Issue link: https://beckershealthcare.uberflip.com/i/267523
17 CFO Roundtable Pam Hess: Our revenue cycle team has been on top of this since it went into effect. There has been a lot of education with our physicians, but we still have more to do. We also have a team of nurse auditors reviewing accounts. We've been working with the Tennessee Hospital Association to lobby against it and are hoping that if we consolidate as a group, CMS might reverse the ruling. We've already seen reimbursement go down because of the new rule. The challenge has been getting physicians to document if a patient will be in the hospital for two midnights when they are admitted so we can bill it correctly. Greg Johnston: What a mess. My favorite thing about all of this is CMS is pushing hospitals to start EHR initiatives, and the two-midnight rule is a paper attestation. Everyone's moving away from paper, and the answer to a new major change in the way you do things is paper. It's just very frustrating. We put together a team led by the vice president of nursing at one of our hospitals who has case management experience. We engaged our IT depart- ment and worked very quickly to try to get that attestation statement into our admitting orders electronically; that was fairly successful. We still have physi- cians who are very concerned about trying to make a time estimate when they don't know the clinical results of tests yet or are not exactly sure what sort of complications will come up with a patient. But I would say I think we have a fairly good handle on it. It's definitely a payment decrease, or a payment cut hidden in regulation. We are reacting to it I think as well as anyone can. We are not perfect yet in this, but we monitor it weekly and report out monthly by hospital. Any time a patient stayed over two midnights who was not admitted, we look at why and try to plug the holes. It's a significant payment decrease. We've spent time, effort and external money working with advisors on this. Additional guidance was needed. It's ludicrous that the clinical condition of the patient doesn't matter, it literally only matters if their stay lapses over the second midnight. Payment should be based on resources used on the patient. Douglas Shirley: First, we formed a multidisciplinary work group of our finance, case management, informatics and revenue cycle areas and our hospitalist group to try to really dig into what information is out there. The biggest problem is that we received very little guidance until the 12th hour. It will evolve over time. Right now, initially, we put all the two mid- night claims under full review. It was a cumbersome process in the begin- ning, and we had to make some changes to our EHR to accommodate this and increase documentation on the claims. I believe with those efforts we mitigated the majority effect of the rule. Q: The price of treatments in hospitals has been under fire from the public and media lately, and the push toward price transpar- ency in healthcare is picking up steam. what are your thoughts on price transparency? Bill Boyer: Currently we have no procedure in place for publishing our rates. We want to make sure we don't drive our patients somewhere else. Hospitals are not like oil companies that can raise the prices and people are still going to buy. In healthcare, patients will find a cheaper hospital if you price your- self out of the market. We look at what our labor cost is, supplies for that procedure and [try to] be reasonable with our mark-up. We have polled area hospitals on a few procedures, and would not be afraid to publish our rates. Pam Hess: That's a tough one. We need to get there. Even me being a con- sumer getting a service done, I don't know what I'm going to pay, and I'm a CFO — I should know to the penny! It all depends on minutes in the proce- dures, physicians in the room or if you need an X-ray. If we could come up with an easy way to say, "Come in for an appendectomy and it will cost X," that would be wonderful. But it's going to be a long time before we get there. Greg Johnston: It is hard to argue against price transparency. Why should healthcare be any different than any other business or service that's provided? However, it is extraordinarily complicated. It is very difficult to translate your chargemaster into the actual price that is going to be paid on a prospective basis. In addition, the Medicare outlier payment formula relies on historic relation- ships between costs and charges that are at risk if you make a major reduc- tion in your overall chargemaster in any given year. So we haven't figured out exactly the best way to be able to prospectively give patients a 100-percent accurate estimate of what the services will cost them. So we do ranges, we put some caveats on it when we provide those estimates, and we [put] more focus on what the patient's portion of the cost will be. Transparency is on the radar screen, we just haven't figured out how to do it. If I could take a magic wand and redo my entire chargemaster tomorrow, I would do it. Every time you start you get a headache and quit, but it's some- thing we absolutely need to figure out how to do. Douglas Shirley: Overall, it will continue to become more of a focus and an issue that has to be addressed. We have a system based on a cost-based Medi- care reimbursement structure, and it's shifting to a more consumer-focused pricing structure as the exchanges roll out. I think price transparency will continue to be as important as quality and safety for hospitals are now. n Becker's Hospital Reivew 5th Annual Meeting May 15-17, 2014 • Swissôtel • Chicago, Illinois For more information visit, www.BeckersHospital Review.com Joe Torre Forrest Sawyer Barry Arbuckle, PhD Toby Cosgrove, MD Keynote speakers include: