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In the News: July 26–August 2

Health Systems Look to Improve Fractured Consumer Experience

A recent Modern Healthcare article highlights how some health system executives are trying to improve consumer experience in several ways, including eliminating waiting rooms, waiving copays or offering free follow-up care if consumers had a previous bad experience. Others emphasized turning to telemedicine to facilitate 2-way conversations or offering more convenient access points such as old shopping malls. Some health systems are also working directly with employers to streamline the process.

The article mentions the way the health care system currently operates not only deters people from receiving care but also increases costs, for both patients and providers. One executive stated, “Providers should remove what doesn’t add value to the consumer experience,” referring to tedious activities such as registration and booking appointments.

Sg2 believes that as consumers increasingly prioritize quality, price, access and convenience, health systems will need to recalibrate their offerings to meet consumer demands. For relevant resources on how to develop a consumer-oriented strategy, see the Sg2 Consumerism Resource Kit.


Hospital-Acquired Conditions Are Declining

A recent JAMA article describes the continued declining trend in hospital-acquired conditions such as adverse drug events and injuries from falls. The Agency for Healthcare Research and Quality released a national scorecard showing an 8% decline from 2014 to 2016, following a 17% decrease between 2010 and 2014 that resulted in 87,000 fewer deaths and $19.9 billion in cost savings.

Despite the declines in hospital-acquired conditions, the threat of antibiotic-resistant (AR) pathogens in hospitals continues to be of particular concern, due to a susceptible patient population and antibiotic use that can inadvertently contribute to AR selection.

Sg2 encourages its members to evaluate the threat posed by AR infections, given the financial risk of a lapse in infection controls. To learn more about strategies to mitigate the risk of AR infections, read the Sg2 Expert Insight Antibiotic-Resistant Pathogens: More Than a Bug, Potential Business Chaos.


CMS Proposed Rule to Expand Site-Neutral Payment Policy in 2019

In a recently released proposed outpatient payment rule, CMS proposed expanding their site-neutral payment policy to physician clinics, which would reduce payment rates by 60% for clinic visits at off-campus hospital outpatient departments (HOPDs).

Another notable change would restrict “grandfathered” exemptions based on clinical family of services rendered at the exempt HOPD. If finalized, this would mean that off-campus HOPDs currently exempt from site-neutral payment reductions would receive reduced facility reimbursement for clinical family of services that they had not provided during November 1, 2014, through November 1, 2015. In addition, CMS will begin collecting data on services provided in hospital-owned off-campus emergency departments in 2019 through a modifier on all claims for outpatient hospital services rendered at these sites.

This latest proposal represents a continuation of CMS’s efforts to accelerate the shift of care to lower-cost sites by equalizing payments at HOPDs with the lowest cost setting. Sg2 believes that as policy changes continue to shift the financial equation, health systems will need to reevaluate strategies to grow their outpatient capacity and services. For more on CMS’s payment parity efforts, read the Sg2 Expert Insight CMS Continues Push Toward Lower-Cost Sites of Care.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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