February 2020 •
Volume 2 •
Issue 13
Providing Current Information on
Health Insurance Industry Issues and Legislation
Bundled Payments a Bust
A new study suggests that bundled payments do not generate much savings or
improve quality of care. Of the 33 inpatient and 4 out-patient conditions in CMS's
bundled payment demonstration program only 1, hip and knee replacements, reduced
spending without a decreased quality and that reduction was below expectations. Hip
and knee replacement costs decreased by just 1.6% over the 2103-2016 test period.
CMS had anticipated a 3.9% drop after providers had participated in the program
for a year. However, one of the study's authors, Dr. Amol Navathe of the University
of Pennsylvania, suggests that with some tweaks "the mandatory joint replacement
bundled payment program should be expanded to more markets and probably
nationwide".
improve quality of care. Of the 33 inpatient and 4 out-patient conditions in CMS's
bundled payment demonstration program only 1, hip and knee replacements, reduced
spending without a decreased quality and that reduction was below expectations. Hip
and knee replacement costs decreased by just 1.6% over the 2103-2016 test period.
CMS had anticipated a 3.9% drop after providers had participated in the program
for a year. However, one of the study's authors, Dr. Amol Navathe of the University
of Pennsylvania, suggests that with some tweaks "the mandatory joint replacement
bundled payment program should be expanded to more markets and probably
nationwide".
Proven Ways to Control Healthcare Costs
While bundled payments may not reduce healthcare costs, there are proven ways
to get the job done. Every year, HHC Group saves its clients and their plan enrollees
millions of dollars with the combination of claims editing, negotiation of in and
out-of-network claims, PPO discounts, Medical Bill Reviews, Reference Based
Pricing and DRG Validation that best meets each client's individual needs.
to get the job done. Every year, HHC Group saves its clients and their plan enrollees
millions of dollars with the combination of claims editing, negotiation of in and
out-of-network claims, PPO discounts, Medical Bill Reviews, Reference Based
Pricing and DRG Validation that best meets each client's individual needs.
HIPAA Risk/Threat Assessment Compliance Alert
A lack of a formal written risk analysis can result in a breach deemed as willful neglect and
result in very heavy fines. According to the 2019 HIPAA Readiness Survey, 42% of survey
participants did not know when their company conducted a risk/threat analysis or said it
had been more than 5 years since the last one was done. A third had not inventoried their
business associates or were unaware if they had done so. The breach notification rule
requires business associates of covered entities to notify the covered entity of breaches at
or by the business associate and hefty fines can be levied for non-compliance.
result in very heavy fines. According to the 2019 HIPAA Readiness Survey, 42% of survey
participants did not know when their company conducted a risk/threat analysis or said it
had been more than 5 years since the last one was done. A third had not inventoried their
business associates or were unaware if they had done so. The breach notification rule
requires business associates of covered entities to notify the covered entity of breaches at
or by the business associate and hefty fines can be levied for non-compliance.
Supreme Court Takes Up Contraception Case
The Supreme Court took up an appeal by the Trump administration asking the Court
to enforce new federal rules allowing employers to obtain religious exemptions
from an Affordable Care Act (ACA) requirement that the health insurance provided
employees pay for women's birth control. The new rules permit any nonprofit or for
profit employer including publically held companies to seek an exemption on religious
or moral grounds. A lower court had issued a nationwide injunction blocking the rule
from going into effect. The court is scheduled to hear the case in April with a decision
expected in June.
to enforce new federal rules allowing employers to obtain religious exemptions
from an Affordable Care Act (ACA) requirement that the health insurance provided
employees pay for women's birth control. The new rules permit any nonprofit or for
profit employer including publically held companies to seek an exemption on religious
or moral grounds. A lower court had issued a nationwide injunction blocking the rule
from going into effect. The court is scheduled to hear the case in April with a decision
expected in June.
Three Star Preferred Provider Program Additions
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