All facilities and assets of the Iowa-based health system will transfer to Trinity Health, which had been operating MercyOne alongside Catholic Health Initiatives, now CommonSpirit, under a joint agreement since 1998.
The move allows Trinity Health to unify MercyOne's 16 medical centers, 27 affiliate organizations, and more than 420 care sites under one umbrella with the aim of improving patient access.
"True to our shared Catholic mission, our goal is to provide high-quality, compassionate care with the best patient/member experience possible," Mike Slubowski, president and CEO at Trinity Health, said in a statement. "We will accomplish that goal through a holistic approach, with a range of health services and technologies that are fully connected and coordinated. This agreement creates a fully integrated MercyOne to care for more people in a unified way."
Trinity Health, which spans 25 states, will transition MercyOne's common platforms into its own, including a single electronic health record, according to the news release. The result should allow the 3.3 million patients MercyOne serves each year to manage their care more easily and conveniently.
"We strongly believe this transition to become a full member of the Trinity Health family will result in a stronger, more cohesive health system better able to offer a convenient and personalized circle of care for all we serve," said Bob Ritz, president and chief executive officer at MercyOne.
Marvin O'Quinn, president and COO at CommonSpirit Health, said of the move: "While the current structure has been instrumental in growing our health care services in Iowa, we believe this decision is ultimately what is best for our patients, colleagues, and our communities."
The acquisition is subject to regulatory filings, with the transaction expected to be finalized by the summer.
The organization wants to improve on administrative process delays often caused by payers.
The Association of American Medical Colleges (AAMC) has joined other groups in supporting electronic prior authorization reform with the aim of alleviating the burden on patients and providers.
The ONC released arequest for information in January to seek comment on electronic prior authorization standards, implementation specifications, and certification criteria to help potential future rulemaking.
Similarly, the AAMC encourages solutions that have been fully developed and tested prior to industry rollout, stating "ONC and CMS should approach potential changes to regulatory schemes judiciously to effectively update and create standard transactions without unduly burdening health care payment processes."
As it relates, prior authorization can have the unintended consequence of negatively affecting patient outcomes. The AAMC points to a recent physician survey conducted by the American Medical Association (AMA) in which 80% of respondents said that patients abandon treatment due to authorization struggles with their health insurer.
"The AAMC recommends that any regulation standardizing prior authorization processing include requirements that health plans issue prior authorization determinations in a timely manner to ensure that patients benefit from process improvements," the group said.
The same AMA survey also found that 88% of responding physicians describe the burden of completing prior authorization as high or extremely high. Streamlining the process has the potential to significantly reduce provider burnout, according to the AAMC.
While the AAMC is mindful of the resources required to implement changes, it believes reform would be beneficial in the long run if insurers did their part and followed suit.
"Provider up-front investment to adopt and implement electronic prior authorization standards is worthwhile to improve care delivery so long as payers and health plans broadly adopt policies to support the use of electronic prior authorization to improve processing and approving requests," the AAMC concluded.
The Lown Institute found that nearly 83% of health systems spent less on charity than the value of their tax breaks, resulting in an $18.4 billion total 'fair share deficit.'
Several of the biggest nonprofit health systems in the country are also among the primary offenders in the failure to invest significant tax breaks into charitable contributions, according to a new study by the Lown Institute.
The healthcare think tank found $18.4 billion in total unrealized community investment between the systems, which could have instead been allocated for housing, food, and furthering health equity.
Using the Lown Institute Hospitals Index, the study compared more than 1,800 hospitals across 275 nonprofit hospital systems to calculate "fair share spending"—how much each system spent on charity in relation to the value of its tax exemption. The data was pulled from hospital tax filings from the fiscal year ending 2019, the most recent year available for most hospitals.
Of the 275 nonprofit systems examined, 227 spent less on charity than the value of their tax breaks. Community investment in the study included community health improvement activities, contributions to community groups, community building activities, and subsidized healthcare services.
Several of the hospitals that had the largest fair share deficits from last year are also part of the systems that appear on this year's list.
Biggest offenders
The 10 systems with the largest deficits accounted for $5.6 billion of the total fair share deficit (30%).
According to the study, many of these systems also received hundreds of millions from the 2020 CARES Act—meant to provide financial relief during the COVID-19 pandemic—and ended the year with excessive revenue.
The total fair share deficit was concentrated in certain regions, with seven states accounting for over $1 billion—California, Massachusetts, Pennsylvania, Ohio, Illinois, New York, and Michigan.
