Hey Hospitalogists,

The last “Ask Hospitalogy” (our new segment featuring smart responses from Hospitalogy Members on pressing Qs about healthcare headlines, ops, and strategy) was well received, so we’re running it back this week!

Please continue to share your thoughts on this new segment (and if you’d like to be featured in a future newsletter, asking or responding to Qs in the Hospitalogy Membership is the quickest way to do it).

Speaking of which… have a question you’d like answered? Drop it here!

ASK HOSPITALOGY

Alright so I've seen a lot of hubbub and varying takes floating around this new UnitedHealthcare policy refusing to cover commercial RPM codes. Need y’alls take on what it means and implications for the future state of RPM.

From what I understand, RPM is table stakes for diabetes management these days so... is there something I'm missing here?

THE ‘NUANCE’ TAKE

Matt DenHartog, Account Executive

“I think this is the perfect example of how healthcare delivery and payment both lack the ability to implement nuance. RPM is absolutely valuable for some patients and it is also being over used by some providers. Instead of coming together to agree on what the right patient is, both sides abuse the system for their own gain and both sides are forced to take advantage of any situation that isn't well defined. Payers may be under paying one place, so providers have to look for areas where they might be over paying. All the while, many patients don't get the best, most efficient care out because both sides are forced to play the game that is created by the healthcare environment we all function in.”

THE ‘COST LOGIC’ TAKE

Munawar Peringadi Vayalil, Product Lead

“My thought is that the equation for UHC was clear. CHF and Hypertensive pregnant patients may utilize more cost in acute care and thus reimbursing them is cost effective. While others may not be incurring utilization as much as in these two categories. (While I don’t have any data to support my thought currently, I believe UHC may have already done that analysis).“

THE ‘POWER PLAY’ TAKE

Ann Somers Hogg, Director, Health Care Research

“Great question. This appears to be an odd move. Perhaps it is either 1) a power play, testing how far they can push their ability to deny care and raise revenues based on their size and market power, so if they can deny RPM, what else can they deny. Or, 2) they’re going to launch an AI solution that performs RPM and then funnel what they’d previously pay out to others to themselves, or 3) by denying RPM access they increase the cost of care for members who will now seek out in-person visits for the same care. This would increase the numerator of the MLR, making it look like they’re paying more for care, so they could deny care elsewhere and still be in compliance with regulations.”

Hospitalogy members can join this discussion here. Not a member yet? Apply to join here.

Hospital margins dipped again last quarter, with labor costs still the top driver. If you had to protect your bottom line today, would you focus on cutting costs or changing your staffing model?

THE FLEXIBLE WORKFORCE TAKE

Craig Premo, Senior Brand Manager

“I would focus on pivoting to more flexible labor models as a way to cut costs without compromising patient care. Healthcare systems have been focused on cutting back on contingent labor such as travel nurses, and this makes sense. However, systems are paying so much in overtime and incentives to full-time staff that contingent labor can be a less expensive alternative in some cases.

Many systems are also building internal float pools that operate at an enterprise level, so nurses can float not only within a hospital but among several hospitals.

It's not unusual for healthcare systems to have a mix of per diem, contingent, and full-time clinicial staff.”

THE EFFICIENCY TAKE

Jayesh Srivastava, Chief of Staff

“I'd take a look at clinical operations efficiency gains, which can positively impact staffing (cost efficiency, morale, etc.)”

THE AGENCY TAKE

Jeff Brown, CEO

“Never worked in hospital environment, but our agency is faced with significant deficit and its very difficult to find the needed gains by squeezing vendors and services. We're all constantly looking for ways to improve efficiencies and take advantage of new technologies and therapy options.

For Home Health it seems as though MEDPAC is working on behalf of corporate entities to make it hard for smaller/locally owned companies to survive in this economic reality. Nothing we do or need costs less, but our reimbursements are reduced seemingly out of hand.

I inherited an understaffed agency that was using agency staff like crazy. Agencies were filling gaps and doing what they do, but it was expensive in several ways. Today we use very little agency, we pay significantly less for our staff salaries than we were paying for all that agency staff. The hard choice I am facing is management overhead is a luxury the agency can no longer afford. It is not an easy task to educate and QAPI an agency with just under 200 patients, but we will be forced to do it with admin and low paid staff and we will suffer in the long term. There are so many ways we are hurt by the current levels of reimbursement.”

THE ECLECTIC TAKE

Patrick Allen - VP of Business Development

“I'm seeing my health system clients focus on cutting (thoughtfully) cost, optimizing staffing, and also increasing revenue. The ways I'm seeing providers tackle the revenue topic are myriad, from opening schedules, adopting or implementing scheduling optimization tools for the procedural areas and infusion clinics, and increasing access to the primary care front door. Any / all of these are viable and effective.”

Hospitalogy members can join this discussion here. Not a member yet? Apply to join here.

ON YOUR RADAR

• Read: My latest article shares how a multidisciplinary care coordination platform is helping organizations solve tough challenges like ED throughput, care navigation, readmissions, and network leakage.*
• Resource: Universal Health Services Q3 Earnings Analysis
• Roundtable: Register for the November Roundtable for Plus Members Friday November 21st, 1pm EST
  
  *this read is brought to you by one of our brand partners.

RECENT HEADLINES

1. CMS announced the GENEROUS Model, a new payment model that allows participating state Medicaid programs to purchase selected drugs at internationally aligned prices. Participation is voluntary for states and drug manufacturers.
2. Shares of health insurers fell as much as 10% November 10 after the U.S. Senate struck a deal to end the 40-day federal shutdown without extending ACA subsidies. A December vote on the issue has been set.
3. All 50 states have applied to the new $50 billion Rural Health Transformation Program, a major federal effort to spur state-driven redesigns of rural health systems focused on access, quality and sustainability.

That's all for this week! Let me know your thoughts on the new Ask Hospitalogy segment.

– Blake

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