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Swing-Bed Considerations for Rural Hospitals in providing Skilled Nursing Care

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Abstract Swing-beds are one approach to addressing two problems in rural communities: the shortage of nursing home beds and the decline in rural hospital occupancy. In the past, swing-bed demonstration hospitals have shown the greatest potential for quality improvement compared to nursing homes in providing a continuum of care.   Background A national swing-bed program was first authorized in the 1980 Omnibus Budget Reconciliation Act allowing Medicare reimbursement of swing-bed care in rural hospitals with fewer than 100 beds. The term “swing bed” is used to describe the level of care hospitalized patients receive once they are no longer in need of acute care. Swing bed admissions are limited to patients who require some level of skilled nursing care and are currently in a hospital acute care bed. Patients cannot be admitted to a swing bed from either the community or a skilled nursing facility unless they have spent three days in an acute care hospital bed for related needs within the past 30 days. Swing beds are generally limited to 40 days per patient under state law . Rural hospital leaders may be quick to blame Medicare and federal regulations for their collective financial crisis, but the biggest reasons so many rural hospitals are in danger of closing is because they simply do not have enough inpatients . Since the passage of ACA there has been a further downward utilization trend and subsequent cash flows issues in small rural hospitals. Increased out of pocket expenses for healthcare, associated with…

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President’s Message

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Dear HFMA South Texas Colleagues, Fall is here and that should mean leaves changing and cooler weather but that is not the case in South Texas. What it does mean is football, so whether you follow high school, college or professional football I hope your team is having a successful season. This fall a much more vicious sport is taking place, the presidential campaigns. I for one am glad it is nearly over. Remember Nov. 8 is Election Day, please get out and vote. As we look back on the last three months, the South Texas Chapter continues to THRIVE! We are coming off of two very successful joint meetings; the HFMA/ACHE Summer Institute held Aug. 25 at the Seton Administration Offices in Austin and the HFMA/TAHFA Fall Symposium held Sept. 12-13 at the Embassy Suites Riverwalk in San Antonio. Both meetings were filled with education around trending healthcare topics as well as plenty of networking opportunities. I want to thank Chairman John Knighten and the program committee for all their hard work. I also want to thank Lisa Keffer and Robbie Connell for an outstanding networking event held Sept. 10 at Top Golf in San Antonio. If you missed it, you missed a great time. If you have not renewed your membership, please take a moment to do so. You can renew online at www.hfma.org/membership. Being a member has advantages including free national and regional webinars, great educational sessions, fun networking opportunities and a variety of other valuable resources. Please…

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The Telephone Consumer Protection Act (TCPA) and Calling Cell Phones

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By: Med A/Rx Under the Telephone Consumer Protection Act (TCPA), calling cell phone numbers using an “automatic telephone dialing system” can cause legal problems for providers and revenue cycle companies trying to contact patients to pay their outstanding account balance. The TCPA (47 U.S.C. 227, 47 CFR 64.1200) prohibits the use of an “automatic telephone dialing system” to contact “any telephone number assigned to a …cellular telephone service” without “express prior consent” from the party being called. More than two-fifths of American homes (45.4%) had cell phones and no landline phones in the 2nd half of 2014 – a 4.4% increase from a year prior, and double since 2008. About 44.1% of all adults (106 million) lived in wireless only homes — and the same for 54.1% of all children (40 million children). In addition, a sixth of American homes (14.9%) still had a landline, but received all or almost all calls on their cell phones.1 To reduce the risk of legal fees associated with calling cell phones, we suggest adding the following language to your current MEDICAL TREATMENT AUTHORIZATION AND CONSENT FORM: You agree, in order for us to collect any amounts you may owe, we or an associated third party may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or e-mails, using any e-mail address you provide to us. Methods of contact may include…

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Presidential Positions: Where the Candidates Stand on Health Care, Housing

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In seemingly every presidential election, we are told by pundits and politicos that this particular contest represents the starkest choice between two vastly opposed ideologies that we’ve seen in decades. The future, your kid’s future and your grandchildren’s future, depends on its outcome. Some may argue that such hyperbole is an understatement this year, and, whether that’s true or not, one thing is clear—this election gives voters the choice between the known and the unknown. If Secretary Hillary Clinton wins, the nation will likely stay on its current path—a pursuit of incremental change shaded by Democratic ideologies. If Donald Trump wins, no one is quite sure what will happen, although a look at his proposals and the GOP’s 2016 platform provides some insight. Health Care Clinton has made it clear she believes in upholding and improving the Affordable Care Act (ACA). Her website lists several other health care policies including: • Expanding Medicare by lowering eligibility age from 65 to 55 • Lower prescription drug costs by requiring drug companies to invest in research and development in order to receive taxpayer support • Incentivize states to expand Medicaid (no specifics given) • Allow families to buy insurance on the health exchanges regardless of immigration status • Identify ways to make providers eligible for telehealth reimbursement under Medicare • Expand federally qualified health centers and rural health clinics • Double funding for primary-care community health centers All this amounts to what would be a hefty expansion of the ACA and would…

