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Mountain talk
President Letter To
HFMA Members About
The 2016 WV Flood
Dear Fellow WV HFMA Members,
It has been an incredibly tough week here for many West Virgini-
ans who have been impacted by the severe flooding throughout
our state. Our prayers especially go out to the families that have
lost loved ones, lost their homes, and have been displaced by the
flooding. The stories, pictures and videos have truly been heart-
breaking.
Governor Tomblin declared a state of emergency for 44 of the
state’s 55 counties and ordered the deployment of over 400 mem-
bers of the West Virginia National Guard. Volunteer firefighters,
EMS, and other first responders have spent incredibly long hours
helping victims through debris-laden floodwaters to a place where
they are safe and can get their medical and nutritional needs ad-
dressed. We cannot express enough appreciation to these hard
working volunteers.
This tragedy has put our people to the test, but as a people, West
Virginians are as tough as they come! We’ve seen almost every-
thing Mother Nature has to offer, lived through tough economic
times, mining disasters, and even had our own water crisis here in
Charleston a couple years ago. To say we have been through a lot
would be an understatement.
With these cards that we’ve been dealt, many would fold and walk
away. Those that do are missing the best part of being a West Vir-
ginian…the Comeback. Our people band together during these
tough times, we reach out our hands, reach into our pockets, and
help our fellow West Virginians get back on their feet. We are re-
sourceful. We respect each other’s needs, and we show unexpected
love.
Many local and national fundraising efforts have kicked off and are
underway. The donations and volunteers have been tremendous
but we all know that this recovery will take time. Our WV HFMA
Chapter will be supporting these fundraising efforts in the upcom-
ing year. We will be working with other organizations, schools, and
families affected to make sure that after this initial wave of media
attention and fundraising has faded that these families’ needs are
still being addressed.
Please stay-tuned to our website (www.wvhfma.org) for additional
information about our Chapter’s fundraising efforts and please
click the “Volunteer today” button found on our homepage fill out
a volunteer application if you would like to help participate in
these efforts.
Together our state and these affected areas will again THRIVE!
Sincerely,
J. Ryan Lindsay, CPA, CHFP
Summer 2016
Transition in Healthcare
Mountain Talk
In This Issue Region IV Executive Fare-
well Page 4
Welcome Elected Region IV
Executive -Page 8
WV Hospital Association
Update Page 11
CMS Proposal -Page 12
Hospital Physician Align-
ment Page 16
Patient Deductibles Falling?
-Page 19
President’s Message
As I was preparing to write my first President’s message I put together an outline of all the
HFMA topics that I wanted to cover, but it was hard to ignore the tragic events that have
affected our state, our country and the world which we live in. It is a challenging time
right now for many people of our state who have to clean up from the worst flooding in
over 100 years. Our nation is dealing with significant political and social unrest, and many
areas of our world are dealing with extreme terrorist threats and attacks. These events
hurt us, let fear creep into our lives, and question the way we have done things in the past,
but above all these events bring us together as a state, a nation and a human race. I have
no doubt that we will overcome these challenges. Good will win over the evil and we will
again Thrive!
Mary Mirabelli, FHFMA, the 2016/2017 HFMA Chair calls on Health Care Professionals
to Thrive in the face of great change. Ms. Mirabelli delivered an inspirational message to
all the members in attendance at the Annual National Institute (ANI) in Las Vegas last
month. She encourages health care professionals to do more than simply respond to to-
day’s changes in healthcare. We must find a way to Thrive in the face of it. If you were not
able to attend this year’s ANI, I would encourage you to read Mary Mirabelli’s touching
story in the June HFM magazine and follow her on Twitter.
The WV Chapter had an amazing Spring Conference in May at Stonewall Resort. We had
some tremendous speakers and as always a great time was had at the networking events.
The new 2016/2017 Board was sworn in and we are all honored to be in a position to help
continue to grow and advance our Chapter.
The Spring Conference brought some new changes to our Chapter. This was the first
meeting in many years that we did a joint session with the West Virginia Hospital Associa-
tion. We heard Dr. Paul Mellor deliver a seminar on…(let me think….uh…oh yeah!)…
improving your memory! This also was the first time we have registered for a conference
with our new website, had an app for our conference, and had electronic evaluations.
Overall, the feedback on these new initiatives was very positive .
Fall 2016
President Message Continued
Our Fall Conference is scheduled for September 28th-30th at the Waterfront Place Hotel in Morgantown, WV. The pro-
gram committee has been hard at work recruiting speakers and planning networking events that you won’t want to miss!
