Becker’s lists major obstacles providers must overcome in 2019 and meeting CMS’ minimum requirements for price transparency won’t help

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Hospital compliance with CMS’ price transparency rule has been a mixed bag since January 1. Some have published chargemasters on their home pages while others have buried the lists deeper within the sites requiring users to hunt. And others? Well, according to an article in Modern Healthcare, “In the case of Sutter Health, the information appeared on the system’s website as a blob of incomprehensible script. A Sutter spokeswoman said the data was published in the .JSON format, which she called “a machine-readable format that complies with the rule.”[1]

Regardless of the way the chargemaster is published, even when they find the list, consumers aren’t getting the help that CMS envisioned. Publishing prices according to the letter of the law will make a hospital compliant. But will it attract new business? Or will incomprehensible scripts chase people away to another hospital who is publishing meaningful prices that make sense and actually help consumers understand what their costs will be?

Publishing chargemaster prices, even if it’s on your website’s homepage, isn’t going to pull people toward you.

There is a better way and it’s an easy, quick one to implement. HealthQRS offers a solution where hospitals publish actual pricing that people can access from an app on their phones. This app can serve as a marketing tool for your hospital and help you beat out your competition. You’ll be compliant, you’ll win the game and, in the process, collect your money upfront.

In addition to consumer backlash from chargemaster lists, hospitals face major obstacles in 2019 as outlined in a recent article in Becker’s Hospital Review by Scott Becker and Molly Gamble:

“Hospitals face many different headwinds. This goes into the concept of healthcare as a zero-sum game. There is only so much pie to be shared, and the hospital slice of pie is being attacked or threatened in various areas.”[2] Becker and Gamble list nine headwinds facing hospitals, and we recommend reading the article in its entirety. HealthQRS can help you with at least these four headwinds mentioned in the article:

Bricks and Mortar

HealthQRS can help you cut costs on bricks and mortar by expanding your services to include telemedicine and make it easily accessible from an app.

Slowing Rises in Reimbursement– Federal and Commercial

HealthQRS can help you focus on getting paid for the services you are rendering to patients with high deductibles by implementing a system that allows you, at the time of scheduling, to collect full payment, or at the very least, set up payment plans with consumers.

Lower Commercial Mix

HealthQRS can help you grow your commercial mix by attracting employers. If you help employers lower their healthcare costs, you’ll gain market share. You can do this by offering employers an e-commerce site for their employees that allows them to shop, schedule and pay for services from an easy-to-use app. HealthQRS offers this service, and our solution helps keep employees in network.

The Loss of Ancillary Income

HealthQRS can help you build and market your own, local, centers-of-excellence by contracting with employers to gain the business of their employees.

 Consumerism is here. Use it to stay in the game. Use it to market yourself to patients, to employers/employees, and promote your higher profit margin procedures to improve revenues and operating margins.

HealthQRS’ solution allows you to provide consumers with what they want: A true retail experience in healthcare. HealthQRS has developed the only complete e-commerce platform for healthcare on the market. We give consumers a site that allows them to use their smartphone, tablets or computers to shop, schedule and pay for services and medications and see actual pricing and options based on their health plans and networks. Our solution is simple to use. We invite you to see for yourself with this 2-minute video of the HealthQRS price transparency tool. Click on this link, then you’ll be instructed to download and watch: https://s3.amazonaws.com/hqrs.media/_misc/Screen+Recording+2018-11-29+at+17.30.45.mov

Our solution will help you comply with CMS’ price transparency rule, but we are much more than a price transparency tool. Our platform has over 30 modules that work independently or all together depending upon your needs to provide a holistic, seamless, total experience for the consumer from start to finish. We combine navigation, the capability to make an appointment, referral management (if needed), payment management and so much more than we can list here.

HealthQRS’ price transparency tool allows you to publish price as well a downloadable readable file that shows realistic pricing, not the charge master or incomprehensible scripts.  In addition, we can provide out-of-pocket pricing. Our solution can also capture the user’s information, such as name, email address and phone number.

