Navigation of Outpatient Settings
With payers pushing towards outpatient settings, hospitals are navigating this by being strategically aligned and controlling their markets. They are also taking a data-driven approach to determine growth potential in the outpatient setting and negotiate contracts with payers.
Steps taken by Healthcare Providers and Payers to Address Rising Healthcare Costs
Healthcare providers and payers are coming under increased pricing pressure due to rising healthcare costs. Memorial Care and Bashar’s hospital have taken steps to address the issue of price transparency and the No Surprises Act. They have increased the entry level for nurses, provided salary raises to employees, deployed Experian Health tools, provided prices on their web portal, and worked with in-network plans. Additionally, they have included language in agreements that allow for re-negotiation if medical CPI increases. However, compliance is being hampered by a lack of enforcement and penalties.
Proactive Measures for Hospitals to Remain Profitable
Hospitals must be proactive and understand their market share, reduce out migration, and be more efficient internally to remain profitable. They must also work with insurance companies and demand a strategy from them. To mitigate the situation, hospitals should look for ways to do more with less, take care of their employees, and adjust salaries for those at the lower end. Additionally, they should look for ways to increase their case volume and realign their block times. Finally, they should bring in new competitors and migrate Medicaid patients into commercial plans.
Strategies for Negotiating with Payers
Negotiating with payers can be difficult, but there are a few things that can be done to help. Healthcare organizations should make sure they have their evidence and documentation ready and consider putting in place technology and efficiencies to increase their leverage. Additionally, they should look into laws that may apply to their state regarding clean claims and dispute resolution. Lastly, they can consider taking legal action if necessary as it can be an effective way of getting the attention of payers.
Importance of Attention to Contract Terms and Clauses in Negotiations
The comments made during the panel discussion emphasized the need to pay attention to the terms and clauses in contracts and document everything properly. It also highlighted the need for better enforcement from regulatory agencies and more vocal advocacy from health systems. It noted that payer edits on the back end can be even more egregious than prior authorization processes.
Collaboration for Better Patient Care
It’s important for hospitals, physicians, and insurance companies to work together to ensure that patients are taken care of. Staying united and fighting for what’s best for patients and the community while keeping up with any insurance issues that arise is crucial for better patient care.
Note: This is an AI generated transcript, not edited by a staff writer and is solely intended for educational purposes. If you have any questions/concerns, reach out to events@beckershealthcare.com
This panel was live on 04/04/2023 at the event listed here.
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