FAIR Health Can Help Hospitals and Health Systems Address Hot-Button Issues
April 18, 2019
Hospitals and health systems today are dealing with multiple pressing issues, including surprise billing, patient migration and the rise of alternative venues of care. FAIR Health data and custom analytics can help to address such concerns and inform business decisions.
Surprise Billing
Surprise, or balance, billing is currently a subject of intense debate. Many states are considering enacting laws to protect consumers from substantial bills they may unexpectedly or unintentionally receive from an out-of-network provider. Several approaches are being evaluated to determining the amounts that plans should compensate providers in such situations, including setting a standard based on billed charges, allowed amounts, a hybrid of billed charges and allowed amounts, or Medicare fee schedule rates. Another approach is independent dispute resolution, with or without articulated guidelines. Robust healthcare claims data from an independent, neutral source are invaluable as a reference for standards or guidelines.
The regulations and/or official governing memoranda pertaining to New York and Connecticut surprise billing laws expressly reference FAIR Health benchmarks. FAIR Health is frequently consulted as a resource on surprise billing by state and federal officials and healthcare stakeholders.
Alternative Venues of Care
The rise of alternative venues of care, such as ambulatory surgery centers (ASCs), urgent care centers and retail clinics, is another topic of concern for hospital and health system professionals. FAIR Health can perform market analyses to reveal trends regarding where certain types of procedures are being performed, which can aid in planning, strategizing and budgeting.
For example, FAIR Health analysis in your primary service area can show whether a larger share of orthopedic procedures are being rendered in ASCs as compared to hospitals from one year to the next.
Patient Migration and Growth Opportunities
Patient migration (“leakage”) analyses can be performed to show the rates at which patients enter and leave the system, where they go for subsequent services and the types of services they then receive. FAIR Health can analyze service line performance of key clinical programs through multiple viewpoints—at a high-level view with year-over-year service line trends; by providers and their performance; by procedure category; and by the specific procedures that are the cause for the highest rate of leakage.
Growth opportunities can be identified through population health analyses. For example, specialty trend analyses for specific patient populations and geographic areas can identify the clinical specialties that align with strategic initiatives, along with locations for possible expansion.
Competitor and Marketplace Evaluation
Performance against general market indicators can also be assessed. A service area analysis of lower back imaging services, for example, could compare patient share, average number of MRIs per patient and average patient age in your facility as compared to those same indicators in your catchment area.
FAIR Health analytics can also be used to evaluate the healthcare market from the perspective of chronic medical conditions and the services used to treat them. The prevalence of patients with diabetes could be analyzed, for instance, based on location and demographic characteristics.
In keeping with our commitment to all stakeholders, FAIR Health President Robin Gelburd presented these issues in a webinar on April 10 to the Healthcare Association of New York State (HANYS) Multi-State Managed Care Coalition, a coalition of state hospital associations focused on managed care issues and representing over 20 states.
For more information on FAIR Health custom analytics, contact us by email at info@fairhealth.org or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.