in the first two weeks of December.
Asked how they would respond to the reduction to the payment conversion factor, more than half, or 51%, of respondents reported that they will be “more aggressive” in challenging denied claims.
About 46% of survey respondents also said they would increase their collections efforts with payers. One respondent added that “we will be more aggressive about authorizations for Medicare Advantage plans,” according to the survey results.
More drastic measures don’t appear to be on the agenda of most practices. Just 16% of respondents said they will add self-pay services; 15% reported that they would limit staff hours; and 11% said they would be forced to delay the purchase of office equipment or software. Less than 4% of practices said that staff lay-offs are on the table, according to Part B News.
These findings come on the heels of a similar survey by Experian Health that found that the nearly three out of four respondents reported that reducing denials is their highest priority, and 70% said that it is more important than prior to the pandemic.
Additionally, the top three reasons for an increase in claims denials in the Experian Health survey were insufficient data analytics (62%), lack of automation in claims/denials process (61%), and lack of thorough training (46%).
To read more, go to Health Leaders Media.
Study Finds MIPS Scores Don’t Reflect True Quality Performance
By Jacqueline LaPointe | January 17, 2023
A recent study out of the Weill Cornell Medical College questions whether the Merit-Based Incentive Payment System (MIPS) accurately captures the quality of care delivered by primary care physicians.
Published in JAMA in December, the cross-sectional observational study of over 80,200 primary care physicians found that MIPS scores were inconsistently related to performance on both process and outcome measures.
Physicians treating more medically complex and socially vulnerable patients were also more likely to receive low MIPS scores even when they provided relatively high-quality care, according to the study.
MIPS is a mandatory reimbursement program for Medicare providers, including physicians, physician assistants, and nurse practitioners, as long as they bill enough for Part B-covered professional services and see enough Part B patients based on Medicare-set levels. Nearly 1 million providers participate in MIPS every year.
Medicare reimburses providers in MIPS based on their performance across four categories: Quality, Promoting Interoperability, Improvement Activities, and Cost.
However, critics of the largest value-based payment program to date have questioned whether the measures used to judge and pay providers are relevant. Some stakeholders have also complained about the administrative burden of MIPS participation.
The JAMA study underscores a disconnect between the measures MIPS uses to judge quality of care and the care actually delivered to patients. For example, for some measures, physicians with the lowest MIPS scores—those subject to financial penalties—had better performance relative to physicians with the highest MIPS scores, who were eligible for “exceptional performance” bonuses.
“The findings support concerns that program performance may not accurately capture the quality of care that physicians provide but rather that quality of care is related to the characteristics of patients they care for and the ability of their organizations to report data,” states the JAMA study.
“Primary care physicians with low MIPS scores tended to see more clinically and socially complex patients than physicians with high MIPS scores; they were also more likely to work in small and independent practices. Importantly, the study did not find evidence that physicians with low MIPS scores provided consistently worse care.”
Researchers point to a clinician’s ability to select the measures they report to MIPS as a possible reason for the high level of discordance between physician MIPS scores and performance on patient outcomes. Other possible explanations include invalid measures, skewed weight distribution of the performance categories, and the program’s tendency to reward clinicians who are better at collecting and reporting data.
CMS has addressed some MIPS concerns, particularly around measure selection. The agency is implementing common sets of measures based on a clinician’s specialty. These MIPS Value Pathways will have subsets of measures and activities that will meet most program requirements.
However, further work will need to be done to ensure that MIPS penalties do not exacerbate health inequities.
To read more, go to Revcycle Intelligence.
Anesthesiologist Highest Paying Job for 2023: US News
By Claire Wallace | January 13, 2023
Anesthesiologist was named the highest paying job in the U.S. for 2023 according to a new report from U.S. News & World Report. It joins 14 other healthcare jobs in the top 25.
