Hospitals expand to attract well-insured patients despite pressures of healthcare reforms

Several hospitals are looking for well-insured patients beyond traditional market boundaries, both in prosperous suburbs and in nearby areas with growing, well-insured populations. According to a study by the Center for Studying Health System Change (HSC) hospitals seeking a competitive edge in the marketplace are targeting geographic expansion into new markets which are well-insured.

The study based on HSC’s visits to 12 nationally representative metropolitan communities, depicted that hospitals are expanding despite the pressures of the healthcare reform. Hospital strategies mainly include – building full-service hospitals, establishing freestanding emergency departments and other outpatient services, acquiring physician practices, and operating medical transport systems with several hospitals building near major highways to be accessible.

Hospitals expansions survey findings

• In all 12 markets surveyed results depicted that hospitals are looking for full-service hospitals or freestanding emergency departments, buying or establishing physician practices and developing a regional presence through emergency medical transport systems
• Recession rather than diminishing has heightened the drive among hospitals to pursue well-insured patients beyond traditional hospital market boundaries
• Expansion appears more frequent where large hospital systems were pursuing significant employment of physicians and where service-line strategies, such as cardiac or cancer care, were well entrenched

Impact on Hospitals & Independent physicians

The overall impact of hospitals’ geographic expansions is still to be observed, there are conflicting views within the industry regarding these new hospital competitive strategies, if they will increase costs, improve care or both. Hospitals are of the view that the expansions will increase efficiency, increase access and improve the quality of patient care, while payers and competitors argue such strategies will lead to elevated costs.

Also Independent Physicians in most markets due to health reforms who are faced with financial pressures along with difficulty in hiring younger physicians, who often prefer employment in larger organizations, are actively seeking the stability and security of employment in larger physician-owned or hospital-owned groups. According to the HSC study in fast growing and well insured Greer, SC, there are no more independent primary-care practices left.

Revenue cycle management amidst hospital expansion and reforms

Hospitals backing expansions as necessary countering that even though there are costs increases, their efforts provide increased high-quality care; will need to cater to higher patient influx and increased medical billing. Hence in this scenario along with the growing pressure of health care reforms, services of skilled service providers possessing the requisite credentials can be availed by hospitals and practitioners to maintain favorable revenue cycles management.

Medicalbillersandcoders.com the largest ‘Consortium of Medical Billers and Coders, servicing over 50 specialty US physicians, are constantly updated with the requisites of the industry and healthcare reforms are the right choice for hospitals and practices. Medicalbillersandcoders.com has in-depth knowledge and expertise in the delivering the best quality services to hospitalists. Hospital employment will affect patients, hospitals and doctors – as healthcare will require greater coordination, greater use of clinical data and collaborative provider teams — which MBC is best positioned to deliver.

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Meaningful Use’ Compliant EHR Technology Implementation – specialists’ perspective

“While specialist practitioners, such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. can claim exemptions and exclusion of certain objectives set out in the Meaningful Use Clause by CMS, they are not treated preferentially as far as documenting clinical processes using approved and compliant EHR software is concerned:  their responsibility for reporting clinical data using Certified EHR Technology and EHR modules remains as mandatory as for general practitioners.”

There has hardly been anything that has got as much an attention as the CMS’ Meaningful Use criterion for medical practitioners – a program for eligible practitioners to be able to qualify for Medicare incentives upon meeting a certain set of core objectives set out in the Meaningful Use Clause under the ARRA. Although CMS has laid down guidelines for general practitioners, who serve the bulk of Medicare beneficiaries, yet their specialist colleagues – such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. – are not out of the CMS’ Meaningful Use ambit; after all they too are indispensable to CMS’ initiative towards an efficient healthcare environment. But, because their service-composition and documenting varies from general practitioners, specialists’ requisite compliance with core objectives set out in the Meaningful Use Clause under the ARRA gets a little different.

Recognizing the diverse nature of specialists, CMS has allowed for certain exceptions and exemptions from complying with certain objectives that does not owe allegiance to these specialist practices. Therefore, of the 20 mandatory objectives to be met out a possible list of 25, specialist practitioners can still seek exemptions on the ground of being unique fields of medicine. Consequently, their mandatory objective-list ultimately becomes less than 20; while CPOE, eRx, Vital Signs, Smoking Status, Electronic Copy of Health Information, and Clinical Summaries are usually allowed exemptions from Meaningful Use objectives, the following exclusions may still be claimed under substantiated evidence: Drug Formulary Checks, Clinical Lab Test Results, Patients Reminders, Patient Electronic Access, Medication Reconciliation, Summary Care Record, Immunization Registries Data Submission, and Syndromic Surveillance Data Submission.

While specialist practitioners, such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. can claim exemptions and exclusion of certain objectives set out in the Meaningful Use Clause by CMS, they are not treated preferentially as far as documenting clinical processes using approved and compliant EHR software is concerned:  their responsibility for reporting clinical data using Certified EHR Technology and EHR modules remains as mandatory as for general practitioners. Thus, everything points towards sourcing and implementing EHR software’s that best serve unique needs of diverse practices while also being compliant with the CMS mandate on Certified EHR Technology for achieving Meaningful Use criterion bench-mark.

Despite the market being replete with numerous EHR software – a prior advisory on judicious selection is always advisable as any hasty selection can have multiple repercussions: adverse impact on clinical documenting, practice management, and revenue generation. Given the prevailing scenario, Medicalbillersandcoders.com proven credentials in advising and implementing certified EHR software platforms –  Medisoft , Misys Tiger, Eclinicalworks, Advanced MD, Office Ally, Sage Medical Manager, GE centricity, Lytec, Altapoint, Dentrix being some its leading names in an exhaustive portfolio innovative and futuristic models – for diverse clients comprising Allergy, Anesthesiology, Cardiology, Dermatology, ENT, Endocrinology, Family Med, GI, Geriatrics, Internal Medicine, Long-Term Care, Multi-Specialty, Neurology, Neurosurgery, OB/Gynecology, Occupational Medicine, Ophthalmology, Optometry, Orthopedics, Pediatrics, Plastic Surgery, Podiatry, Psychiatry, Psychology, Pulmonology, Rheumatology, Surgery, SurgicalCenter, Urgent Care, Urology, and the rest.

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