RANK
HOSPITAL SYSTEM
FAIR SHARE DEFICIT
1
Providence Saint Joseph Health
-$705 M
2
Trinity Health
-$671 M
3
Mass General Brigham*
-$625 M
4
The Cleveland Clinic Health System
-$611 M
5
UPMC
-$601 M
6
University of Pennsylvania Health System
-$571 M
7
Catholic Health Initiatives
-$515 M
8
Advocate Aurora Health
-$498 M
9
Dignity Health
-$456 M
10
Ascension Health
-$388 M
*Used FYE 2018 data
When reached for comment, Providence Saint Joseph Health said in a statement: "The Lown report paints an incomplete picture of the Providence family of organizations' community investments. The methodology used falls short by failing to account for all forms of community benefit, including the unpaid costs of Medicaid and other means-tested government programs.
"For example, uncompensated care as a portion of community benefit is considerable and without it, the numbers in the report are incomplete. Providence organizations serve a large proportion of patients who rely on government programs for health insurance or are uninsured. In 2019, Providence organizations provided $816M in uncompensated costs of Medicaid, alone.
"In 2019, our total community benefit investments totaled $1.5B. Included was free or low-cost care (charity care) and the costs of uncompensated care for government-funded programs, along with proactive investments such as community health improvement programs and services and subsidized health services."
The American Hospital Association (AHA) released their own statement criticizing the Lown Institute's report and defending hospitals' use of financial resources.
"The Lown Institute’s latest report on hospital community benefits is an obvious example of relying on pre-conceived notions and faulty methodology to draw inaccurate conclusions," the AHA stated. "The report cherry-picks categories of community investment while simply ignoring others, such as researching life-saving treatments and cures and training and educating the next generation of caregivers. It overlooks many of the essential contributions hospitals make to their communities that are critically important, especially during the pandemic."
Best performers
Hospitals that were considered to have paid their fair share committed at least 5.9% of their overall expenditures to charity and community investment.
RANK
HOSPITAL SYSTEM
FAIR SHARE SURPLUS
1
Memorial Hermann Healthcare System
$147 M
2
Wellstar Health System
$144 M
3
The Nebraska Medical Center
$108 M
4
Christus Health
$93 M
5
Houston Methodist
$80 M
6
Hackensack Meridian Health
$74 M
7
Baptist Memorial Health Care Corporation
$64 M
8
UCHealth
$62 M
9
Yale New Haven Health System
$56 M
10
Methodist Health System
$53 M
While there are systems that do their part by putting money back into the community, the discrepancy between the systems' fair share surplus and fair share deficits is significant.
"Would half a billion in taxpayer dollars be better spent by directly funding addiction, food insecurity, or homelessness efforts?" Dr. Vikas Saini, president of the Lown Institute, said in a statement. "We should all be asking those types of questions given the vastness of these sums and the significant public health crises many communities are facing."
The full 2022 Lown Institute Hospitals Index, with rankings across more than 50 metrics, is expected to be released in late June.
Since taking effect on January 1, the No Surprises Act protects patients from unexpected medical charges after scheduled items or services are completed.
This affects the front-end revenue cycle, which must be adjusted to effectively implement requirements for both providers and patients.
To ensure compliance with the No Surprises Act, CMS has continued to release resources outlining answers to common questions. After recently providing updates on good faith estimate requirements, CMS has now published two more sources of material on implementation.
According to the newly published guidance, CMS outlines that providers and healthcare facilities must publicly disclose patient protections against balance billing. Providers must also give a good faith estimate of expected charges to uninsured or self-pay patients at least three business days before a scheduled service (or upon request), according to the new guidance.
Some of the other topics covered in the guidance includes:
Additional new surprise billing requirements and prohibitions
Provider and facility requirements
What types of patients are covered
What types of providers the requirements apply to
What waiving surprise billing protections entails for patients
Administrative and entity fees for the Federal Independent Dispute Resolution process
Meanwhile, highlights from the FAQs on good faith estimates for uninsured and self-pay patients include:
When providers are required to provide a diagnosis code
If good faith estimates need to be provided after an initial visit
How a change in insurance status from the time of scheduling to the time of service affects a good faith estimate
The Detroit-based health system leader suggests a blend of solutions to tackle the labor shortage challenges in healthcare.
Amid a challenging financial climate riddled with labor shortage issues, Henry Ford Health CFO Robin Damschroder says the healthcare industry's best path forward is to "get back to basics" while continuing to innovate.
Though the COVID-19 pandemic is no longer at its peak, several challenges that were either created or exacerbated over the past two years remain for hospitals, physician groups, and payers. The labor shortages, in particular, have caused financial strain for healthcare's decision-makers. But there are strategies that CFOs can implement to alleviate the burden.