This conference will focus on today’s Healthcare Issue but will also highlight the Early Careerists in our profession. HFMA
defines the Early Careerist as someone working in or considering working in the healthcare profession that is under the
age of 40. We want to encourage everyone to reach out to the under 40 professionals in your office and bring them to this
conference. We are developing a Wednesday afternoon session that will focus on issues that will appeal to the under 40
attendees but are also open to all conference attendees. If the Early Careerist is a new attendee of one of our conferences,
we are offering a special registration rate of ONLY $50!! That includes the entire conference (Wed-Fri) and over 15 hours
of CPE! It’s a great deal meant to encourage our Healthcare Leaders to introduce some of the Generation X or Millennials
to WV HFMA. Please look around your office and encourage these future leaders to attend!
I would like to encourage all of you to volunteer to help the WV HFMA Chapter thrive in the upcoming year. Becky Ham-
mer and many of the Past Presidents of WV HFMA have done such a tremendous job of giving their time and positioning
our chapter for continued success. We have so many initiatives ongoing that it’s sometimes hard to keep track of them all.
From secure data storage to webinar development our chapter continues to advance and succeed to meet our goals. This
can’t be done without the volunteers that our chapter is fortunate enough to have. If you would like to become a volunteer,
please go to our website – www.wvhfma.org and click the Volunteer Today button at the bottom on our home
page. Our new Volunteer coordinator, Belinda Bennett, will be in touch with you to welcome you and discuss opportuni-
ties.
One of my personal goals last year was to obtain HFMA’s Certified Healthcare Financial Professional certification before
my year at President began in May. Last fall, I registered for the first Module of the CHFP Program: Business of Health
Care. After a few weeks of reviewing the study materials at night for an hour or two, I sat for the online test. I received in-
stant feedback that I had passed the first Module and was now qualified to take the second part Module II: Operational
Excellence Exam. This time, I was a little more confident that I had a good grip on the concepts and probably only studied
the Module II materials a few days before taking and passing this section. The second part of the exam is more case studies
so your healthcare experience will help you more in Module II. This certification is something I plan to maintain my whole
career and I would encourage you to consider setting this goal for yourself. More information on this certification is availa-
ble on the HFMA website (www.hfma.org/certification/). As an incentive, the West Virginia Chapter reimburses the cost
of this exam for the first two members that pass the certification exam each year.
In closing, I want to thank all of the Sponsors, members of the 2016/2017 Board, and all of the Committee members for
dedicating their time and effort to support our Chapters efforts. You have all inspired me to be the best President that I can
be. I know we will have continued success and Thrive in the upcoming year.
Thank you for this incredible opportunity and please feel free to contact me with any thoughts or concerns you may have in
the upcoming year!
Sincerely,
J. Ryan Lindsay, CPA, CHFP
WV HFMA President 2016/2017
Region IV Executive
2015-2016 Farewell
Hello Region IV HFMA members.
I wanted to take a moment and thank you for a great 2015-2016 HFMA year while I served as
Regional Executive for Region IV. It was truly an honor to serve the chapters, their members
and leaders during my term. I was able to visit each chapter at least one time while serving as
Regional Executive and each visit provided an opportunity to observe both the similarities and
differences among the five chapters in Region IV. I had a great time meeting many of you
along the way and sharing with your chapters. Thank you for the hospitality! The commonali-
ties that come to mind as I look back on my experiences with the different chapters are pas-
sion, pride, quality, integrity, excellence, fun, loyalty, dedication and commitment. As I
worked closely with the chapter presidents and presidents elect of Region IV, and interacted
with leaders from other regions, it was clear to me that Region IV truly stood out from the oth-
ers and was clearly one of the best HFMA regions in the country.
Well, as they say, the proof is in the pudding. I am proud to say that during the 2015-2016
HFMA year, Region IV was the only region in the country to have all of its chapters achieve a
score of 100 on their Chapter Balanced Scorecards. This means that each chapter met or ex-
ceeded goals in: 1) Total Education Hours and Education Hours per Member; 2) Membership;
3) Membership Satisfaction; 4) Certification; 5) Days Cash on Hand; 6) Timely Reporting of
Chapter Events and Newsletters; and 7) Provider Board Composition of 40% and above. This
is a true indicator of the quality leadership and volunteers within Region IV that strive each
day to provide the very best in education and networking events for HFMA members. Con-
gratulations on a job well done!