We enable telehealth connectivity as well. Our technology enables people to connect to more cost-effective, consumer-oriented healthcare options and we keep them in-network. HealthQRS integrates fully to your EHR and can also enhance your existing portals and other patient engagement solutions and improve your meaningful use numbers and increase meaningful use funds. Consumers can access your retail site and shop, schedule and pay for your services via an easy-to-use app on their smartphones or tablets.

We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. HealthQRS can provide this to you for as low as $500 per month and we can have you compliant by January 1, and not only that, your facilities will be much more attractive to consumers than your competition who is publishing charge master prices.

Developing a solution of this magnitude didn’t happen overnight. We started with the consumer experience in mind and spent years drawing on the knowledge of best-of-breed experts to perfect, fine tune and put together this complicated, yet complete solution for medical e-commerce.

In fact, HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We also invite you to watch our user-friendly app video that you can use to win consumers as well as our point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information.

Contact us right now to schedule a personalized demo. We can help you publish compliant pricing. We can help you face the headwinds. Even more, we can help you give consumers what they want. And that will keep them coming back to you.

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[1] Harris Meyer, “Hospitals vary in publishing CMS chargemaster prices,” Modern Healthcare, Jan. 7, 2019, https://www.modernhealthcare.com/article/20190107/TRANSFORMATION04/190109931?utm_source=modernhealthcare&utm_medium=email&utm_content=20190107-TRANSFORMATION04-190109931&utm_campaign=am

[2] Scott Becker and Molly Gamble, “Healthcare as a zero-sum game: 7 key points,” Becker’s Hospital Review, Dec. 19, 2018, https://www.beckershospitalreview.com/hospital-management-administration/healthcare-as-a-zero-sum-game-7-key-points.html

 

Consumers not buying hospital listed prices

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CMS’ rule on price transparency took effect January 1, but so far, patients aren’t seeing positives from prices published by hospitals. News outlets around the country are reporting negative patient experiences from confusing price lists. It seems that regardless of where you live, figuring out how much your healthcare is actually going to cost hasn’t gotten any easier.

Savannah, GA:

“The prices on Memorial’s website will be the same price you see on St. Josephs Candler’s website but, that’s not the price you’ll pay.

If you have insurance you will most likely pay a lower price negotiated by your employer. That price depends on things like the procedure and specialty.

‘We need an understanding you know it’s vital to our health care services,’ said Gwendolyn Green, a registered nurse.

Green said even as a nurse healthcare pricing is confusing. ‘I mean we should not be left in the dark trying to figure out what’s what and going to Google and trying to Google and find out and you know what it is and what I should and shouldn’t do that’s not essential to our overall healthcare and I mean besides that adds more stress to whatever it is that we are already going through,’ said Green.”[1]

Louisville, KY:

“A federal mandate requiring hospitals in Kentucky and throughout the United States to reveal their once-secret master price lists still leaves patients in the dark.

The government required hospitals to make these lists available to the public with the Affordable Care Act in 2010, but until this week, hospitals were not required to publish them. The prices are now online, but figuring out how much that bag of saline or a medical sensor actually costs is a much different story. It’s buried in pages upon pages of prices, listed with names most don’t know and won’t understand.

‘We have our doubts as to what value it will actually bring to the consumer,’ said Carl Herde, vice president of finance for the Kentucky Hospital Association and the former CFO of Baptist Health. “We think there are better ways to help inform the consumer.’”[2]

Chicago, IL:

“As of Jan. 1, people can find a comprehensive list of medical procedures on all hospital websites, including DMH, HSHS St. Mary’s and Memorial Medical Center.

Area hospitals have almost 2,000 procedures listed on them, but they aren’t in any particular order. They aren’t alphabetized or put into a certain category – rather, they are organized by CPT codes.

‘The problem is, it’s hard to understand the different charges and procedures and how does that interplays with insurance,’ Roszehart said.

According to Roszehart, CPT codes are codes put out by the American Medical Association.

Even though the lists are aimed at being beneficial to patients, when insurance and other factors are accounted for, prices can change or even increase.

