Meir Meystel

If you click on the link you will see a report called Expense Distribution. I know this report more than you can imagine. It's based on paid claims. It shows that for this plan half the members were essentially self-insured as individuals. If I was the CEO of this company, you can bet I would make sure the rates my employees were paying for their own care were reasonable. If not, I'd be personally liable. #deerhold #ContractRateExplorer #MRFInsights

9

2 Comments

I hole heartedly agree Benjamin Schwartz, MD, MBA. Anywhere else in an economic system, innovators who can deliver a better product at lower costs are almost always rewarded with greater market share, and frequently set the direction for the future of a product or industry. Not so in healthcare. I think that Terry Adirim, MD, MPH, MBA (below) hit the nail on the head when she references for-profit health insurers in the mix. Although policies have been enacted with the idea of providing better healthcare at lower costs, they have always given the job of administering those policies to a middleman (insurance companies) whose motives are at odds with the objective they claim to be administering. Profit! Innovation is not in the best interest of the payer. They profit through the inefficiency of the system. Until this lack of alignment between quality patient care at low costs and for-profit health care plans is addressed, process innovation and improvement will only be able to nibble at the edges.

1

Necessary steps to reduce payment delays in medical billing: 1. Verify Insurance 2. Submit Clean Claims Electronically 3. Check the Status on Reports 4. Submit Documentation to insurance companies upon request. 5. Post Contractual Adjustments

1

Fresh off multiple warnings to #callcenters and #brokers at Medicarians, here’s another black eye for the industry. Last week two #ACA broker call centers, TrueCoverage, LLC and Enhance Health, got sued for a scheme to dupe low-income individuals into #ObamaCare plans they didn’t know they were signing up for. EnhanceHealth is notable as Bain Capital launched it back in 2021 with $150M in capital. The complaint: both companies misled customers with nonexistent #benefits, and then also switched plans on customers without consent. The lawsuit shines another light on broker misconduct and the #compliance exposure they create for insurers, especially in #MedicareAdvantage. Check out the screenshot below, from an email from a TrueCoverage Regional Director to reps concerned about misleading enrollees. He literally talks about a “wheelbarrow full of cash.” 🤮 This kind of shit should be mounted on the wall of every brokerage and #FMO as yet another example of what not to do. I know call centers, brokers and FMOs serve a legit purpose in government health programs. I know most mean well and don’t flaunt the rules like this. But these scandals have plagued this sector since its inception, and they’re going to scam their own way out of existence if they keep this shit up.

113

29 Comments

How'd HCA, Tenet, CHS and UHS do in Q1? Here's a handy little table I put together on high level financial and operating performance in Q1 2024. Net Revenue & Growth: • HCA Healthcare - $17.3B (11.2%) • Tenet Healthcare - $5.4B (6.9%) • UHS - $3.8B (10.8%) • Community Health Systems - $3.1B (1.0%) Adjusted EBITDA & Margin: • HCA - $3.4B (19.3%) vs. $3.2B (20.3%) in Q1 2023 • THC - $1.0B (19.1%) vs. $0.832B (16.6%) in Q1 2023 • UHS - $0.526B (13.7%) vs. $0.421B (12.1%) in Q1 2023 • CHS - $0.378B (12.0%) vs. $0.335B (10.8%) in Q1 2023 Same-Store Admissions Growth: • HCA - 6.2% • THC - 4.2% • UHS - 5.7% • CHS - 3.8% Same-Store Patient Days Growth: • HCA - 5.4% • THC - 3.2% • UHS - 4.4% • CHS - 3.1% Same-Store ER Visits Growth: • HCA - 7.2% • THC - 4.0% Conclusion: Volumes were STRONG in Q1 given effects of calendar and ongoing, sustained elevation in utilization, leading to a favorable setup for most of these operators. Side note: does it bother anyone else that Community Health Systems' logo is CHS, but its stock ticker is CYH? PS - if you like breakdowns like these, join 30k+ others on my newsletter Hospitalogy! https://lnkd.in/gniNmHvz

130

10 Comments

🧑‍💻Mind Sharing Your Cost for J9263? CA Hospital acquires chemo agent for $0.86, charges $13,964.88 They thought no one would find out... 340B Hospitals Acquire for $.86, Charge $$,$$$$ Drug goes generic, cost drops 99%. Hospital increases price instead of decreasing. This pattern is seen in hospitals nationwide. We're partnering with clients to challenge these practices. Medicare data: price dropped on 251 drugs (2010-2024). Did your hospital drop their prices? To uncover these hidden practices, you need to analyze your transparency and claims data and marry it up with acquisition cost data. 🧑‍💻 We need to find these key insights and hold hospitals accountable. 

