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In the News: Apr 4–11

1 in 7 Commercially Insured Patients Got Surprise Medical Bills

A recent Modern Healthcare article discusses the Health Care Cost Institute’s analysis of 2016 commercial claims in 37 states that found approximately 1 in 7 patients received a surprise out-network-bill when obtaining care at an in-network hospital. Ten states had 15% or more of their in-network admissions result in out-of-network claims, though there was a high level of variation across the states.

One reason for these out-of-network bills is that not all physicians at an in-network provider location are in-network physicians. Of the medical specialties, anesthesiology was the leader for out-of-network claims at 16.5%, with primary care second at 12.6%. Specific medical services are also contributing, as 22.1% of independent lab services and 12% of emergency medicine services are billed out-of-network for in-network providers. Patients have little access to this information, and if they do, it is often not clear.

Addressing surprise medical bills, along with other billing practices such as balanced billing, through legislation has gained increased bipartisan support. As consumer frustration with the US health care system continues, Sg2 believes the next wave of disruption will require a new look at clinical service lines. For actionable approaches to consider when building tomorrow’s consumerism strategies, register for the upcoming webinar Consumerism 3.0: The Era of Service Line Disruption.


Pediatric Providers Continue to Embrace Telehealth Integration

A recent Modern Healthcare article discusses telehealth services’ potential to redefine patient interaction with providers and health systems, despite low adoption. In 2016, only 15% of physicians worked in practices using telemedicine. The slow rate of adoption suggests the industry is gradually becoming more informed about the potential patient benefits of telehealth services. Today, industry leaders are seeing a broader push toward the adoption of telemedicine services as consumers seek greater convenience and access to care.

Thus far, providers who adopted telehealth services early on have been able to treat a wide range of illnesses. For example, pediatric practices have been able to expand access and provide more consumer-friendly services, with several pediatric hospitals offering telehealth programs that include a 24/7 on-call service patients can access via a smartphone or laptop. Pediatric telehealth encounters are most commonly sought for skin-related symptoms, GI-related health concerns, asthma treatment and emergency department follow-up.

Recent trends in the pediatric landscape suggest that virtual health, either through school-based or hospital-based programs, can enable convenient low-acuity and specialty care for pediatric patients by removing geographic and time barriers to care. To learn strategic considerations for children’s hospitals evaluating virtual health programs, read the Sg2 Expert Insight ­Leverage Virtual Health to Offer Convenient Pediatric Care in Multiple Settings.


Leapfrog Group Will Issue Quality Ratings for Ambulatory and OP Surgical Services

According to a recent FierceHealthcare article, The Leapfrog Group, which has graded US hospitals on patient safety and quality for almost 2 decades, will begin issuing quality ratings for ambulatory and OP surgical centers. As 60% of surgeries now occur in OP units or ambulatory surgery centers (ASCs), the Leapfrog Group decided to expand its data collection and scoring outside of IP care.

Although the 2019 survey is available for ambulatory and OP surgical services, The Leapfrog Group will only release an aggregate report to the public on the performance of ASCs this year. The individual OP surgery center and ASC results will be publicly reported on The Leapfrog Group’s website in 2020.

With the increasing shift of surgeries to OP settings such as ASCs, it is crucial for health systems to understand their quality performance in order to maximize growth in these settings. For an in-depth exploration of the drivers shifting procedures to lower-cost sites of care, read the recent Sg2 report Procedure Sites of the Future: Transitions and Growth Across HOPDs, ASCs.

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