‘This was a good first step, but it’s only a first step and it’s not a particularly useful first step,’ Roszehart said. ‘The charges are exactly what an individual will see.’”[3]

Nashville, TN:

“The costs on Vanderbilt University Medical Center’s website is tricky to find.

First, on the main page, you go to patient and visitor info. Click on financial assistance. Then, you’ll see a tab on the left side of the screen that says “our charges.”  Click on another link that says “view list of charges.”  Then agree to terms and conditions, enter in a valid email address.

Once you’ve done all that, you’ll find a complete list of charges for drugs, supplies, and other standard charges for hospital procedures.”[4]

There’s a better way

There is a way to comply with the price transparency rule AND satisfy patients’ need to know their costs. Why not put a price list together that helps, rather than hurts you? Something the consumer can actually use, that won’t put them off, but will attract them to you.

People want to know what their costs are actually going to be. They want to know if there are discounts for pre-payment. Are there terms? Do they qualify for charity?

HealthQRS can help you provide actual pricing and all of the bells and whistles that consumers expect from any shopping experience.

HealthQRS’ price transparency tool allows you to publish price as well a downloadable readable file that shows realistic pricing, not the charge master.  In addition, we can provide out-of-pocket pricing. Our solution can also capture the user’s information, such as name, email address and phone number.

We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. HealthQRS can provide this to you for as low as $500 per month and we can have you price-transparency compliant, and not only that, your facilities will be much more attractive to consumers than your competition who is publishing charge master prices.

We also have a smartphone application that consumers can use to shop, see actual costs, schedule and pay for services with a few finger taps. Our solution is simple to use. We invite you to see for yourself with this 2-minute video of the HealthQRS price transparency tool. Click on this link, then you’ll be instructed to download and watch: https://s3.amazonaws.com/hqrs.media/_misc/Screen+Recording+2018-11-29+at+17.30.45.mov

HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We also invite you to watch our user-friendly app video that you can use to win consumers as well as our point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information. Contact us right now to schedule a personalized demo and be compliant by January 1.

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[1] Alex Bozarjian, “Hospitals must post prices online starting Jan. 1,” WSAV, Jan 2, 2019, https://www.wsav.com/news/local-news/hospitals-must-post-prices-online-starting-jan-1/1684066834

[2] Gilbert Corsey, “Patients confused as Louisville-area hospitals post inflated prices online,” WDRB, Jan 4, 2019, https://www.wdrb.com/news/patients-confused-as-louisville-area-hospitals-post-inflated-prices-online/article_6097985a-0f98-11e9-b586-8bc972461ab8.html

[3] Madison O’Brien, “New price transparency in hospitals seems not so transparent with patients,” WANDTV, Jan. 2, 2019, https://www.wandtv.com/news/new-price-transparency-in-hospitals-seems-not-so-transparent-with/article_5dd6203a-0ee1-11e9-8e61-ef13930779f1.html

[4] Edward Burch, “New law requires hospitals to show procedure prices online” WSMV, Jan 2, 2019, https://www.wsmv.com/news/new-law-requires-hospitals-to-show-procedure-prices-online/article_2d8115c0-0ec8-11e9-9692-ebb468023b4a.html

Ignoring consumerism leads to lower volume. AHA and HFMA offer a few tips on how to share prices with consumers

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Revenue loss after revenue loss. Losses getting bigger each year. Financial woes for hospitals in the U.S. are nothing new. But things are getting worse and showing no signs of improving. Take LifePoint Health and Community Health Systems. Two huge hospital systems whose revenues have dropped and losses have grown and each year reveals a bleaker picture.

According to an article in Becker’s Hospital Review, “LifePoint’s financials were affected by lower patient volume. The company said admissions, inpatient surgeries, outpatient surgeries and emergency room visits all declined year over year in the first quarter of 2018. After factoring in operating expenses and one-time charges, LifePoint ended the first quarter of this year with a net loss attributable to the company of $8.8 million. That’s compared to the first quarter of 2017, when the company posted net income of $59.9 million.”[1]

HealthCareDive reported that Community Health Systems third quarter net operating revenues had a decrease of 5.9% from the year before, a massive shareholder loss of $325 million, (a $215 million greater loss than the year before). “Lower volume was partially to blame, as the quarter saw a 12.4% decrease in total admissions and a 12.2% decrease in total adjusted admissions compared with the same period in 2017.”[2]

Then there are the community hospitals. Almost every week we see reports of bankruptcies and closures. Community hospitals make up 85% of all hospitals in the country.[3] What is happening to our healthcare systems? Why is the situation so dire?