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Healthcare Consumerism Study Shows Patients Need Financing Options

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Where patient satisfaction was once solely measured from a clinical standpoint, patients are increasingly judging and rating their satisfaction with healthcare organizations by the amount of repeat business and referrals they bring. Since 1992, ClearBalance has partnered with health systems to provide consumer-centric affordable care while improving net recovery of patient pay and overall financial performance. We recently conducted a study to measure awareness, loyalty and satisfaction with that program. The second annual Healthcare Consumerism Study was sent out in August, completed by nearly 2,700 patients. Of those survey respondents, healthcare cost was undeniably a concern: 79 percent stated that it was a factor when selecting a physician, and 81 percent stated the same when choosing a healthcare provider. Relative to their cost concerns, one out of every three consumers stated they would delay care if a loan program wasn’t made available to them. So, while cost is a factor for patients when selecting a specific physician or healthcare provider, the availability of a loan program is still critical in the decision-making process. One survey respondent said, “It’s helpful not to have to pay a large, unexpected medical bill all at once.” This seemed to be a common opinion amongst respondents, as an overwhelming 91 percent stated that healthcare was an expense that required financing of more than 12 months. Of those who use the ClearBalance program, more than half reported their annual insurance deductible to be $3,000 or less. Seventy-two percent of respondents depended on their employer-provided insurance to…

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President’s Message

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Dear HFMA South Texas Chapter Colleagues, I am honored to serve as President of the South Texas Chapter for the 2016-2017 year. I want to thank the membership for the privilege of leading the chapter this year. I also want to thank outgoing President, Clint Owen, for his dedication and innovative ideas over the last year. Clint has set some very high standards, demonstrating what it takes to lead with passion and commitment. As a testament to Clint’s and last year’s board’s leadership the South Texas Chapter was awarded four awards at last month’s ANI Annual Chapter Awards Dinner — A Multi-Chapter award for the Region 9 networking event; A John M. Stagl Silver Award of Excellence for education; A Bronze Award of Excellence for membership growth and retention and a Helen M. Yerger Award for membership. As our new year begins the one thing that stays constant is change! Our chapter has, and will continue, to make significant changes to ensure we deliver — what you — our members need to be successful both personally and professionally. With a strong board, officer team and committee volunteer base, I am confident we will continue to be an indispensable resource for our membership. I am excited to tell you about a couple of new offerings: We now have a South Texas Chapter smartphone app! The app will enable you to communicate with chapter members and get real time/interactive information from the chapter. You can search the app stores for “hfma south…

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Millennials Force Healthcare in Digital Direction

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Millennials raised in the digital age with the convenience of online services are driving healthcare providers to change how they engage with patients and improve the customer service aspect of care. While older generations value in-person communication and cultivating relationships with medical professionals, millennials desire a different approach. Accustomed to instant gratification, millennials don’t want to phone in for an appointment and then wait weeks to see a doctor. Nor do they like to be locked in to health plan network restrictions. They often will search online for healthcare information, even before seeing a doctor. A key finding in a global survey of over 3,000 people is that millennials tend to select doctors based on referrals from family and friends. But while older patients express dissatisfaction directly to doctors, millennials share unsatisfactory experiences with friends, often on a social network. The survey also revealed that this generation is likely to trust social feedback, handing providers another challenge. Not only do providers need an online presence, they must monitor and manage their social reputation. Millennials aren’t tied to the notion that they must have one specific doctor; they don’t develop personal relationships with them. For standard checkups and consultations, some don’t feel the need to see a doctor at all, opting instead to see a physician assistant or nurse practitioner. They don’t want to spend hours at a doctor’s office for minor medical complaints. Part of this is due to millennials being generally healthy; pressing health concerns typically are for accidents…

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The Hospital Accelerator Model

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Evolving reimbursement models, the Affordable Care Act and the activation of patients as consumers are among the major drivers of anticipated disruption to the provider landscape. This shifting financial, regulatory and patient preference has led to not only industry veterans attempting to recalibrate ways of doing business, but has also notably attracted outside entrepreneurs and capital vying to establish a presence in a massive industry ($1.5 trillion was spent on hospitals, physicians and clinics in 2013, according to the Kaiser Family Foundation) that historically has had large barriers to entry. StartUp Health reported  that capital flows for digital health increased from $1.2 billion in all of 2010 to $4.7 billion in the first three quarters of 2015. Despite all the above tailwinds, however, adoption of new business models has been relatively slow. A number of factors must be overcome, including: Cultural Differences: Many new entrants come from outside industries, such as technology. Current health care leaders may question new players’ understanding of the intricacies of health care, including fund flows, the level of control any one entity has over an entire episode of care, privacy, compliance, etc. New entrants, for their part, may view incumbents as slow adopters who have not faced the sort of innovation-driving market competition seen in other industries. Both viewpoints have merit. Financial Incentives: While the Centers for Medicare and Medicaid Services (CMS) is moving toward value-based reimbursement models such as shared savings or capitated payments, many (if not all) regions of the country are still…

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