For US Healthcare Providers, Hope for Rescue From Shrinking Margins Lies in ‘People, Process, Technology’: Everest Group
A majority of healthcare providers in
In
The key challenges facing healthcare providers include the following:
- Not only Obama-era regulations, such as MACRA, but also some
GOP -proposed / -passed regulations such as Tax Cuts and Jobs Act (TCJA) are putting pressure on hospital margins. MACRA alone is likely to cause a decline in hospital Medicare reimbursement by at leastUS$250 billion by 2030. - Massive investments into extremely expensive electronic health record (EHR) systems with little or no preparedness and vision have led to poor financial performance.
- Continuing fraud, lack of education, and the inability of the
Centers for Medicare & Medicaid Services (CMS) to address these issues have resulted in doubling of improper payments in the past five years, with improper payments in 2016 reaching approximatelyUS$102 billion . - Claims denials totaled more than
US$250 billion in 2016, highlighting the significance of payment risk for hospitals. - Talent shortages, escalating training costs and a lack of collaboration are also among the key issues affecting health systems' workforces.
To engineer a turnaround in this bleak trend,
- To address the talent shortage, hospitals should hire visiting physicians and nurses, link incentives with performance, and collaborate with specialists for training purposes to enhance people management.
- Technology investment is a must; however, hospitals also need to sort out issues regarding technology illiteracy and improper implementation in order to achieve a positive return on investment.
- Digital transformation does not end with EHR implementation; rather it involves continuous investments in other systems such as revenue cycle management (RCM) as well as tools for analytics and automation. Providers should set their sights on the ultimate objective: interoperable systems with end-to-end patient engagement.
- The uninsured population is expected to increase with the removal of the Individual Mandate; hence, healthcare providers need to strengthen front-end processes such as eligibility verification and pre-authorization to avoid claims denial at later stages.
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Read the full story at http://www.prweb.com/releases/2018/04/prweb15430549.htm
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