U.S. hospital systems continue to ignore the reality of consumerism in healthcare. And yet, consumerism IS a major part of healthcare and it’s here to stay. People vote with their feet, with convenience and price dominating their choices. Portals and websites are not effective and do not provide a retail experience. For outpatient services, the choices are growing, hitting hospitals with more and more competition.

Walmart, already a player in healthcare, has just announced plans to build clinics in their parking lots, yet one more nail in healthcare systems’ coffins. A Walmart spokesperson told Business Insider, “We envision a more robust and dynamic shopping experience that combines entertainment venues, curated local food vendors, health and fitness services as well as recreational opportunities in a way that connects and engages with the community.”[4]

Convenience and price. Two of the main factors that draw consumers. Walmart and Amazon have perfected these drawing cards. Providing consumers with the Amazon retail experience in healthcare is a way to combat the myriad of disrupters and competition facing traditional hospital systems.

Consumers are the new payers in healthcare and they are worried about the high costs of healthcare and tired of not being able to get a straight answer about the cost before services are rendered. Many are either putting off healthcare services or not able to pay once they receive them. According to a survey referenced in Becker’s Hospital Review, “twenty-seven percent of respondents with children said they delayed care in the last two years because they couldn’t afford it.” [5]  And 46% of people “said they would be concerned about their ability to cover an unexpected medical expense of $1,000 or more.”[6] That’s up from 39% just last year.

The upcoming price transparency rules by CMS are just the beginning of regulations within healthcare that the administration is putting into place to help consumers. Are you going to take the path of least resistance and publish a charge master? That might satisfy the government, but it will scare off the consumer who has more options than ever before.

To help hospitals prepare for price transparency, The American Hospital Association published a price toolkit, and part of it contains suggestions from the Healthcare Financial Management Association (HFMA) to prepare for price transparency. One tip stood out to us because it helps people easily find the prices:

Consider how care purchasers will access the information you provide. Price information might be publicly posted on a website, made available on a password-protected website (e.g., for health plan members), or made available in response to an inquiry submitted via website or made by phone. However you plan to provide access to price information, make sure that patients can easily find out how to get it.”[7]

HealthQRS provides the way to publish prices on a website that can be easily accessed by people. We have the platform to help you with this and we can have you ready to go in a matter of weeks.

RevCycleIntelligence also published tips for providers to improve their price transparency.[8] We can help with each one:

  1. Prepare for Hospital Price Transparency

HealthQRS allows you to provide actual prices, not just estimates, in an easy-to-use smartphone app where people can stay in network, shop for services, schedule with you, and pay for those services right from the app. You can set business rules to allow for discounts based on early payments, charity, and whatever else you wish to structure.

  1. Consider a Bundled Pricing Strategy

Our solution allows you to bundle pricing. This helps avoid surprise billing, which, in turn, allows for more satisfied patients. It also ensures that more providers actually receive their money.

  1. Educate Staff on How to Discuss Prices and Patient Financial Responsibility

Our point-of-service solution has interactive, intuitive scripts that your scheduling department, registrars and front-office staff can use to discuss prices and patient responsibility. Discounts can be offered at scheduling and check-in, and staff members can instantly see actual patient responsibility, not just estimates.

  1. Implement Price Transparency Tools

Within a few weeks, we can have your entire system up and running with fully-implemented price transparency tools. We go beyond just providing a transparency tool to meet CMS requirements. We allow you to meet the requirements, and we provide an easy-to-use retail platform that gives consumers the Amazon retail experience. Our solution integrates fully with your EHR and allows you to provide meaningful use numbers as well.

