Rural Healthcare in Crisis

Health Management in Rural America is struggling to meet the increase in Medicaid patient demands. In Northern California the amount of Medicaid patients doubled to approximately 40,000 under the Affordable Care Act (ACA). The ACA requires Americans to sign up for healthcare insurance or be fined annually.

What rural healthcare networks especially those that serve low-income individuals and families are seeing is an increase in demand for services but not enough nurses and physicians to meet the demand.

In rural Northern California some health centers have had to stop accepting new Medicaid beneficiaries which causes the patients in some cases to have to travel long distances for primary care or use local emergency departments for regular or preventative care.

It’s a tug of war of resources affecting patients, physicians, hospitals, clinics, emergency rooms and even potential health care providers looking into the career of health management.

Share your Thoughts:

How would you as a health manager deal with the increase in Medicaid recipients in a rural area? What could you see as potential solutions and barriers? Does your State participate in the ACA Medicaid expansion, if so what effects have you seen?

Thank you to Baylor University MBA in Healthcare for the skill to brainstorm and help problem solve complex health management questions.

Sources:

https://www.advisory.com/daily-briefing/2016/08/05/medicaid-expansion-straining-rural-providers?WT.mc_id=Email|DailyBriefing+Headline|DBA|DB|2016Aug05|ATestDB2016Aug05||||&elq_cid=1339315&x_id=003C000001tclvqIAA

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Hospitals Expect More Negative Margins for Medicare Reimbursment

Medicare reimbursement rates have always been a big focus for healthcare managers and administrators because it is an area where hospitals/clinics can potentially hemorrhage money. Medicare reimbursement is not dollar for dollar for procedures that are carried out so healthcare management is always mindful of how they can improve their hospitals to qualify for the best reimbursement rates. However according to Medicare Payment Advisory Commission (MedPAC) hospitals are expected to see a negative 9 percent average on their Medicare margins. This compared to negative 5.8 margins in 2014.

So why are these margins falling? The results from MedPAC point to declining Medicare reimbursement and the implementation of other federal policies for example the move towards value-based payments and 0.8 percent payment reductions to recoup improper overpayments related to coding errors.

What can healthcare management do to help lessen their losses and the pressure they feel with all the changes occurring in the healthcare industry?  Here are a few suggestions listed by the Advisory Board Company:

• ·         Instill greater employee accountability for benefit costs
• ·         Accelerate the transition to ICD-10 coding
• ·         Build clinical model for population health
• ·         Implement Best-in-Class CDI programs
• ·         Gain new patients with Convenient Offerings
• ·         Standardize care across Clinics and Sites of Care

Hopefully by considering new strategies to lessen losses healthcare management can alleviate some of the strain placed on health facilities by dropping reimbursements.

Share Your Thoughts:

How do you view the issue of declining Medicare reimbursement margins? How would you solve the problem in Healthcare Management? What role do you see physicians and clinical healthcare professionals playing in the Medicare reimbursement margins?

Thank you to Baylor Healthcare MBA for introducing early on the strengths and struggles seen daily by healthcare management.

Sources:

https://www.advisory.com/research/financial-leadership-council/resources/margin-intensive/margin-intensive-infographic

https://www.advisory.com/daily-briefing/2016/05/02/medicare-margins-projected-to-decrease

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