Booming Demand: How Urgent Care Centers are Impacting Hospital Operations

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The construction and use of urgent care centers in the health care industry has steadily increased over recent years. The growing popularity of urgent care centers presents an opportunity for hospitals to extend networks or expand partnerships in order to reach new clientele. Further, it offers an opportunity to enhance brand recognition in new and existing markets. According to the Urgent Care Association of America (UCAOA), urgent care dates back to the late 1970s and was created with the intention of meeting a community’s immediate health care needs. It was a slow but steady start for urgent care in the beginning, but the concept of seeing a physician without an appointment eventually began to gain popularity among patients. Over the past 20 years, the urgent care industry has continued to expand and earn the trust of those seeking a safe and affordable place to receive medical attention. Today, urgent care centers are physician-staffed and typically offer extended hours (evenings and weekends), providing quality care without the costs and wait times associated with the average emergency room (ER) visit. Urgent care centers are best suited for situations that require more immediate attention; often times, this serves to be more practical than seeing a primary care provider, who can be challenged with offering consumers the hours or immediacy an illness or accident can demand. Why the Increase in Popularity? There are various drivers behind the recent growth of urgent care. The UCAOA estimates that growth has been steady the last several years,…

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Medicare Certification Process – Setting the Stage for Success

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According to a 2015 Comprehensive Error Rate Testing (CERT) Report recently released by the Centers for Medicare and Medicaid Services (CMS), “the denial rate for Skilled Nursing Facilities (SNFs) increased from 6.9% to 11% due to missing or incomplete certification/recertification.” A certification that the beneficiary requires daily skilled care that can only be provided in a SNF/swing bed setting is key to Medicare Part A coverage and claim approval. The SNF must obtain and retain the certification and recertification statements as Medicare Administrative Contractors or other Medicare contractors may request them as part of a medical review to determine if SNF services were reasonable and necessary. CMS does not require a specific format for the certification or recertification process but does have a list of requirements that need to be met for the resident’s stay to be deemed valid. The certification process is not the same as an order to admit to the SNF or an order for a skilled level of care. A separate statement indicating the resident will require on a daily basis SNF covered skilled care is required. The initial certification must be obtained at the time of admission, or as soon thereafter as reasonable and practicable. BKD recommends the physician certification be signed within the first two days of admission. Faxed signatures are acceptable. The initial certification must clearly indicate that; Skilled nursing or rehabilitation services are required on a daily basis, The services can only be provided in the SNF or swing bed hospital on…

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Embracing Change: Issues regarding the potential re-designation of Critical Access Hospitals to Free-standing Rural Emergency Centers

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While an estimated 19% of the US population lives in rural areas, 54% of all traffic fatalities occur in these geographic areas as opposed to urban areas1. For persons living in rural areas, a closed hospital means farther travel, even hours, for care. This is simply not an option for cardiac issues, workplace injuries, or automobile accidents. Today, critical access hospitals face a three-pronged challenge of high volumes of uninsured and underinsured patients, declining reimbursements from government payers, and a sharp decline in census for inpatient services. While Rural Health providers face continual challenges, the same cannot be said for the nation’s free-standing emergency departments than now number at over 500 sites. Most are affiliated with a large hospital system and serve as a feeder for patients needing inpatient care. Also, these EDs are usually located within 20 miles of a full-service hospital, typically located in more affluent suburban areas to target privately insured patients2. The same can be said of Urgent Care Centers that cherry-pick locations based on socio-economic factors such as rates of commercially insured residents. So, the prospect of a large for profit ED or Urgent care center opening in a rural community to compete with the local CAH is near non-existent. As a result, Critical Access Hospitals are the only option for persons seeking both emergency and urgent care. Nearly twenty years have passed since the Critical Access Hospital designation was created as part of the Balanced Budget Act of 1997 in response to a string…

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President’s Message

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Dear HFMA South Texas Colleagues, It has been an honor and a privilege to serve as your 2016-2017 President. I can’t believe how quickly the time goes. I was just starting to get the hang of this president thing and we are almost through our fiscal year. First, I would like take this opportunity to recognize the many people who make it possible for the South Texas Chapter to continue to THRIVE. To our sponsors, none of this could be done without your support, THANK YOU! To the officers, board, committee chairs, co-chairs and volunteers, I am grateful for the time and talents you all continue to contribute. To the past presidents, your support, encouragement and advice has meant more than you know. It takes an inspired team to coordinate and facilitate the programs and initiatives we deliver and I am lucky to be a small part of it. As we look back on this past year, we held fantastic educational and networking opportunities for our members-most recently, Healthcare Landscape 2017, our annual joint conference with the South Texas Chapter of ACHE and the Greater San Antonio Healthcare Foundation. The speakers included Mary Mirabelli, HFMA National Chair and Vice Admiral Raquel C. Bono, United States Navy, Director, Defense Health Agency, Medical Corps. The HFMA Texas State Conference was back in Austin this year with great educational sessions and a networking event at Maggie Mae’s on 6th Street that bowled people over. Thank you to John Knighten, John Montaine and David…