As you face mounting competition, your hospital system does not have to succumb like the others. You can offer people a better experience. You can give them the Amazon retail experience in healthcare and HealthQRS can help you do it right now.

HealthQRS can set you up with a full retail site right now. Our platform is ready and we can help you proactively publish prices and beat the competition who is digging in their heels waiting for the forced mandates. Walmart could even use our platform for their employees and their customers.

HealthQRS provides you with the infrastructure to create an online experience for consumers including accurate pricing (not just estimates). We enable telehealth connectivity as well. Our technology enables people to connect to more cost-effective, consumer-oriented healthcare options and we keep them in-network. HealthQRS integrates fully to your EHR and can also enhance your existing portals and other patient engagement solutions and improve your meaningful use numbers and increase meaningful use funds.

HealthQRS is the perfect vertical application for integrated delivery networks. We provide regulation compliance and serve as a marketing tool for your facilities. In addition, HealthQRS allows you to be compliant with the new CMS transparency rules beginning Jan. 1, 2019.

We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. We also have a smartphone application that consumers can use to shop, see actual costs, schedule and pay for services with a few finger taps.

HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We invite you to watch our user-friendly app video that you can use to win consumers. We also have a point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information. Why not contact us right now to schedule a personalized demo?

Walmart is ready to snap up consumers looking for alternatives because they are giving them an easy healthcare shopping experience. You need to be giving your consumers that same level of customer service if you want to compete.

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[1] Ayla Ellison, “LifePoint slips to $8.8M net loss as admissions decline,” Becker’s Hospital Review, May 4, 2018, https://www.beckershospitalreview.com/finance/lifepoint-slips-to-8-8m-net-loss-as-admissions-decline.html

[2] Rebecca Pifer, “CHS sees massive Q3 net loss amid weak volume, aftershocks of HMA settlement,” HealthCareDive, Oct. 30, 2018, https://www.healthcaredive.com/news/chs-sees-massive-q3-net-loss-amid-weak-volume-aftershocks-of-hma-settlemen/540868/

[3] Brooke Murphy, “50 things to know about the hospital industry | 2017,” Becker’s Hospital Review, Jan. 25, 2017, https://www.beckershospitalreview.com/hospital-management-administration/50-things-to-know-about-the-hospital-industry-2017.html

[4] Áine Cain, “Walmart is building ‘town centers’ in its parking lots – and it could redefine the one-stop shop,” Business Insider, Oct. 26, 2018, https://www.businessinsider.com/walmart-town-centers-parking-lots-2018-10

[5] Kelly Gooch, “27% of families are putting off medical care because of costs, survey finds,” Becker’s Hospital Review, Oct. 30, 2018, https://www.beckershospitalreview.com/finance/27-of-families-are-putting-off-medical-care-because-of-costs-survey-finds.html

[6] Gooch, “27% of families,” Becker’s Hospital Review, Oct. 30, 2018, https://www.beckershospitalreview.com/finance/27-of-families-are-putting-off-medical-care-because-of-costs-survey-finds.html

[7] American Hospital Association, “Achieving Price Transparency for Consumers: A Toolkit for Hospitals,”: “Preparing for Price Transparency: A Five-Point Checklist,” Healthcare Financial Management Association, http://www.ahacommunityconnections.org/content/14transparency-5ptchecklist.pdf

[8] Jacqueline LaPointe, “4 Strategies for Providers to Improve Hospital Price Transparency,” RevCycleIntelligence, June 4, 2018, https://revcycleintelligence.com/news/4-strategies-for-providers-to-improve-hospital-price-transparency

 

Patient portals aren’t saving the healthcare industry. The Amazon experience could.

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All over the country, hospitals are succumbing to unsustainable business models. Since Jan. 1, 22 hospitals have either closed or filed for bankruptcy. Larger providers like Ascension and Cleveland Clinic are also suffering from poor financial results. Blame is placed on many factors. But we suggest there is a common thread running through the financial devastation in healthcare: the failure to embrace consumerism and give people the Amazon experience in healthcare.