As we begin the 2016-2017 HFMA year I ask that you please welcome my replace-ment, Okey Silman, as your Regional Executive for Region IV. Okey is a past president of the West Virginia Chapter and he is truly passionate about HFMA. Okey will honorably serve the needs of each chapter and the leaders within Region IV as they strive to meet and exceed their goals for this next year. Okey will also serve as a liaison between the Region IV chapters and the national office of HFMA, providing insight and feedback for both sides of the equation. Okey will do an outstanding job this year and I know that you will all make him feel at home as he visits the chapters.
The Region IV presidents, presidents elect and chapter board members for 2016-2017 are a great group of leaders. Please support their efforts and volunteer with-in your chapter any way that you can.
I wish you all the best in the coming year and I know that the Region IV chapters will have a great year!
Sincerely,
Tom
Tom Henderson 2015-2016 Region IV Regional Executive
Reserve your room today! Call 304-296-1700 for reservations. Group Name:
WVHFMA 62nd Conference
Enjoy the opportunity to network with your peers and vendors in HFMA as
well as the CEOs from around the state.
Co-sponsored with the WV Society of CPA’s (12 CPE Credits)
Join Us
WV HFMA Fall Institute
September 28-30, 2016
Waterfront Place
Morgantown, WV
FOLLOW US ON SOCIAL MEDIA
Did you attend the
Spring Education
Meeting at Stone-
wall Jackson?
A word from our
Elected Region IV
Regional Executive
Okey Silman II
I am honored to have been elected to serve as the 2016-2017 HFMA Regional Executive for Region IV. I want to
thank Tom Henderson, the outgoing RE for providing the support and guidance to our region and mentoring me over
the past year. Region IV was the only region, where every chapter achieved 100% on their chapter balance score
card metrics for the 2015-2016 chapter year. We have an outstanding group of chapter leaders and volunteers in our
region.
I joined HFMA 10+ years ago mainly for the quality educational sessions that HFMA offers as well as the infor-
mation provided on the industry changes and regulations. What I have learned, is that HFMA is so much more, if
you get involved and volunteer. After attending the educational sessions for a couple of years, I was asked if I
would have an interest in volunteering to serve on the program committee. And later asked, if I might have an inter-
est in going through the officer chairs. And now, I am beginning my term as Region IV’s Regional Executive.
HFMA has not only enhanced my professional growth, but personal growth as well. By volunteering, you build life-
long friendships and have the opportunity to meet and speak with industry leaders from all around the world. Net-
working events have provided invaluable knowledge that I have been able to utilize and implement in my organiza-
tion.
Each year HFMA elects a new person to sit as the National Chair for HFMA who is responsible for selecting a
theme for their year. Mary Mirabelli was elected as our 2016-2017 HFMA National Chair and her theme for this
year is “THRIVE”. During my year as President of the WV Chapter, I took the themes for the previous 5 years
molded them into a single statement. I would like to share that statement now. It is compelling and conveys a pow-
erful message.
“It is time for us to “STEP UP (2010)” as we “BELIEVE TO ACHIEVE (2011)” because
“LEADERSHIP MATTERS (2012)” as we do “WHATEVER IT TAKES (2013) in “LEADING
THE CHANGE (2014)” as we “GO BEYOND (2015)” our own boundaries by embracing change, al-
lowing the healthcare industry to “THRIVE (2016)”.
I would encourage all members to volunteer and get involved. I encourage non-members, to become
members, and experience all of the benefits of being part of such a rewarding volunteer organization.
Thank you for being a member of HFMA and volunteering your time and efforts. Thank you to our
providers for supporting those members in their efforts to make a difference in healthcare. Thank you
to our sponsors and vendors for the support and commitment to our chapters. The educational sessions
and events could not be done without all that you do for HFMA. In closing, I would like to express my
gratitude for the honor to serve as the Regional Executive for Region IV and getting to work with all of
the wonderful and talented members in our region. Please let me know if I can be of assistance to you
in anyway.
“Be open to change! Never stop learning! THRIVE!” Marry Mirabelli 2016-2017 HFMA National Chair
Respectfully,
Okey Silman II
West Virginia Chapter of HFMA
2016-2017 Regional Executive – Region IV
BLUE JEAN NETWORKING!!!!
DON’T MISS OUT!
By: Carol Haugen
VP Financial Planning
WV Medicaid Managed Care Update
Following a lengthy acquisition process, West Virginia Medicaid awarded managed care con-tracts for the term July 1, 2016 to June 30, 2017.