356

82 Comments

Bottom line, right now, there’s a gap in the market. What is needed are indie TPAs who are effective and efficient and not owned by a health plan because, if history is any predictor of the future, the second the TPA gets owned by a health plan, the TPA sort of ceases to be a TPA and becomes a health plan—with all the attendant bells and whistles that, a lot of times, an employer can’t opt out of. And also, the whole not sharing data becomes a thing, both cost data and also quality data. Also mentioned in this #healthcarepodcast: Elizabeth Mitchell; Lauren Vela, MBA; A. J. Loiacono; Justin Leader; Mark Flores; Doug Aldeen; Chris Deacon; Brad Brockbank; Olivia Webb Kosloff; Mark Cuban; Harold Miller; Moby Parsons, MD; Benjamin Schwartz, MD, MBA; Mishe Health; Sidney Haitoff; Rik Renard Click to read the full article on the RHV Web site and listen to the Relentless Health Value Podcast: https://cc-lnk.com/EP436

37

10 Comments

📈 This Week in Compliance: Essential Tasks for ALF Operators and Executive Directors Staying ahead in compliance is a key part of maintaining excellence in assisted living management. This week, take proactive steps to ensure your facility not only meets but exceeds standards. Our carousel will guide you through critical compliance activities that you can tackle right away: 1. Audit 1823 Forms: Ensure all resident forms are updated and accurately filled. 2. Review Staff Files: Check that all staff credentials and training records are current. 3. Conduct Elopement Drills: Test and refine your facility’s response to potential elopements. Each slide is packed with actionable tips to help you manage these tasks efficiently and effectively. Stay tuned and swipe through to enhance your facility’s compliance this week! #AssistedLiving #ComplianceManagement #HealthcareLeadership #ALFOperators #ExecutiveDirectors #SeniorCare #FacilityManagement #HealthcareCompliance #ElderCare #ProfessionalDevelopment

2

📢 Tackling the Caregiver Retention Crisis in Home Care The home care industry is facing a staggering turnover rate of nearly 80%. This challenge not only disrupts patient care but also strains agencies and remaining staff. Here are the top 3 strategies home care agencies can implement to reduce turnover and retain their invaluable caregivers: 1. Competitive Compensation & Benefits: Offering fair wages and comprehensive benefits can make caregivers feel valued and secure in their roles. This includes health insurance, paid time off, and retirement plans. 2. Robust Training & Support Programs: Providing ongoing education and support helps caregivers feel competent and confident in their abilities. Mentorship programs and continuous professional development opportunities are key. 3. Positive Work Environment & Recognition: Fostering a supportive and appreciative work culture where caregivers' contributions are recognized can significantly boost morale and job satisfaction. Simple acts of recognition and opportunities for advancement make a big difference. What other strategies have you found effective in reducing caregiver turnover? Share your thoughts and experiences below! 👇 #HomeCare #CaregiverRetention #Healthcare #WorkCulture #EmployeeEngagement #ComfortKeepers #SeniorCare Comfort Keepers Of Delaware County, Montgomery County and Chester County Read more about this critical issue here: https://hubs.li/Q02FG6TL0

11

2 Comments

Click https://lnkd.in/gHHDBMsV https://lnkd.in/gqR6mv-K @Eatdrinkandmarry Health Life Business Relationships Startyourstoryeveryday #innovation #management #digitalmarketing #creativity #technology 619-777-6792

2

President Biden has been hitting the campaign trail touting record enrollment of 21 million in Obamacare this year. And it is impressive if a number to tout is your goal, but if its the people behind those numbers, we should be a little more concerned about some of the harm being driven mad rush to get folks "signed up." Rogue brokers have manipulated a system, which continues to remain VERY easy to manipulate despite notice of these issues, at the expense of the most vulnerable. These brokers are fraudulently switching people’s health plans without their knowledge, leading to lost coverage, unexpected costs, and/or tax headaches. Why is this still happening? The system’s inaction stems partly from the challenge of balancing secure access with easy enrollment, or lack of balancing in this case. Many federal regulators ( and most rational people) would immediately consider stronger security measures like two-factor authentication, in order to protect people from these unscrupulous actors. But regulators are being told to tread carefully lest they create any barriers that could deter genuine enrollees—or lower that 21M headline number.