Many hospital leaders will say they are, in fact, doing everything they can to enhance patient satisfaction. They will show you their patient portals and the patient engagement efforts they have put in place. But notice the language: they are still calling their customers “patients.” And their answer to “patient engagement” is to give people portals.

People want to be treated like consumers, and money spent on portals simply isn’t paying off. Even though by 2015 nearly 90 percent of eligible providers and hospitals offered patients access to portals, by 2017, according to the Government Accountability Office (GAO), only “15 percent of eligible providers and 30 percent of hospitals saw any patients view, download, or transmit their patient portal data.”[1]

Portals are not a match for – or replacement of – an ecommerce platform that gives patients an Amazon experience in healthcare. They are not e-commerce platforms. People want to more than access their records. They want the ability to shop for services, see actual prices, schedule the services and pay (or at least make a down payment) from their smartphones. If they can also access their records from the same app, and communicate with their providers, and even see a teledoc, so much the better.

The HealthQRS app does all that. The HealthQRS ecommerce platform fully integrates with existing EHRs, allows patients to access their records, allows them to shop for healthcare services, and provides them the Amazon experience in healthcare.

A feature article about portals in Patient Engagement HIT says that “organizations are exploring how to leverage additional patient engagement technologies and feature to supplement the capabilities of patient portals and create seamless, holistic experiences for users.”[2] Really? With portals?

If providers are truly looking to create great experiences for users, then start treating those users like consumers and give them a retail experience in healthcare.

HealthQRS is not a replacement for EHRs. We are a complement that adds incredible value to the EHR.

We can partner and integrate with any EHR system to make it be everything you need it to be. We provide the front-end, retail shop at the point-of-service while your EHR continues to provide the necessary clinical and behind-the-scenes back office tools. We can be the value-added solution that provides a seamless experience, from start-to-finish, for your consumers and your employees. And, with HealthQRS there is no duplication of entry. Your staff doesn’t have to enter the same information into different legacy systems. We merge everything together behind-the-scenes and provide an easy-to-use retail experience for consumers and an easy point-of-service experience for your staff.

For example, many provider employees have to re-key everything they do because they don’t have one solution that automatically converges different systems. HealthQRS automatically posts payments to EHR systems. We automatically verify insurance, medical necessity, charity, our system can send all of that to your EHR.

HealthQRS gives you what you need to compete on many levels. Our solution provides people a full retail experience in healthcare just like they are used to receiving from Amazon for retail goods. From their smartphones, consumers can search for services and procedures in their network, see true prices – not just estimates – schedule the service, search for discounts, pay for the service or set up payment plans, find transportation, receive appointment alerts, wellness alerts, and even see a doctor via telemedicine. You name it. We offer it.

HealthQRS provides you with the infrastructure to create an online experience for consumers including accurate pricing (not just estimates). We enable telehealth connectivity as well. Our technology enables people to connect to more cost-effective, consumer-oriented healthcare options and we keep them in-network. HealthQRS integrates fully to your EHR and can also enhance your existing portals and other patient engagement solutions and improve your meaningful use numbers and increase meaningful use funds.

HealthQRS is the perfect vertical application for integrated delivery networks. We provide regulation compliance and serve as a marketing tool for your facilities. In addition, HealthQRS allows you to be compliant with the new CMS transparency rules beginning Jan. 1, 2019.

We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. We also have a smartphone application that consumers can use to shop, see actual costs, schedule and pay for services with a few finger taps.

HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We invite you to watch our user-friendly app video that you can use to win consumers. We also have a point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information. Why not contact us right now to schedule a personalized demo? Move beyond portals and give people what they really want. Treat them like consumers.