Contracted managed care organizations are –
CoventryCares of WV
UniCare
WV Family Health
The Health Plan
Trusted Health Plan
CareSource
Trusted Health Plan and CareSource are new managed care organizations to be entering the WV Medicaid market. As such, they are contractually subject to a readiness review and ap-proval prior to enrolling Medicaid beneficiaries. The timeline for those activities has not been determined; however, both organizations are developing provider networks, preparing WV Medicaid specific policies, and working toward successful entry to the WV market.
How one can define success is subject to interpretation, but hospitals are always looking for valuable business partners. With the ever changing landscape, new Medicaid MCO’s is only one example of adapting to the market changes.
CMS Proposes Hospital Outpatient Prospective Payment
System Changes to Better Support Physicians and Im-
prove Patient Care
The Centers for Medicare and Medicaid Services (CMS) proposed updated payment
rates and policy changes in the Hospital Outpatient Prospective Payment System
(OPPS) and Ambulatory Surgical Center (ASC) Payment System. Several of the pro-
posed policy changes would improve the quality of care Medicare patients receive by
better supporting their physicians and other health care providers. These proposals are
based on feedback from stakeholders, including beneficiary and patient advocates, as
well as health care providers, including hospitals, ambulatory surgical centers and the
physician community.
“The items in this proposal are designed to improve care and value when Medicare ben-
eficiaries receive care in an outpatient setting,” said Andy Slavitt, Acting CMS Adminis-
trator. “Today’s proposed updates better support physicians in providing beneficiaries
with the right care at the right time.”
Addressing Physicians’ Concerns Regarding Pain Management
Today’s proposed rule would address physicians’ and other health care providers’ con-
cerns that patient survey questions about pain management in the Hospital Value-
Based Purchasing program unduly influence prescribing practices. While there is no
empirical evidence of this effect, we propose to remove the pain management dimen-
sion from the Hospital Value-Based Purchasing program to eliminate any potential fi-
nancial pressure clinicians may feel to overprescribe pain medications. CMS continues
to believe that pain control is an appropriate part of routine patient care that hospitals
should manage and is an important concern for patients, their families, and their care-
givers. Thus, CMS is also currently developing and field testing alternative questions
related to provider communications and pain to include in the program in future
years. We will solicit comment on this alternative in future rulemaking.
CMS PROPOSAL
CONTINUED
Focusing Payments on Patients Rather
than Setting
In addition, CMS is proposing policies to
implement section 603 of the Bipartisan
Budget Act of 2015, which provides that
certain items and services provided by cer-
tain hospital off-campus outpatient depart-
ments would no longer be paid under the
OPPS. Currently, Medicare pays for the
same services at a higher rate if those ser-
vices are provided in a hospital outpatient
department, rather than a physician’s office.
This payment differential has encouraged
hospitals to acquire physician offices in or-
der to receive the higher rates. This acqui-
sition trend and difference in payment has
been highlighted as a long-standing issue
of concern by Congress, MedPAC, and the
Department of Health and Human Services
Office of Inspector General. This difference
in payment also increases costs for the
Medicare program and raises the cost-
sharing liability for beneficiaries.
Congress addressed this issue through the
Bipartisan Budget Act of 2015, and CMS
proposes implementation details in today’s
proposed rule. CMS believes these pro-
posed policies will help to ensure that Medi-
care beneficiaries – and the Medicare pro-
gram – do not pay more for care simply be-
cause of the setting in which that care was
received. The CMS Office of the Actuary
estimates that these changes should re-
duce OPPS spending by approximately
$500 million in 2017. CMS sought com-
ment and feedback from stakeholders dur-
ing the development of this proposed rule,
and CMS encourages further feedback dur-
ing this proposal’s comment period.
Improving Patient Care through Tech-nology CMS is supporting physicians and other providers through today’s rule by increasing flexibility for hospitals and critical access hospitals that participate in the Medicare electronic health records (EHR) Incentive Program. Earlier this year, CMS conducted a review of the Medicare EHR Incentive Program for clinicians as part of our imple-mentation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), with the aim of reconsidering the program so we move closer to achieving the full potential health information technol-ogy (IT) offers. Based on that review, CMS streamlined EHR reporting requirements under the proposed rule to implement cer-tain provisions of MACRA to increase flexi-bility and support improved patient out-comes.
Today, we propose taking a similar step for
hospitals and critical access hospitals par-
ticipating in the Medicare EHR Incentive
Program. These changes include a pro-
posal for clinicians, hospitals, and critical
access hospitals to use a 90-day EHR re-
porting period in 2016 – down from a full
calendar year for returning participants.
This increases flexibility and lowers the re-
porting burden for hospital providers.