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President’s Message

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Dear HFMA South Texas Colleagues, Happy New Year everyone! I hope 2017 is a year full of good health, opportunities, success and fun. As I get older I can’t believe how time goes by so fast. We are halfway through our fiscal year and it feels like we just started. As we look back on the last three months, the South Texas Chapter continues to THRIVE! We had a fantastic Region 9 meeting in New Orleans in November. Thanks to John Montaine and David Glazener for representing South Texas on the Region 9 planning committee. If you missed it, you missed a great time. Also, our Leadership Forum was held Jan. 20 at the Blanton Art Museum in Austin. The meeting was filled with interesting healthcare and leadership topics. The Forum ended with a guided tour of the museum and a networking event at Sholtz Beer Garten. I want to thank Chairman John Knighten and the program committee for all its hard work. We ask you to invite a colleague to join HFMA. We include the membership goal, set by National, and progress in each newsletter so you can see how we are doing. Please help us meet our membership goal by renewing your membership or sponsoring a colleague. This can be done online at www.hfma.org/membership. Membership satisfaction is also tracked. Thank you to those who took the time to complete the membership satisfaction survey. We value your feedback! We have many exciting programs scheduled in the upcoming months. Healthcare Landscape…

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Focusing on Patient Care: The Final Rule

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For the approximately 16,000 nursing home operators across the country, increased scrutiny and constant realignment have become a way of life. And if trying to prepare for a new administration that is likely to enact significant regulatory and reimbursement changes in the near future wasn’t enough, long-term care providers also end 2016 with a new 700-page rule from the Centers for Medicare & Medicaid Services (CMS). The new rule, commonly referred to as either “The Final Rule” or the “Rules of Participation,” is a series of guidelines and requirements for long-term care facilities that receive Medicare or Medicaid funding. The guidelines will be implemented in three phases. The first phase was initiated on Nov. 28, 2016, phase two will be implemented by Nov. 28, 2017, and phase three will be implemented by Nov. 28, 2019 (Figure 1). The goal of the new regulations is to continue the advancement of service delivery and safety that has occurred over the past several years, as well as put in place a series of mechanisms designed to achieve improvements in quality of care while simultaneously attempting to reduce burdens on providers. The new regulations represent the most comprehensive update in decades. The first time Medicare and Medicaid requirements were published by CMS was in 1989, and although there have been periodic revisions since then, this is the most thorough overhaul since 1991. Clearly, the health care industry has experienced substantial changes in care delivery in the past decades, so the Final Rule’s arrival has…

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Healthcare IT Spending on the Rise

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Survey finds top drivers of healthcare IT investment are improving patient experience and engagement In an era of digital natives, new technological solutions to healthcare challenges appear almost daily. Not surprisingly, two-thirds of hospitals report increased tech budgets for this fiscal year. Additionally, over a quarter of hospitals have seen more than a 5 percent increase. A recent survey* by First American Healthcare Finance, in partnership with the American Hospital Association, identified this rise in budgeting for hospital and health system information technology. Where Are Healthcare Organizations Investing? With endless possibilities, where are providers investing IT? In 2016, First American met with over 700 unique healthcare organizations to learn about their top investment priorities. Out of 900+ projects, top IT investments fell into four buckets: Infrastructure to run operations and keep data safe with server, software, and wireless infrastructure upgrades. Communication to make verbal and digital flow of information more efficient, using tablets, iPhone, nurse call systems, EMR upgrades, and telehealth. Patient monitoring devices to boost preventative care using heart failure prevention devices (necklaces, wristbands, and watches), nutrition tracking devices and apps, and food scanners. Revenue generating items such as da Vinci robots, hybrid operating rooms, cutting-edge ultrasound and imaging equipment, artificial intelligence in robots, and 3D bio-printing. In the past, technology in healthcare organizations meant a handful of computers, some digital monitoring equipment, and a few pieces of imaging equipment. In today’s healthcare environment, technology has never been more aligned with every aspect of the patient experience. Additionally, as…

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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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