Health System Consolidation Expands to Post-Acute Care
The first installment of this three-part Health Capital Topics series regarding provider consolidation will discuss the recent trends in the consolidation of healthcare enterprises and its spillover into the post-acute care sector of the healthcare industry. The consolidation of healthcare enterprises has been a consistent trend in the healthcare industry since the 1970's, but has only recently affected the post-acute care sector. This first installment will examine the recent trends in the consolidation of healthcare enterprises; the providers currently seeking to consolidate in the post-acute care sector; and, the impacts of consolidation on the various stakeholders in the healthcare industry. (Read more...)

Congressmen Question Reach of Fraud & Abuse Enforcement
During three recent hearings, various members of Congress openly questioned the scope and integrity of federal healthcare fraud and abuse enforcement, remarking that CMS and other federal agencies have created a "significant burden" on non-criminal providers through overreaching recovery audit programs that seek to reclaim improperly distributed funds from the Medicare program. During recent hearings and discussions in the U.S. House of Representatives and U.S. Senate, legislators claimed that CMS recovery audit programs have created a 28-month backlog of over 450,000 appeals to CMS relating to coverage denials by Medicare auditors, which hinders the ability of providers to care for patients. (Read more...)

Navigating Hospital Rating Systems Can Be Difficult for Consumers
Perhaps as a result of the passage of the Affordable Care Act, many consumers have taken a renewed interest in the healthcare delivery system, and are increasingly concerned with the quality of care they receive. Many of these concerned consumers have turned to the Internet as a resource, as reports that rate hospital and physician performance, as well as hospital and physician rankings based on patient satisfaction, safety, and infection rates, are becoming increasingly popular. However, there is a lack of consistency in rating methods between reporting agencies, and, as such, separate reports will often come to different conclusions for a single healthcare entity. These conflicting reports can make the process of finding a high quality provider more difficult for consumers, and potentially decrease hospital and physician patient volume, and therefore revenue. (Read more...)

Co-Ops Remain Available in Health Insurance Marketplace Despite Low Enrollment
The first installment of this four-part Health Capital Topics series on Health Insurance Exchanges highlighted the issues beneficiaries and insurers faced in the Marketplace during the 2014 enrollment period. This second installment will address the Consumer Operated and Orientated Plans (CO-OPs) that are operating within the Marketplace, as well as the benefits and drawbacks of offering these plans to beneficiaries. CO-OPs, which are customer-directed, non-profit organizations designed to offer quality health insurance at a reasonable cost, both within, as well as outside, the Marketplace, reemerged during the drafting of the Affordable Care Act, likely due to their ability to offer consumer-directed insurance, while increasing competition with other insurers. (Read more...)