Highest paying healthcare jobs for 2023 and their median salary:
1. Anesthesiologist: $208,000
2. Oral and maxillofacial surgeon: $208,000
3. Obstetrician and gynecologist: $208,000
4. Surgeon: $208,000
5. Orthodontist: $208,000
6. Physician: $208,000
7. Psychiatrist: $208,000
8. Nurse anesthetist: $195,610
To read more, go to Becker’s ASC.
HHS Extends Public Health Emergency for 12th Time
By Susan Morse | January 11, 2023
Three years after the federal government announced the first public health emergency due to COVID-19, Health and Human Services Secretary Xavier Becerra has again extended the PHE. Becerra announced the extension Wednesday morning.
This is the 12th time HHS has extended the public health emergency. The declaration was first made in January 2020.
On October 13, 2022 Becerra issued another 90-day declaration.
Former HHS Secretary Alex Azar issued the first declaration on January 31, 2020, as the COVID-19 pandemic was just beginning to ramp up in the United States. Azar renewed the PHE on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021.
Becerra continued those renewals on April 15, 2021, July 19, 2021 and October 15, 2021, and on January 14, April 12, July 15 and October 13, 2022.
HHS has promised to give providers 60 days’ notice before ending the public health emergency.
To read more, go to Healthcare Finance News.
Fitch: 2023 Could be Turning Point for Nonprofit Health Systems
By Caroline Hudson | January 11, 2023
Nonprofit healthcare systems are in for a tough year, but a Fitch Ratings report released Wednesday projects even the hardest-hit providers may start to see improvement in the coming months.
The industry ended 2022 with depressed margins, and some health systems saw billions of dollars in operational losses. High labor costs, along with ongoing supply chain issues and inflation, continue to drag on systems’ financial performance. The challenges have no short-term fix, and labor expenses are expected to stay elevated through at least 2023, said Kevin Holloran, senior director at Fitch.
The credit ratings agency downgraded the nonprofit health system sector to “deteriorating” in August and maintains that outlook in its latest report, acknowledging the likelihood that negative outlooks for health systems will outnumber positive ones for a time.
Holloran said hospitals still need a better balance between medical and surgical volumes. The so-called “tripledemic” – COVID-19, respiratory syncytial virus and flu – means fewer inpatient beds are being used for revenue-driving services like elective surgeries.
“It’s almost a running joke that ‘I lose money for every case I do’ because the labor is so expensive, particularly in those medical cases,” Holloran said.
But 2023 could be a turning point, according to the report, which projects many providers will be able to break even in their operations on a month-to-month basis sometime this year, with “gradual improvement” from there.
“We think that we are beginning to come out of the worst of it and towards the end of the year, sometime during this year, we’re going to break through that barrier and get more and closer to back to normal,” Holloran said.
That doesn’t mean providers will leave their financial challenges behind. More systems are at risk of defaulting on credit agreements this year – a situation exacerbated by declining cash flow and growing interest expense. In December, Moody’s Investors Service reported 34 healthcare organizations were rated B3- or lower, holding nearly $65 million of combined outstanding debt.
Improvements in the investment markets or debt waivers would soften some of the hit to credit ratings, the Fitch report noted.
Holloran said he expects more systems to exit payer networks and contracts, as well as push for shorter contract periods, as providers continue to navigate expenses.
To read more, go to Modern Healthcare.
The Healthcare Facilities Where No Surprises Act Disputes Are Most Common
By Jakob Emerson | January 10, 2023
Hospital emergency rooms make up 81 percent of where No Surprises Act disputes occurred between April 15 and Sept. 30, according to CMS’ initial report on the independent dispute resolution process.
Top places of service for disputes:
Hospital emergency room: 70,071Inpatient hospital: 11,432On campus outpatient hospital: 7,789ASC: 1,990Off campus outpatient hospital: 1,056Office: 328To read more, go to Becker’s Payer Issues.
Affordability, Labor Shortages Top Issues for Healthcare Execs
By Jacqueline LaPointe | January 9, 2023
Confronting affordability and solving clinical labor shortages are among the top pivotal issues for healthcare executives in 2023, according to a new report from PricewaterhouseCoopers (PwC).