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[1] Sara Heath, “Moving Beyond the Portal with Patient Engagement Technologies,” Patient Engagement HIT, https://patientengagementhit.com/features/moving-beyond-the-portal-with-patient-engagement-technologies?eid=CXTEL000000260100&elqCampaignId=7078&elqTrackId=9b618c67503a467cb8ba9e2e737d0d83&elq=2c277b53f5b444fc855b17bb07adc73c&elqaid=7497&elqat=1&elqCampaignId=7078

[2] Heath, “Moving Beyond the Portal,” https://patientengagementhit.com/features/moving-beyond-the-portal-with-patient-engagement-technologies?eid=CXTEL000000260100&elqCampaignId=7078&elqTrackId=9b618c67503a467cb8ba9e2e737d0d83&elq=2c277b53f5b444fc855b17bb07adc73c&elqaid=7497&elqat=1&elqCampaignId=7078

Moody’s reports ‘unsustainable path’ for hospital systems. Cleveland Clinic, Ascension and Verity are proof

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Number one rule of successful business: profits must exceed losses. Yet for hospitals, the opposite has been happening for several years. And it’s not just community hospitals. The big boys are taking major hits. If they are suffering, everyone is.

Take Verity Health Systems’ recent Chapter 11 bankruptcy filing. According to CEO Richard Adcock in the company’s bankruptcy announcement, “‘After years of investment to assist in improving cash flow and operations, Verity’s losses continue to amount to approximately $175 million annually on a cash flow basis,’ and more than $1 billion overall.”[1]

Financially struggling Ascension has joined the ranks of other major health systems to divest, selling off a Washington-based hospital as it moves toward a long-term strategy in outpatient care. HealthCareDive reports huge losses for Ascension:

For the first nine months of FY2018, Ascension Health reported year-over-year drops in operating income ($282 million from $749 million) and revenue ($17.09 billion from $17.15 billion) as it undergoes restructuring. The system has divested hospitals, cut leadership and dropped ancillary businesses, saving $400 million in administrative costs and hoping to cut $61 million in that area over the next fiscal year.”[2]

Then there’s Cleveland Clinic, one of the most renowned and well-known hospital systems. This giant saw its operating income spiral down by 80% due to increased expenses.[3]

Verity, Ascension and Cleveland Clinic join the ranks of other large providers experiencing huge losses in operating income. You cannot indefinitely spend more than you earn and expect to survive. Yet so many hospitals are doing just that, prompting Moody’s to state that nonprofit hospitals are on an “unsustainable path” and report: “Not-for-profit and public hospitals spent more than they gained in revenues for the second consecutive year in fiscal 2017.”[4] A bad rating from Moody’s puts hospitals in an even more precarious situation because bonds will become more expensive for them, making their loans pricier than if they were healthy.

When you look at closures, the writing is on the wall. Over the past five years, 2.5% of all hospitals closed. A recent Morgan Stanley report puts that figure in perspective, stating that “about 18% of more than 6,000 hospitals studies were at a risk of closure or are performing weakly. About 8% of studied hospitals were at risk of closing and 10% were called “weak,’ according to that report.

Why are hospitals failing? Moody’s attributes part of it to “lower reimbursements, the shift to outpatient care, increased M&A activity and additional ambulatory competition.”[5] Moody’s also noted that the trend in moving away from inpatient to outpatient services is into its fifth year.

Competition among providers is more than simply ambulatory. Many corporations are fed up with rising costs and are directly contracting with providers. The news of JPMorgan, Amazon and Berkshire Hathaway is one of many such arrangements. Comcast is another large company directly contracting with providers. And the company is seeing major savings. By going direct, Comcast has seen yearly cost increases in its healthcare expenditures of only one percent in the past five years as compared with 10% increases of one-fifth of the nation’s other big companies, according to an article in HealthCareDive. [6] The article cites that by going direct, companies strive to ”step up their cost management strategies and replace the traditional employer-insurer-provider model with an employer-provider relationship.”[7]

Shift to outpatient. Going direct by big corporations. At the heart of it? Consumerism. When consumers account for 30% of hospital revenue – and they have choices in where they go – the pressure mounts to an irreversible tide. Follow the money. People spend it with providers who make it easy for them, who give them the Amazon experience in healthcare. Math doesn’t lie.

If businesses contract with your competitor, you’ve lost. You’ve got to get into this game and you need the infrastructure to do it.

