Another New York Hospital Hemorrhages to Death!
Is it time for providers to TOTALLY outsource billing, collecting and appealing?
A Brooklyn hospital, Interfaith Medical Center, has just filed for Chapter 11 bankruptcy. Apparently, the hospital's cash expenses exceed its receipts by two million dollars.The hospital is claiming that they require twenty million from the State to continue operating; actually needing a bailout in order to pay its vendors and meet payroll.
I wholeheartedly sympathize with the people on the receiving end of such proposed funds. However, as a Providers Advocate who is much too keenly aware of the dismal financial future facing so many providers who continue to resist change, I am APPALLED at the concept of bailing out ANY institution that does not agree to be held accountable to doing just that: Changing the quantity and quality of the payments due them through health insurance appeals as well as no-fault, workers compensation, and personal injury claims.
I believe that it is time for providers to let go of the battle so that they can win the war-- before they lose the war. Get out of the claim business and focus on making people well because that is what they do best.
Inasmuch as the average hospital annually leaves approximately 5 million dollars of no fault and workers compensation claims uncollected (average surgical centers actually never even collect on 60% of their No fault and workers comp claims) regrettably I must concur with Kenneth Raske, president and C.E.O. of the Greater New York Hospital Association: “...it may turn out that profound problems with the ways health care is paid for... will make it virtually impossible for all but a small number of the city’s hospitals to stay afloat” because the hospitals are just NOT getting paid enough for these potentially lucrative services.
In addition, hospitals are losing many more millions of dollars annually because they do not have the staff to consistently and effectively appeal adverse determinations for health care payments from insurance carriers.
Utilization Managers do not have enough resources to deal with myriad claim denials for numerous hospital departments. Bill collection agencies focus on collecting money from the patients (many of whom are too sick to appeal their claims) instead of focusing on the insurance companies who have the means to pay appealed claims.
Hospitals should out-source this end of the business so that every single substantial service they provide by every single department in the hospital, can be handled in the most profitable way. The time has come.
Tuesday, December 4, 2012
Monday, August 27, 2012
No Fault, No Problem.... Hospitals let insurance companies keep $5 million annually!
No Fault, No Problem.... Hospitals let insurance companies keep 5 million annually!
(blog in progress)
(blog in progress)
Friday, August 10, 2012
Tuesday, July 17, 2012
Hemorrhaging Hospitals: Open Letter to Kenneth Raske
“Hemorrhaging Hospitals Toxic Money Waste Syndrome”
-- Was St. Vincent’s
an accident waiting to happen?
An Open Letter to Kenneth Raske, President and C.E.O. of the Greater
New York Hospital Association
In
the Oct 25, 2010 New Yorker “News and Features” column entitled “St. Vincent’s
Is the Lehman Brothers of Hospitals”, Kenneth
Raske, president and C.E.O. of the
Greater New York Hospital Association, was quoted as saying “Its
demise was only the beginning. An alarming number of New York’s major medical
institutions are teetering on the financial edge. Indeed, it may turn out that profound
problems with the ways health care is paid for, combined with the inherent
disadvantages of doing business in New York, will make it virtually impossible
for all but a small number of the city’s hospitals to stay afloat.” Mr. Raske affirms, “We’ve got a lot of
hospitals in trouble”.
Trouble?
This is an understatement. It is a little known fact that most New York
hospitals are losing hundreds of millions
of dollars annually because they do not regularly appeal concurrent or retrospective
adverse determinations for health care service payments from insurance carriers.
However, in New York State alone, HMO providers and patients win over 47% of
internally appealed claims and 40% of externally appealed claims!
Inasmuch as only 5,543 internal and 542
external claims were appealed in 2010 (according to New York Consumer Guide to Health
Insurers) it is hard to imagine that St. Vincent’s appealed very many claims on a regular basis --if at all. Thus, my theory remains valid
that toxic money waste was a feasible culprit in our city’s loss of a
very important institution.
With
success rates of way over 40%, why aren't ALL hospitals and other providers
implementing the resources available to them?
While
many provisions of Health Care Reform regulate insurance companies’ dealings,
surprisingly, waste practices by hospitals have gone unaddressed thus far. We
are not talking about toxic medical waste here. No, instead we are addressing
Toxic Money Waste: un-appealed,
unclaimed money for covered claims! Sounds like a tongue twister, but this is
no funny riddle. Toxic money waste is real, and it is happening all across
America, and in a New York hospital near you.
This unhealthy medical practice has devastating far-reaching effects on Americans
in areas such as personal bankruptcies, hospital closings, job losses, government
spending, and increased medical care expense to patients.
Simply
put, the fewer and lower the payments that hospitals receive from insurance
companies, the worse off we all are.
Many healthcare reforms mean more money for hospitals -- but New York hospitals are not using
resources to go and get it. Is it hubris on their part? When I contacted a well known Upper East Side
hospital that had only recently begun participating in networks other than
Empire Blue, the C.F.O. rudely announced that his hospital was “quite capable
of doing their job”
Funny,
I thought the hospital’s job was to make people well -- not to be insurance experts. I wanted to
remind him of that proverb which speaks to pride coming before a fall. I wanted
to beg him to reconsider taking a better look at the systems his hospital does
NOT have in place because most
Utilization Managers need to stay more “medically minded” than financially aggressive, and sadly they do not
have enough resources to deal with concurrent claim denials -- let
alone retrospective ones. I wanted to tell him that his billing clerks do not
have the time, means or sophistication to take the initiatives required for dealing with C.E.O.’s of insurance companies and Sate Insurance Commissioners. I wanted to tell him that bill collection
agencies focus on collecting money from the patients (many of whom are too sick to
appeal their claims) instead of focusing
on the insurance companies who have the means to pay appealed claims. I wanted
to tell him that consultants work on a contingency basis so that there is no
risk or up front expense to the providers.
I wanted to tell him all this, but he hung up the telephone rather abruptly after he
told me that he "had ripped up not only mine, but all the letters he receives
which offer to help him on a contingency basis."
If hospitals administrators would please think outside the proverbial box, they will increase revenue by millions of
dollars and possibly head off this disaster before it is too late.
Mr. Raske is correct:
"profound problems with the ways health care is paid for... will make it virtually impossible for all but a small number of the city’s hospitals to stay afloat.”
In light
of ever-increasing costs to providers
in malpractice insurance and lower reimbursement levels, it is unconscionable that hospitals do not
take full advantage of their rights to submit first and second level appeals as well as External Review appeals and complaints.
And
so my personal appeal, and I mean
this with the utmost respect, is that Hospital administrators would stop complaining about insurance company reimbursements,
and begin complaining to them and to the State, without delay. Unless providers
make use of healthcare benefit reforms right now, health reform may be too little,
too late, for all of us.
These
are extenuating circumstances. Please: step up the plate and stop the
hemorrhaging!
There is no need to blame this hemorrhaging on "disadvantages of doing business in New York" -- we are the greatest city in the world and we love our great hospitals! We want to keep them here -- and financially healthy.
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