CMS PROPOSAL
CONTINUED
Emphasizing Health Outcomes that
Matter to the Patient
Finally, CMS proposes to add new quality
measures to the Hospital Outpatient
Quality Reporting Program and the Am-
bulatory Surgical Center Quality Report-
ing Program that are focused on improv-
ing patient outcomes and experience of
care. Other changes in the proposed rule
would enhance the outcome require-
ments for organ transplant programs, so
that the programs may help more benefi-
ciaries accept more grafts, while main-
taining compliance with Medicare stand-
ards for patient and graft survival.
CMS estimates that the updates in the
proposed rule would increase OPPS pay-
ments by 1.6 percent and ASC payments
by 1.2 percent in 2017.
To learn more about the proposed rule, please visit: https://www.federalregister.gov/public-inspection. CMS looks forward to feed-back on the proposal and will accept comments until September 6, 2016. Comments may be submitted electroni-cally through our e-Regulation website at: https://www.cms.gov/Regulations-and-
Guidance/Regulations-and-Policies/eRulemaking/index.html.
A fact sheet on this proposed rule is
available at: https://www.cms.gov/
Newsroom/MediaReleaseDatabase/Fact-
sheets/2016-Fact-sheets-items/2016-07-
06.html.
Networking
What are you
missing by not at-
tending your
Chapter Confer-
ences?!
If you attended
the Spring Con-
ference you
would know why
Okey is excited!
Michael Ehlan
Background: Establishing and monitor ing patient panels is a powerful tool for increasing practice revenue and reducing unnecessary practice expenses. Provider based primary care practices should care-fully define the patient panel size for their employed physicians and their physician assistants, (PA) and/or nurse practitioners, (NP). Panel size can be defined as the number of individual patients seen by a provid-er, or the entire practice, over a determined time period. Most practices use 12 months of data for their panel size calculations. However, 18 months is more ideal to capture some established patients, who tend not to visit the practice within a year time frame. If a physician’s panel is too large, the excess demand will spill over to other providers. Patient satisfaction will suffer. Care quality and practice revenue will spiral downward. This puts the practice in a position where it cannot be successful. There is only so much time in one day. If a physician’s panel is too small, the demand for services may not be enough to cover the practice’s expenses and large losses can occur. Current Patient Panel Size Determination: In order to perform meaningful financial analysis, each patient on the practice’s active patient roster should be assigned to one provider. Because there are going to be some patients, who have been treated by more than one provider in the practice, a set of rules should be used to designate which patients are assigned to each provider. Some of the more common rules for patient panel designations are:
Patients treated by only one provider are automatically assigned to that provider. Patients treated by multiple providers are assigned to the provider with the highest visit count for that
patient. Patients treated by multiple providers, where there is a tie between two or more providers for the high-
est visit count are assigned to the provider the patient saw on their most recent visit. Keep in mind that current patient panel size can be influenced by other factors such as weekly hours
available for appointments, the physician’s “bedside manner,” and the age and gender of the pa-tient panel population. As more physicians align with hospitals, consolidating information systems will allow for powerful enhancements to patient panel levels, i.e. making an adjustment to one pro-vider’s panel based on acuity to account for more return visits than the other providers in the same practice.
Improve the Bottom Line with Appropriate Patient Panel Size: Patient access can make or break a
practice. If daily patient demand for appointments is greater than daily provider capacity, backlogs and bottlenecks will occur. Patients may have to wait days for their next appointment. If one of the practice’s providers has a patient panel size, which is too big, leakage will occur as patients “lose their patience” and leave the practice. Staff will also be flooded with increased phone calls and cancellations. Many patients will experience poorer clinical outcomes, which increases return visit lengths, and puts more stress on the practice’s capacity and productivity.
A simple, but effective method to evaluate each provider’s panel size is to perform an “Effort versus Reward” calculation as follows:
1. Select a time frame to measure, at least 12 months, preferably 18 months. 2. Total all the net revenue received by the practice over the time frame selected. Total and
divide each provider’s patient panel net revenue by the total net revenue to compute the percentage rendered by that provider’s panel.
3. Total all the visits or treatments performed by the practice over the time frame selected. Total and divide each provider’s patient panel’s number of visits by the total number of visits to compute the percentage of “effort” rendered by that provider’s panel.
4. Compare the percentage of revenues for each provider panel to its corresponding percent-
age of effort. The higher the percentage of revenue compared to the percentage of effort, the better. An equal ratio indicates a provider is only getting out what they put in and margins are suffering. In those cases, where the revenue ratio is less than the effort ratio, further analysis is required as there are significant problems. Looking at panels this way helps identify scheduling issues quickly. The next step would be to look at specific pro-vider workflow issues such as shorter patient revisit intervals or the number of days a provider is booked for patient visits.
