Becker's ASC Review

September/October 2023 Issue of Becker's ASC Review

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34 HEALTHCARE NEWS 34 'It's ridiculous': Why hospitals pay millions to get paid electronically By Giles Bruce H ospitals and physicians are paying millions of dollars for a hidden fee to receive reimbursement from payers electronically, ProPublica reported Aug. 15. Payers and middlemen charge healthcare providers as much as 5 percent to process electronic payments, according to the story. The ACA required payers to offer electronic funds transfers and nudged physicians to take them. CMS at one time prohibited the processing fees before reversing course. Tim Reiner, senior vice president of revenue management of Altamonte Springs, Fla.-based AdventHealth, complained to CMS about the fees in 2020, the news outlet reported. "I have to pay $1.8M in expenses that I could use on PPE for our employees, or setting up testing sites, or providing charity care, or covering other community benefits," he wrote. "It's ridiculous," Karen Jackson, a retired senior CMS official, told the news outlet. The U.S. Department of Veterans of Affairs has declined to pay the fees, declaring them illegal, according to the story. The pushback against the fees has been led by Alex Shteynshlyuger, MD, a private urologist in New York City, while the campaign to keep them has been spearheaded by Matthew Albright, chief lobbyist at payment processing company Zelis, according to the article. Mr. Albright, a former CMS official, had pressed CMS on getting rid of its ban on the fees. The agency told ProPublica it had no legal authority to outlaw the fees, adding that it "receives feedback from a wide range of stakeholders on an ongoing basis." Other electronic payment vendors include UnitedHealth Group subsidiaries Change Healthcare and VPay. UnitedHealth told ProPublica the companies cut down on administrative burden and speed up payments for providers. Zelis told the news outlet that it helps prevent "many of the obstacles that keep providers from efficiently initiating, receiving, and benefitting from electronic payments." n to it without knowing the salary. I just wanted to lead our nursing staff." Here, Dr. Kline discusses the issues facing nurses, technological advances and leadership. Question: What's the greatest challenge facing nurses right now? Dr. Melissa Kline: e greatest challenge is the pace of changes happening. ere's a lot of changes in how we deliver healthcare. I think people are finally paying attention to prevention instead of just treating disease, so we have a focus on that prevention while also providing care within the hospitals. ose changes, coupled with a nursing shortage and technological advances like artificial intelligence and virtual care, means we are testing different care delivery models. Aer COVID-19, how do we keep the pace of change going in order to provide appropriate and quality care? It's a lot to change and adapt to. Q: What concerns you most about the healthcare field? MK: e shortage of care providers in all specialties, but especially primary care. How do we keep people engaged in the work and attract them to healthcare? It's very rewarding. ere are many roles that are flexible but there are people who have to work holidays, night shis and weekends. So being attractive to people in the workforce can be difficult. We've been partnering with different education institutions like high schools and colleges to get the younger generation interested in healthcare and nursing. We have a nurse internship type program for juniors and seniors where they interact with nurses and get to shadow them on the job. But we also expose students to other careers in healthcare. ere's something for everybody from marketing to information to quality to food and nutrition. Most people think of healthcare as front-line caregivers, and we try to show them all aspects of the field. Q: What new technology, innovation or research are you most excited about? MK: I am most excited about all the newer technology, such as artificial intelligence, and how that can be used to support nursing and nursing care. Part of nursing is the people aspect of care connection and I think we have to be careful about the use of technology and how it can help nurses focus on the relationships with patients to enhance outcomes. We've started doing virtual nursing in the inpatient units and have had great feedback from patients. Our nurses also like virtual nurses because it allows them to connect and interact more with the patients and reduces the administrative work so in-person nurses can focus on care. Q: What's something your hospital is doing that you're most proud of? MK: We're really taking a deep dive into healthcare disparities. For example, our patients have good blood pressure control, but some people are doing really well, and others not that well. How do we diminish the gap to ensure everyone is managing their blood pressure? We're looking into those disparities across multiple factors like sex and race to ensure that all in our community are healthy. at process is made easier by the electronic health record where we can collect and analyze demographic information and determine what processes may need to be implemented. Without the EHR, it would be very challenging to connect the huge volume of data to the different pieces that contribute to care. Q: What's the best leadership advice you've received? MK: Don't expect your team to do something that you wouldn't do yourself. I think part of being a good leader is setting a good example and staying connected with your team. So whether that's being visible or jumping in to help, I think that says a lot about a leader. n

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