HealthQRS gives you what you need to compete on many levels. Our solution provides people a full retail experience in healthcare just like they are used to receiving from Amazon for retail goods. (And it’s not a portal because employers don’t want their employees to be forced into portals.) From their smartphones, consumers can search for services and procedures in their network, see true prices – not just estimates – schedule the service, search for discounts, pay for the service or set up payment plans, find transportation, receive appointment alerts, wellness alerts, and even see a doctor via telemedicine. You name it. We offer it.

HealthQRS provides you with the infrastructure to create an online marketplace that provides a full retail experience for consumers including accurate pricing (not just estimates). We enable telehealth connectivity as well. Our technology enables people to connect to more cost-effective, consumer-oriented healthcare options and we keep them in-network. HealthQRS integrates fully to your EHR and can also enhance your existing portals and other patient engagement solutions. Our user-friendly app points them to your portals which will improve your meaningful use numbers and increase meaningful use funds.

HealthQRS is the perfect vertical application for integrated delivery networks. We provide regulation compliance and serve as a marketing tool for your facilities. In addition, HealthQRS allows you to be compliant with the new CMS transparency rules beginning Jan. 1, 2019.

We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. We also have a smartphone application that consumers can use to shop, see actual costs, schedule and pay for services with a few finger taps.

HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We invite you to watch our user-friendly app video that you can use to win consumers. We also have a point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information. Why not contact us right now to schedule a personalized demo? Follow the money and it will lead you to consumers. We can help you win them and keep them.

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[1] Rebecca Pifer, “California’s Verity system files bankruptcy, faces $175M in annual losses,” HealthCareDive, Sept. 4, 2018, https://www.healthcaredive.com/news/californias-verity-system-files-bankruptcy-faces-175m-in-annual-losses/531524/

[2] Samantha Liss, “Ascension exits Northwest with sale of Washington hospital,” HealthCareDive, Sept. 6, 2018, https://www.healthcaredive.com/news/ascension-exits-northwest-with-sale-of-washington-hospital/531663/

[3] Meg Bryant, “Cleveland Clinic’s operating income plummets 80% in Q2,” HealthCareDive, Aug. 31, 2018, https://www.healthcaredive.com/news/cleveland-clinics-operating-income-plummets-80-in-q2/531364/

[4] Les Masterson, “Nonprofit hospitals ‘on an unsustainable path,’ Moody’s says,” HealthCareDive, Aug. 30, 2018, https://www.healthcaredive.com/news/nonprofit-hospitals-on-an-unsustainable-path-moodys-says/531245/

[5] Les Masterson, “Nonprofit hospitals ‘on an unsustainable path,’ Moody’s says,” HealthCareDive, Aug. 30, 2018, https://www.healthcaredive.com/news/nonprofit-hospitals-on-an-unsustainable-path-moodys-says/531245/

[6] Rebecca Pifer, “Amazon-Berkshire-JPM healthcare venture picks COO,” HealthCareDive, Sept. 5, 2018, https://www.healthcaredive.com/news/amazon-berkshire-jpm-healthcare-venture-picks-coo/531618/

[7] Rebecca Pifer, “Amazon-Berkshire-JPM healthcare venture picks COO,” HealthCareDive, Sept. 5, 2018, https://www.healthcaredive.com/news/amazon-berkshire-jpm-healthcare-venture-picks-coo/531618/

Ascension’s new strategy embraces consumerism

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For several months now, we’ve been asking how hospitals and other service providers plan to survive and compete in this disruptive market. Ascension has made news with its multi-layered strategic plan to do just that. One of the giants is waking up to the fact that traditional methods of healthcare delivery are changing, and they need to evolve their model. Part of Ascension’s strategy is to become less hospital-centric and to invest in telemedicine services as well as expand its reach in the revenue-cycle arena.

Aetna, Humana, UnitedHealth and now Anthem pulling out of healthcare markets will drive consumerism

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With Aetna, Humana, UnitedHealth and now Anthem pulling out of many insurance exchanges we could be looking at a bare market soon and the risk is growing with uncertainty about the fate of ACA. This will lead to more bad debt and self pay. With self pay comes heavy reliance on the consumer. And to keep the consumer happy, you need a great consumer experience. Think Amazon. The Amazon consumer experience is the standard for today’s shopper.