Summary: Besides the br ief panel size analysis above, there are many other physician practice performance drivers, where panel size financial analysis can be applied by today’s healthcare financial manager. Some of the more established uses are:
Adjusting for physician productivity: If a physician, whose bed-side manner creates longer office visits, resulting in a patient panel size that is 90 percent of the practice’s bench-mark patient panel size, their compensation might be adjusted to reflect this.
Predicting practice overhead: Patient panels can be used to budget or analysis demand for
tests, procedures and even some hospital stays based on age, sex and payor considera-tions.
Improving patient outcomes: Providers, who identify with their own patients, take owner-
ship of them through their patient panels, are able to make the commitment to continuous quality care, which leads to reduced costs or increased revenue or both.
The ability to extract key performance measures from a practice’s patient panel size by physi-cian, based on their individual scope of practice, patient mix and office hours can only improve future Hospital/Physician relationships. Michael Ehlen is a managing partner with M&E Healthcare Financial Advisor Group located in Hilton Head, South Carolina. He is a current member of the South Carolina HFMA chapter. If you have any questions regarding this article or hospital-physician alignment issues, Michael can be reached at [email protected]
Michael Ehlan
EMERALD LEVEL
HELP Financial
RUBY LEVEL
SAPPHIRE LEVEL
CBCS Credit Management Company
Gray, Griffith & Mays, CPA’s
The SSI Group, Inc.
PEARL LEVEL
Collection Service Center, Inc.
JP Recovery Services, Inc.
National Hospital Collections
Revenue Cycle Solutions, LLC
United Collection Bureau, Inc.
**This list of sponsors is based upon sponsorship renewals received at the time of this publication**
Median deductibles for marketplace healthcare insurance under the Affordable Care Act (ACA) have fallen to $850 this year from $900 in 2015, the Centers for Medicare and Medi-caid Services (CMS) said Tuesday.
CMS said the drop was attributed to the fact that “about 60 percent of 2016 HealthCare.gov Marketplace consumers qualify for financial assistance that reduces their deductibles, out-of-pocket maximums, and other cost-sharing ob-ligations.”
The federal agency also reported that “for the first time in our nation’s history, the uninsured rate last year fell below 10 percent,” with 20 million more people owning health coverage in the six years since enactment of the ACA.
In a data brief that often strikes a defensive tone, CMS writes, “Unlike many insurance pol-icies sold before the Affordable Care Act was enacted, all Marketplace plans have out-of-pocket limits that protect consumers from cata-strophic costs.” Calling its findings “consistent with other data showing that Marketplace policies are provid-ing consumers with access to care and financial protection,” CMS adds, “These facts may seem surprising given anecdotes about Marketplace policies with very high cost sharing.”
Other data cited in the CMS brief include:
Nearly one-third of Marketplace enrollees (32 percent) have deductibles less than or equal to $250, but 44 percent bear deductibles that exceed $1,000, with 17 percent of enrollees paying deductibles of $5,000 or more
Marketplace policies on average cover sev-en common healthcare services (most often ge-neric drugs and primary care visits) with no or low cost-sharing before consumers meet their deductibles
Marketplace consumers are overwhelming-ly choosing silver plans – which generally in-clude higher premiums, but lower cost sharing – in lieu of bronze plans, which generally offer the lowest premiums “These data show that the promise of the Af-
fordable Care Act is being realized for millions
of Americans,” CMS said. “It wasn’t that long
ago when too many of our friends and neigh-
bors were locked out of health coverage be-
cause it was too costly or because of a preexist-
ing condition. The Affordable Care Act
changed that.”
