Wednesday, November 14, 2012

Health insurance policy and indirect methodologies for cost control


Last week the Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2013 Home Health Prospective Payment System. The rule includes rate reductions as well as complex new requirements for re-assessment and coding.

It is only a 298 page document that requires accountants, lawyers, and politicians to interpret but don't worry.

It has been interesting in the last week to read email and press releases from therapy staffing agencies who are struggling to process the changes associated with the new CMS rules in addition to the realities of aspects of the Affordable Care Act which has impact on health benefits they need to offer to their own employees.  These staffing agencies took a double hit this past week so if you know anyone who owns one of these agencies or functions as a manager of these services I strongly suggest you offer them Advil, a shoulder to cry on, or perhaps a long vacation.

Normally I am not a big fan of 'travel' therapy or temporary therapy staffing agencies, but even I am moved to sympathy for these organizations.  Yesterday I received a press release from a staffing company (who will not be named, because it is NOT their fault) and they announced that new hires will be subject to contracts that are less than 30 hours per week as well as reduction in reimbursements.  I called them to ask what their motivation was for the 30 hours per week limitation and the poor person who answered the phone danced and spun in circles trying to explain how they hope to have a more 'flexible' workforce and if a new hire wants more than 30 hours they will have to do it in more than one facility and that may require additional travelling.  Also, if they want those health care benefits they will need to be more 'flexible' with their scheduling and go to multiple facilities.  Now this really confused me because last I knew the Affordable Care Act was going to mean people could keep their health insurance and that it was going to create 400,000 jobs immediately and 4 million jobs in total...

or something like that. Oh well.

Maybe they didn't mean for health care providers?  Maybe they meant jobs for people who write 298 page rules??  And the wizards we all need to hire to interpret the rules???

Anyway, I am thinking that the best answer to all this is for therapists and health care agencies to begin altering their expectations for reimbursement in a broad sense.  After seeing the 298 page document from CMS that tells me how much money I can bill for and what hoops I need to jump through in order to obtain that reimbursement, I am thinking that it will be more profitable to just see people who have Medicare for free.  That way I will avoid the costs with trying to read, understand, and comply with ever-increasing bureaucratic demands and it will leave me free to watch C-Span so I can listen to politicians tell me  how good my life is going to be.

Anyone with me on this???

1 comment:

Barbara TherExtras said...

I'm with you, Chris.

Your last 2 paragraphs are exact correct.