Blended strategy
Like many other health systems, Henry Ford Health's 2021 numbers veered closer to surviving rather than thriving. It posted a consolidated operating loss of $168.2 million for year end, representing an operating margin of -2.5%. Much of that loss was due to COVID-19-related costs and medical claims for the Detroit-based system, an integrated healthcare network that operates five acute-care hospitals, two psychiatric hospitals, the Henry Ford Medical Group, Health Alliance Plan of Michigan, and a network of ambulatory centers, health clinics, home-based care, and retail-oriented services.
For Damschroder, the path to thriving is all about a balanced approach.
"I've been at this for 30 years and this is unprecedented. We all have to get back to basics," Damschroder told HealthLeaders. "With the up and down volatility that comes with the COVID waves, we've got to learn to manage that within our capacity and throughput. Now that we've been through it, we have to start to shift from the volume being pandemic to more endemic."
COVID and its variants are just part of what's plaguing health systems.
"The biggest short-term burden out there, hitting the entire nation, is the labor shortage," Damschroder said. "In healthcare, it's not just created by the Great Resignation. We're watching people retire and leave the workforce, just due to burnout. Our most significant concern for the short term and long term is for our people."
For Henry Ford Health, Damschroder says the best approach to the situation will be a blend of the old and new—a reinvestment in people combined with an embrace of technology.
As a more traditional approach, Damschroder points to strategies Henry Ford Health has used in the past.
"Like many, we're recruiting nurses from the Philippines," Damschroder said. "We've done this two other times in the past 30 years and it's been successful. That initiative has started, and we expect by September to have 100–150 of those nurses here. It will probably be a two-year plan to get all those slots filled."
She added: "And just like everyone, this was a wake-up call for employers about what employees want in flexibility around their time and flexibility around which benefits to choose. We've had a lot of studies going into how do you respond to the different [perspectives] … in your organization, as well as to the different generations and needs [of] people. We've learned that you've got to create greater flexibility."
As far as an innovative solution, automation has the potential to play a significant role.
"There are certain jobs that are probably going to go away because we don't have people to do them. So how do we use technology to fill that gap?" Damschroder said. "We have a real opportunity to redesign our care models and our roles."
According to a study by the U.S. Government Accountability Office (GAO), patients face greater challenges with receiving approval for mental health services than medical services.
The demand for mental healthcare is on the rise, but even those with coverage are experiencing difficulties accessing services, a new study by GAO found.
One of those hurdles is prior authorization, which is less likely to be granted for mental health hospital stays compared with medical and surgical hospital stays, according to the study.
For the report, GAO interviewed federal officials and representatives from 29 stakeholder organizations representing consumers, health plans, providers, insurance regulators, and mental health and Medicaid agencies.
Sixteen of the 29 stakeholder organizations pointed to non-quantitative treatment limitations (NQTLs) used by health plans as causing delays in accessing mental health treatment or limiting time spent in treatment. Prior authorization, in particular, was highlighted as a challenge by representatives from most of the organizations.
"In some cases stakeholders said that health plans are applying these limits to consumers' mental health benefits in more restrictive ways than to medical and surgical benefits, which highlight ongoing mental health parity issues," the study stated.
Aside from mental hospital stays being less likely to be granted, other examples of prior authorization issues cited by the representatives in the report included:
Denial rates were slightly higher for inpatient pre-authorization for mental health services compared to medical and surgical benefits, according to officials from one insurance regulator
Private health plans and Medicaid plans said they wouldn't cover mental health inpatient treatment any longer, even if the physician determined that additional treatment was needed, according to representatives from a health system that provides mental healthcare
Whether it's in mental or medical healthcare, prior authorization continues to be a source of consternation. While physicians and medical groups agree that streamlining the administrative process can significantly cut down on delays and restrictions in care, implementing a regulated method brings its own set of challenges.
When it comes to mental health, however, the GAO report states that the parity laws in place should be requiring that mental health treatment is no more restrictive than coverage for medical or surgical treatment.
"Within their parity oversight responsibilities, the Department of Labor and the Department of Health and Human Services are taking steps to enhance their oversight of the use of NQTLs in mental health coverage, which, according to these officials, could improve access to mental health care," the study concluded.
The widely-used EHR company Epic has developed a customer management system and is building a best practices app after coming out with new software.
Following its recent release of new software, Epic is continuing to push healthcare technology with more launches to improve patient communication and resources for independent medical groups.