Chris Nerney July 13, 2016
Autumn Rogers
Title: Accountant
Company: Grant Memorial Hospital
City/State: Petersburg, WV 26847
Work Phone: (304) 257-1026
E-mail: [email protected]
Dan Given
Title: Associate
Company: Arnett Carbis Toothman LLP
City/State: Charleston, WV 25301-1500
Work Phone: (304) 346-0441
E-mail: [email protected]
Marie Buffy
Title: Audit Senior Associate
Company: Arnett Carbis Toothman, LLP
City/State: Clendenin, WV 25045-8012
Work Phone: (304) 346-0441
E-mail: [email protected]
Autumn Heaster
Title: Manager, ADT/ Registration
Company: United Hospital Center
City/State: Bridgeport, WV 26330-9006
Work Phone: (681) 342-1714
E-mail: [email protected]
Holly L. Sabatino
Title: Financial Administrator
Company:
WVU Medicine - WVU Heart & Vascular Institute
City/State: Morgantown, WV 26505-2201
Work Phone: (304) 598-4922
Email: [email protected]
WV HFMA Fall Institute— Sep 28—30, 2016 Waterfront Place, Two Waterfront Place, Mor-
gantown, WV
Fall Revenue Cycle Meeting—Oct 19, Days Inn Conference Center, Flatwoods
Region IV MidAtlantic Meeting— Nov 13—15, Grove Park Inn, 209 Macon Ave, Asheville, NC
Upcoming Live Webinars
Learn about timely healthcare finance topics and earn CPEs. Most live webinars are free
for HFMA members and $99 for non-members, unless otherwise noted. Become a mem-
ber today!
Aug 17, 2016
—2016 Proposed Rule Changes to the Outpatient and Ambulatory Service Center Payment Systems
Sep 10, 2016
—Aligning Physicians to Improve Reimbursement, Reduce Denials, and Enhance Regulatory Compliance
Feb 17, 2017
—Bridging the Clinical and Financial Divide for a New Era of Health Care
For more events visit HFMA webpage at http://www.hfma.org/
Advisory Past President Belinda Bennett, Lisa Simmons Keith Morgan, Jim Holden, Jan Strope Awards Dianna Cessa Belinda Bennett, Becky Hammer, Okey Silman, Ryan Lindsay Financial Review Outgoing President Whitney Patterson Webmaster Lisa Simmons Sponsorship Joan Namey Newsletter Laura Adkins Program and Entertainment Cindy Linger-Long Joe Barnes, Okey Silman, Dianna Marcia Leighton Cesa, Jamie DeMuth, Becky Hammer, Tony Rumberg Ryan Lindsey, Lynsey Berg, Chad Wright, Joan Namey, Leah Klinke, Lisa Simon, Patricia Weese, Whitney Patterson, Joshua Tuck, Kyle Pierson, Chris Rawlings, Debbie Kincell, Susan McDonald, Belinda Bennett, Laura Adkins Certification Ryan Lindsey Certification Contact Ryan Lindsey DCMC Contact Joe Barnes Founders Contact Dianna Cesa Nominating Lisa Simmons Okey Silman Revenue Cycle Tony Rumberg Jr. Link Ryan Lindsay Membership Linda Dugan Social Media Marcia Leighton Ryan Lindsay Communication Chair Leah Klinke Volunteer Belinda Bennett Ryan Lindsay
Comittee Name Chair Members
E
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The Republican party has been constant in its call for repeal of the Affordable Care Act, and the 2016 plat-
form re-affirms its view that healthcare needs less government involvement.
But President Obama is now urging Congress to re-consider a public healthcare plan that would compete with private insurers in parts of the U.S. with limited options for consumers. He outlined his views in a lengthy paper published in the Journal of the Ameri-can Medical Association to go beyond the Affordable Care Act (ACA).
“The Affordable Care Act has made significant pro-gress toward solving long-standing challenges facing the U.S. health care system related to access, afford-ability, and quality of care,” Obama wrote. “Despite this progress, too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewilder-ing system; and remain uninsured. More work to re-form the health care system is necessary.”
The president said he expects tools created by the ACA – such as the Center for Medicare and Medicaid Innovation and the Accountable Care Organization program – will continue to play “centrals roles in this work,” along with the Medicare Access & CHIP Reau-thorization Act of 2015 (MACRA).
While the Centers for Medicare and Medicaid Ser-vices (CMS) has said MACRA is designed to ease the burden of compliance and reporting requirements under meaningful use, it has been criticized by some providers and provider organizations as continuing in the wrong direction.
Noting that 12 percent of marketplace enrollees live in areas with fewer than three health insurance pro-viders, Obama suggested that lawmakers reconsider a public plan to fill the gap in available options.
“Some parts of the country have struggled with lim-ited insurance market competition for many years, which is one reason that, in the original debate over health reform, Congress considered and I supported including a Medicare-like public plan,” he wrote. “The public plan did not make it into the final legislation. Now, based on experience with the ACA, I think Con-gress should revisit a public plan to compete along-side private insurers in areas of the country where competition is limited.”
Obama said a public plan would provide affordable options to consumers in areas with few insurers while also helping the federal government save money on healthcare.
