Stormy Sessions at ACCC’s Mid-Atlantic Regional Meeting
“A Category 5 hurricane is coming, and we’re waiting to see where it makes landfall,” said presenter Ron Howrigon of Fulcrum Strategies, who explored today’s stormy shifts in healthcare during the Association of Community Cancer Centers’ Mid-Atlantic Regional Oncology Economic and Management Meeting on June 19, 2012, in Rockville, Md.
Insurance companies will take a direct hit. They will see limits on how much profit they can make, increased risk, no protection from losses, and the lack of clarity that will come from new healthcare exchanges, according to Howrigon. To protect themselves from the storm, private insurers are seeking to transfer risk to providers through a variety of contracting options, including episode of care, with-hold and shared savings, capitation, and patient-centered medical home (PCMH). At the same time, Medicare is experimenting with new mechanisms to control cost, including pay for performance, shared savings as we move away from fee for service and the sustainable growth rate, and accountable care organizations (ACOs).
Providers won’t be spared. “No matter what happens with the Affordable Care Act, ACOs and PCMH or something like them are going to get pushed by Medicare and private payers,” said Howrigon. “How you get paid, who pays you, and what they pay you for is going to change. A new skill set is needed for the future and new tools and systems are necessary.”
Another storm is brewing: the massive ICD-10 CM coding conversion.
“I’m pretty confident that October 1, 2014, will be our implementation day,” said Melody W. Mulaik, MSHS, of Coding Strategies, Inc. “This will be the largest transition we have ever had. Every data system has to be changed.”
With ICD-10 the number of codes will jump from about 13,000 (in ICD-9) to 68,000—54 for breast cancer diagnoses alone.
The biggest challenge, according to Mulaik, will be to get physicians on board, since they do not expect to or are unsure if they will recoup their outlay on ICD-10 implementation. Although hospitals may already be preparing for ICD-10 with coding systems in place, physician offices and freestanding centers may need to consider buying software and hiring a coder. Sixty percent of physician leaders expect that the impact of ICD-10 will worsen their overall labor costs and negatively affect cash flow.
The healthcare storm is not sparing patients.
“In the blink of an eye, the crippling cost of healthcare becomes a reality,” said Allan P. DeKaye, MBA, FHFMA, DEKAYE Consulting, Inc., who discussed the effects of high medical bills on patients, particularly the uninsured and underinsured. He emphasized the importance of financial counseling programs at both hospitals and private practices. “Patient financial advocacy starts at the top with leadership and commitment.”
DeKaye urged providers to explain and advise patients about costs and financial responsibilities during the first visit. Determine a patient’s ability and willingness to pay, request or require time-of-service payment, and use technology and data to improve operations, he said.
A special workshop held concurrently with the Mid-Atlantic Regional Oncology Economic and Management Meeting explored the role of patient financial advocates or counselors. Increasingly, hospitals (and some oncology practices) are using a patient financial advocate as liaison between the patient and physicians, insurance, and social workers. The financial advocate determines a patient’s out-of-pocket costs, referencing the treatment plan and insurance coverage. They establish a patient’s financial situation and assist with traditional internal and external funding sources.
“The patient financial advocate tries to reassure the patient and start the trust process that I am here to help you,” said Ann Kaley, (shown at center) a patient financial advocate at St. Luke’s Mountain States Tumor Institute in Meridian, Idaho. She joined Tara Lock, MHA, of Southcoast Hospitals Group in Fairhaven, Mass., (shown at right) and Eileen Walker, BSN, MBA, of Cancer Care Northwest in Spokane Valley, Wash., (at left) at a panel discussion. Kaley tells the patient, “Remember that when the bills come and obstacles come I am the person you can talk to. When a patient says, ‘I can’t afford to do this,’ I say, ‘Maybe we can work something out.’”
Kaley’s busy schedule includes financial screening, local and hospital assistance applications, authorizations, pharmacy assistance, and co-pay assistance. She sees on average 55 to 60 patients each month.
Learn more about resources cancer program staff can use to provide financial assistance to patients and families. “The Financial Information and Learning Network for Community-Based Programs” has exceptional online courses…and more!
Protect yourself from the healthcare storm. The ACCC 29th National Oncology Conference, October 3-6, 2012, in San Antonio, explores the new payment models, reimbursement changes, ICD-10-CM implementation, and more. Make plans to attend.
Do you live in or near San Francisco? The ACCC Western Regional Meeting will be held in Berkeley on June 27, 2012. Co-host: Association of Northern California Oncologists