The EHR company just introduced Cheers, its first-ever customer relationship management system for health systems and is close to unveiling Best Care for My Patient, an app for physicians to research best practices for patients, according to Madison.com.
The new developments come on the heels of Epic announcing Garden Plot, a new software to streamline access to its suite and keep patient records for smaller, independent medical groups.
Garden Plot was conceived after the American Medical Association found that nearly half of physicians worked in independent medical groups in 2020. These finidings marked the first year that less than half of doctors (49.1%) worked in a practice wholly owned by physicians. For comparison, 60.1% of physicians worked in a private practice in 2012.
With challenges increasing and incentives dwindling for physicians choosing to be independent over working at hospitals and health systems, Epic's new technology aims to address a need for all clinicians.
"We've always been really good at helping clinicians keep record of patient care," Epic director of clinical informatics Jacqueline Gerhart told Madison.com. "What we are trying to do… is take that to the next level. It's not just about having information but using that information for good… from access to care, to figuring out the (health) ecosystem around the individual and bringing that all together."
Cheers, which is reportedly being used by dozens of organizations and will ramp up over the next year, allows providers to better connect with their patients.
Sam Seering, Epic's product manager, told Madison.com that the technology can send out communication like emails, text messages and calls through Epic's MyChart app if a particular kind of care is needed. It can also pull up a caller's record by connecting to an organization's phone system.
Best Care for My Patient, meanwhile, will be populated by Cosmos, a dataset with over 135 million patient records and 2.2 billion clinician visits, Gerhart told the news outlet. The app is reportedly expected to launch in the next year to year-and-a-half.
Advancements in EHR technology should allow physicians to spend less time dealing with billing and regulations and more time with patients providing necessary care.
The pandemic accelerated the trend of healthcare moving into outpatient care settings, forcing health systems to look for tactics to maintain their bottom line.
The pandemic has created a multitude of challenges for hospitals, but an increased shift toward lower-cost outpatient or in-home care is threatening organizations' revenue growth and margins, according to new research by Moody's Investors Service.
Traditionally, inpatient care revenue has been the measure of presence and market share in the industry for hospitals and healthcare systems.
Between a rise in telehealth and fewer emergency room visits, [[{"fid":"12399","view_mode":"default","fields":{"format":"default"},"link_text":"the report","type":"media","field_deltas":{"1":{"format":"default"}},"attributes":{"class":"file-default media-element","data-delta":"1"}}]] finds that traditional hospital-based care is becoming less of the norm, as outpatient revenue has exceeded inpatient revenue in the past few years.
Though this trend has been prevalent for years, COVID-19 has caused an acceleration, with Moody's identifying changes in reimbursement models, risk-sharing, investment in outpatient services, and advances in drugs and medical devices as contributing factors.
Telehealth boomed in the early stages of the pandemic, increasing 63-fold during 2020, according to the Department of Health and Humans Services data cited by Moody's. While telehealth hasn't sustained that usage as in-person visits have returned, it will continue to be an access point many patients opt for, particularly for certain specialities, the report said.
At-home acute care models are also expanding, with many hospitals and health systems striving to provide services in patients' homes. In May 2021, Kaiser Permanente and Mayo Clinic invested in Medically Home to help systems reinvent their method of delivery of complex care.
"These models would allow some providers, such as critical-access hospitals, to reduce inpatient beds and costs but allow others, such as academic medical centers, to increase inpatient capacity where needed," Moody's said.
Mayo, Kaiser, and Medically Home, along with 11 nonprofit health systems, launched the Advanced Care at Home Coalition in October 2021 to extend telehealth and remote services.
Moody's reports that hospitals are also investing in outpatient services such as ambulatory surgery centers (ASC). Several nonprofit hospital systems have already created partnerships to develop or expand their ASCs, like Allina Health System joining Optum's Surgical Care Associates, and Ascension Health working with Regent Surgical Health.
Meanwhile, multiple for-profit systems, like Tenet Healthcare's United Surgical Partners International and Envision Healthcare's AmSurg, are among the largest ASC consolidators, putting them ahead of nonprofits in certain markets.
Key findings
Additionally, Moody's points to several other factors that will play significant roles in the shfit to outpatient care.
Reimbursement changes to hospitals. Payers will continue to incentivize providers to offer less expensive outpatient care, potentially further restricting hospital care with denials of coverage.
CMS' decision. By removing certain orthopedic and cardiac procedures from its inpatient-only list, CMS is further driving treatment to hospital-based outpatient departments or ASCs. CMS also introduced hospital penalties for excessive readmissions for certain conditions, as part of the 2010 Affordable Care Act.