In contrast, the Republican platform proposes a limit on federal requirements on both private insurance and Medicaid, explaining “For most Americans, those who are insured now or who seek insurance in the future, our practical, non-intrusive reforms will pro-mote flexibility in State leadership in healthcare re-form, promote a free-market based system, and em-power consumer choice. All of which will return direc-tion of the nation’s healthcare to the people and away from the federal government." The party endorses block grants for Medicaid and state programs.
"We believe that taking care of one’s health is an
individual responsibility," the platform reads. "Chronic
diseases, many of them related to lifestyle, drive
healthcare costs, accounting for more than 75 per-
cent of the nation’s medical spending. To reduce de-
mand, and thereby lower costs, we must foster per-
sonal responsibility while increasing preventive ser-
vices to promote healthy lifestyles.
Chris Nerney July 19, 2016
Ryan Lindsay, CPA CHFP
President, Certification Chair, LINK Committee Chair, Social Media Co-Chair
Gray Griffith & Mays
707 Virginia Street East—Suite 400
Charleston, WV 25301-2788 Phone: (304) 345-9400 Email: [email protected]
Joe A. Barnes, CPA
President Elect, DCMS Contact, Founders Contact
Grant Memorial Hospital
117 Hospital Drive
Petersburg, WV 26847-9566 Phone: (304) 257-5802 E-mail: [email protected]
Rebecca J. Hammer
Past President, Certification Co-Chair
Davis Health System
PO Box 1484
812 Gorman Avenue
Elkins, WV 26241-1484 Phone: (304) 637-3156 Email: [email protected]
Whitney R. Patterson
Treasurer
Fairmont Regional Medical Center
1325 Locust Ave
Fairmont, WV 26554-1435 Phone: (304) 367-7109 Fax: (304) 333-6295 E-mail: [email protected]
Dianna L. Cesa
Secretary, Awards Chair
WVU Healthcare
PO Box 8031
Morgantown, WV 26506-8031 Phone: (304) 598-6376 E-mail: [email protected]
James J. DeMuth
Board of Director 2nd Year
Healthcare Financial Services
1204 Kanawha Blvd. E.
Charleston, WV 25301-2900 Phone: (304) 388-6865 Fax: (304) 345-4323
E-mail: [email protected]
Leah S. Klinke
Board of Director 2nd Year, Communications Chair
WVU Hospitals
1 Medical Center Drive
Morgantown, WV 26506 Phone: (304) 598-4032 x74198 E-mail: [email protected]
Lisa Marie Simon
Board of Director 2nd Year
Ohio Valley Hlth Services & Educ. Corp.
2000 Eoff Street
Wheeling, WV 26003-3823 Phone: (304) 234-8407 E-mail: [email protected]
Jill Griffith
Board of Director 1st Year
Arnett Carbis Toothman
155 East Broad Street Suite 2100
Columbus, OH 43215 Phone: (614) 223-9209 Email: [email protected]
Marcia Leighton
Program Chair, Social Media Chair
Patient Matters
518 South Magnolia Ave. 3rd Floor
Orlando, Florida 32801 Phone: (817) 228-9593 Email: [email protected]
Cindy L. Linger-Long
Program Co-Chair
Grant Memorial Hospital
PO Box 1019
Petersburg, WV 26847-1019 Phone: (304) 257-5815 x2161 E-mail: [email protected]
Tony D. Rumberg
Revenue Cycle Co-Chair
Charleston Area Medical Center
130 – 138 57Th St., Building 3
Charleston, WV 25304 Phone: (304) 388-1145 E-mail: [email protected]
Joan M. Namey
Sponsorship Chair
Healthcare Financial Services
1204 Kanawha Blvd E
Charleston, WV 25301-2900 Phone: (304) 388-6802 Fax: 304-345-4323
E-mail: [email protected]
Laura A. Adkins
Newsletter
5658 Deepwater Mountain Road
Fayetteville, WV 25840
Phone: (304) 575-0398 E-mail: [email protected]
Linda R. Dugan
Membership Chair
Linda R. Dugan
Monongalia General Hospital
1200 J. D. Anderson Dr
Morgantown, WV 26505-3494 Phone: (304) 285-2690 E-mail: [email protected]
Belinda Bennett
Volunteer Chair
Plateau Medical Center
430 Main Street
Oak Hill, WV 25901 Phone: (304) 469-8620 E-mail: [email protected]
Lisa Ann Simmons
Webmaster
WVU Healthcare
231 Wayland Street
Morgantown, WV 26505 Phone: (304) 598-6247 E-mail: [email protected]
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