“The business environment of 2023 will likely force all health plans and health systems to confront affordability head on,” the report states. “They need to reshape strategies, reengineer financial and business models to aggressively deliver greater value — or others will.”
As the COVID-19 pandemic showed, remote and retail care are viable, even successful, alternatives to the traditional care model. Both types of care are a more convenient way to access medical care while typically costing patients less than visiting their doctor in the office or hospital.
But health systems and payers will have to transform their businesses while balancing a delicate clinical workforce. Health systems, in particular, are facing severe clinical labor shortages that are threatening margins and even hospital viability, PwC says.
Other pivotal issues for healthcare executives in 2023 include the digitization of healthcare, customer retention and acquisition, cybersecurity risk, and delivering value.
Delivering value to the consumer is key to confronting disrupting forces while ensuring the costs of care remain affordable for patients, the report indicates. Health systems will also “need to seize every transformational opportunity — from foundational technology investments, regulatory shifts, deals or crises — to clear the path for a drastically different cost, capabilities and business footprint by 2030.”
2030 is likely to be a pivotal year for health systems and payers, the report suggests. PwC believes that the healthcare sector will move to a new ecosystem in which organizations will need to adopt new roles to survive and thrive. They can either be orchestrators, which focus on delivering a seamless, humane experience; integrators, which align incentives and reduce waste for more convenience; or platform and solutions platers, which create technology and cloud infrastructure for better data management.
“Health services companies that follow their North Star — finding ways to develop stronger relationships with consumers and improve the patient experience, rethinking traditional workforce and business models, and continuing to invest in technology and innovation — will likely be well positioned for what’s next,” the report states.
To read more, go Revcycle Intelligence.
Where No Surprises Act Disputes are Happening the Most
By Jakob Emerson | January 5, 2023
Five states represent the majority of where No Surprises Act disputes occurred between April 15 and Sept. 30, according to CMS’ initial report on the independent dispute resolution process.
The report noted that the five states where disputes happen the most have their own laws that would apply to many payment disputes. Because of that, the report said it’s possible that the reported disputes involve self-insured plans, which aren’t subject to state laws.
Top 10 disputes by state:
Texas: 24,987Florida: 9,695Georgia: 7,288Tennessee: 6,819North Carolina: 5,040Virginia: 4,079New York: 3,603Arizona: 3,469Indiana: 2,434New Jersey: 2,276View the full ranking here.
To read more, go to Becker’s Payer Issues.
Want a Clue on Health Care Cost in Advance? New Tools Take a Crack at It
By Julie Appleby | January 3, 2023
Need medical treatment this year and want to nail down your out-of-pocket costs before you walk into the doctor’s office? There’s a new tool for that, at least for insured patients.
As of Jan. 1, health insurers and employers that offer health plans must provide online calculators for patients to get detailed estimates of what they will owe — taking into account deductibles and copayments — for a range of services and drugs.
It’s the latest effort in an ongoing movement to make prices and upfront cost comparisons possible in a business known for its opaqueness.
Insurers must make the cost information available for 500 nonemergency services considered “shoppable,” meaning patients generally have time to consider their options. The federal requirement stems from the Transparency in Coverage rule finalized in 2020.
So how will it work?
Patients, knowing they need a specific treatment, drug, or medical service, first log on to the cost estimator on a website offered through their insurer or, for some, their employer. Next, they can search for the care they need by billing code, which many patients may not have; or by a general description, like “repair of knee joint,” or “MRI of abdomen.” They can also enter a hospital’s or physician’s name or the dosage amount of a drug for which they are seeking price information.
Not all drugs or services will be available in the first year of the tools’ rollout, but the required 500-item list covers a wide swath of medical services, from acne surgery to X-rays.
Once the information is entered, the calculators are supposed to produce real-time estimates of a patient’s out-of-pocket cost.
Starting in 2024, the requirement on insurers expands to include all drugs and services.
To read more, go to KHN.