Advances in drugs and medical devices. The need for hospitalizations will reduce as new orthopedic technology bolsters outpatient procedures.
Looking ahead
In the immediate future, however, many hospitals will see a greater demand for inpatient services due to higher-acuity patients who delayed care during the pandemic, Moody's said.
Long term, the hospitals best positioned to sustain demand for inpatient services will be those that focus on quaternary and tertiary care, such as academic medical centers. Moody's also views markets as a factor, with hospitals in regions like Florida, Texas, Arizona, Utah, and Idaho likely continuing to experience strong overall volume.
The company, which is used by more than 1,000 hospitals and health systems, is focusing on offering end-to-end revenue cycle management.
nThrive is changing its name to FinThrive as part of a rebrand to further commit to end-to-end revenue cycle management for hospitals and health systems.
The software-as-a-service platform, which is already used by more than 1,000 hospitals and health systems, announced that the name change is reflective of its aim to offer a more efficient approach to the administrative process.
"For healthcare to realize its true potential, revenue cycle management software needs a new vision," said Hemant Goel, president and CEO of nThrive. "The future of the healthcare economy requires a connected and holistic approach."
"We are challenging the status quo and envisioning a better way to optimize healthcare revenue and the patient experience," continued Goel.
nThrive's rebrand comes on the heels of its acquisition of TransUnion Healthcare, the healthcare data and analytics business of TransUnion. By combining its claims and contract management, front-end capabilities, and workflow for acute and ambulatory providers with TransUnion's social determinants of health data and insurance discovery, nThrive wants to offer complete end-to-end revenue cycle management solutions.
nThrive also signed an agreement to acquire PELITAS, a leading provider of healthcare patient access, digital patient intake, and front-end revenue cycle management software solutions.
Automation has the potential to play a larger role in revenue cycle management for hospitals and health systems, with the benefits apparent from both an efficiency and cost-savings perspective.
With this, utilizing revenue cycle management software is becoming more of the norm for organizations.
As Elizabeth Woodcock, medical practice and revenue cycle management expert, previously mentioned to HealthLeaders, by automating time-consuming processes such as intake, consent management, payments, and scheduling—and turning those tasks over to patients—medical practices and health systems can also alleviate their hiring challenges and boost staff efficiency without adding new employees.
Automating tasks within the revenue cycle can also help ease employee burnout and increase retention by opening up staff time to concentrate on higher-value tasks, including focusing on the patient experience.
The National Hospital Flash Report found minimal improvement from January to February as most hospitals suffered margins decline for the month.
Hospitals continued to feel the adverse effects from the omicron variant in February as operating margins remained in the red for a second consecutive month, according to a new National Hospital Flash Report from Kaufman Hall.
While COVID-19 cases and hospitalizations significantly decreased from the all-time highs of January, the report found that challenges with labor shortages and global supply chain led to high hospital expenses in comparison to prior years.
The key data points from the report on February, which is based on data from more than 900 hospitals, include:
The median Kaufman Hall Operating Margin Index for hospitals was -3.45% in February, up from -4.52% in January "but still below sustainable levels." Despite the improvement in median actual margin index, most hospitals reported margin declines for the month.
The median change in operating margin was down 11.8% from January, while the median change in operating EBITDA margin fell 7.5% month-over-month.
Patient days decreased 13.3% and the average length of stay was 5.3% less month-over-month. Surgery volume experienced a moderate rise as "some patients returned for nonurgent procedures that were delayed during the omicron surge," with operating room minutes increasing 6.5% from January.
Gross operating revenue dropped 7.4% and outpatient revenue decreased 5% from January. Inpatient revenue suffered significant decline, falling 19.3% after a nearly 3% increase in January due to record volume.
Hospital total expense per adjusted discharge was down 4.5%, labor expense per adjusted discharged fell 6.1%, and non-labor expense per adjusted discharged declined 3.6% from January. However, total expense per adjusted discharge rose 10.4% and non-labor expense per adjusted discharge increased 8% compared to February 2021. Lower staffing levels were offset by wage competition, which drove up labor expense per adjusted discharge 15.3% year-over-year.
"2022 is off to a very difficult start for our nation's hospitals and health systems," Erik Swanson, senior vice president of data and analytics with Kaufman Hall and the author of the report, said in a statement. "Margins, revenues, and inpatient volumes declined for most organizations in February, while outpatient care signaled only slow returns. The metrics indicate a challenging recovery from the omicron surge in the coming months."