23

19 Comments

Medical bills less than $500 won't go on your credit report. So why pay them? Because it's the right thing to do: pay a reasonable rate for the services provided. However, if a facility/lab bills you $500 for a metabolic panel (less than $10 retail) and doesn't want to negotiate a reasonable rate, then don't pay it. Now what happens when all unpaid medical bills don't show up on your credit report....

20

9 Comments

Tuesday tip. 😉 When looking for a new broker do NOT have multiple firms ‘shop around for you’ We all have access to the same markets, with the same rates. (Fully insured and level funded) Do yourself a favor and chose a broker you like first, that you feel would adequately support your company and its needs…then allow that one person to go to market. Embark Benefits #humanresources #employeebenefits #healthinsurance

27

1 Comment

Did you know healthcare private equity firms have paid fines exceeding $500 million in over 34 lawsuits filed under the False Claims Act (FCA) since 2014? The scrutiny over private equity investment is increasing pressure to monitor compliance with the FCA. Moss Adams has a dedicated healthcare compliance team that is supporting investors with compliance due diligence, including billing and coding reviews. Please contact me with any questions or to speak with our compliance advisors and billing/coding team.

7

Read about the strategies Juniper Communities is implementing to increase revenue. One strategy involves the value-based care entity Perennial Consortium, through which Juniper offers Medicare Advantage and other payment plans. Perennial Consortium is a joint venture that is operated by and partially owned by Curana Health.  #Valuebasedcare #Seniorliving #IntheNews

27

New Updates on the Steward Health Care bankruptcy case: The bankruptcy court has just approved the sale and bidding procedures. This may not sound like a big deal, but there are some nuances to the order that are really important to understand if you're not a bankruptcy expert. This is a key step in the somewhat rapid process of selling off Steward's assets and provides some significant benefits/advantages to stalking horse bidders. First, what is a stalking horse bidder in the bankruptcy context? They set the initial bid for the assets, creating a baseline that is supposed to encourages other potential buyers to join in. This is intended to help ensure a fair auction, setting a baseline bid and encouraging other bidders to participate - which should be better for all parties involved - including creditors that may otherwise walk away with nothing if the sale isn't successful. The theory goes, stalking horse bidders should be well compensated and provided financial "comfort" because they are taking on a certain amount of risk when they step up to the plate to establish the baseline bid. These financial protections include substantial break-up fees and expense reimbursements, which will receive super-priority status in the bankruptcy case. What does that mean, before any unsecured creditors are paid, and often before even many secured creditors are paid, the "stalking horse" bidder is granted super-priority and will be paid its "reasonable expenses" and break up fee first, before anyone else. How much are we talking about? 3% of the purchase price is typical. 3% of $1B is $30M... not an insignificant sum. The sales order also provides that once designated as a qualified bidder, the stalking horse's bid is deemed a qualified bid, making it challenging for other bidders to challenge their position, further securing the stalking horse's advantage. We will know the outcome soon enough. Bid deadline is 6/24/24 with an auction three days later and a final sale hearing only days after that. Stay tuned for more updates as this case progresses.

12

2 Comments

We have terrible difficulty reconciling ACH payments from TPAs to claims. Claims are often paid in batches all included in one check, the payments don't have good identifiers, and we usually have to dig into portals to get EOBs. Before I agree to Zelis' 2% of charges highway robbery fee to get electronic 835s, is there another way to deal with this? The Federal Reserve says any financial institution involved with these ACH payments is required to provide detailed identifiers, is anyone able to access those? Another issue is that TPAs often send no acknowledgment of receipt of electronic claims and don't even enter them into their portals until they are processed. Is there a workaround for this? I would appreciate any advice in advance of tags for folks who could potentially help. Health Rosetta Free Market Medical Association Free Market Medical Association - Houston Mitigate Partners BenefitsPRO The Granite List LynAnn Henderson Rachel Means Chris Deacon Sean Schantzen Montara Pfannenstiel Green Imaging Lee Ann Sullivan Moore

6

19 Comments

✅Successful shift-filling strategies ensure your home has a full compliment of team members to deliver exceptional care.😀 ✅Don't assume Saturday or Sunday is the hardest day to fill shifts. StaffStat's workforce data will identify your best & worst fill rates so you can plan accordingly.📆 ✅What is the best time to post shifts in your home? Increase your fill rates using StaffStat data.⬆️⬆️ ✅StaffStat's Predictive Posting Feature allows you to anticipate staffing needs weeks in advance, enabling more strategic use of agency resources when necessary.💻 ✅Automating administrative tasks enhances the efficiency of healthcare professionals, allowing them to focus more on resident care. 🚀 #StaffStat #Technology #SeniorCare #Innovation

1