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Objective We describe our experience in implementing enterprise-wide standardized structured reporting for chest radiographs (CXRs) via change management strategies and assess the economic impact of structured template adoption. Methods Enterprise-wide standardized structured CXR reporting was implemented in a large urban health care enterprise in two phases from September 2016 to March 2019: initial implementation of division-specific structured templates followed by introduction of auto launching cross-divisional consensus structured templates. Usage was tracked over time, and potential radiologist time savings were estimated. Correct-to-bill (CTB) rates were collected between January 2018 and May 2019 for radiography. Results CXR structured template adoption increased from 46% to 92% in phase 1 and to 96.2% in phase 2, resulting in an estimated 8.5 hours per month of radiologist time saved. CTB rates for both radiographs and all radiology reports showed a linearly increasing trend postintervention with radiography CTB rate showing greater absolute values with an average difference of 20% throughout the sampling period. The CTB rate for all modalities increased by 12%, and the rate for radiography increased by 8%. Discussion Change management strategies prompted adoption of division-specific structured templates, and exposure via auto launching enforced widespread adoption of consensus templates. Standardized structured reporting resulted in both economic gains and projected radiologist time saved.

The pandemic is shaking up health care delivery and markets. And it's an election year.

Health policy is often designed to help protect patients' financial security. However, there is limited understanding of the role medical debt plays in household finances. We used credit report data on more than four million Americans to study the age profile of people whose medical bills were sent to a US collections agency in 2016. We found that, unlike health care use and spending, medical collections decreased substantially with age. The average size of medical debt decreased nearly 40 percent from patients age twenty-seven to sixty-four, with increases in health insurance coverage and incomes likely playing important mediating roles. However, the frequency of medical collections-that is, the proportion of people with a collection by age-was less closely tied to insurance coverage rates. A potential explanation is that most medical collections were relatively modest in size, with more than half of them less than $600 annually. As a result, medical collections could still occur under typical insurance plans. We discuss how these results could inform policies targeting medical debt and insurance regulation, such as restrictions on age rating.

On the island Nation of Guam, the United States Department of Defense has stationed military personnel from every service branch. Guam is utilized as a strategic waypoint for the U.S. military in the Pacific theater. As the largest service branch in the region, the Navy has placed a few Diving Medical Officers in Guam to collectively manage and treat patients with recompression therapy. Guam is also a popular tourist destination, with multiple recreational diving companies certifying individuals who are looking to take advantage of the beautiful warm water and exotic marine life. Unfortunately, with an increase in training and certifying inexperienced divers, came an increase in the operational tempo of the U.S. Navy’s recompression chamber on Guam. The recompression chamber on Naval Base Guam (NBG) has been treating patients since 1971. With the only multiplace chamber in the Mariana Islands, Diving Medical Officers, with the accompanying chamber staff, treat military personnel, active-duty sponsored patients and civilian patients. Treating civilian patients by military providers through military treat- ment facilities presents multiple issues that must be addres- sed in an effort to provide efficient quality medical care. This article reviews the records, documents, and activity of the NBG chamber over the last four decades. Through the obtained data the information provides projected financial reimbursement from civilian patients. The article also sheds light on areas of needed improvement with regard to data collection, third-party financial collection efforts and the necessity of an inclusive electronic health record (EHR) for military and civilian patients.

Background Consumer credit may reflect financial hardship that patients face due to cancer treatment, which in turn may impact ability to manage health after cancer; however, credit’s relationship to economic burden and health after cancer has not been evaluated. Methods From May to September 2015, 123 women with a history of breast cancer residing in Pennsylvania or New Jersey completed a cross-sectional survey of demographics, socioeconomic position, comorbidities, SF-12 self-rated health, economic burden since cancer diagnosis, psychosocial stress, and self-reported (poor to excellent) credit quality. Ordinal logistic regression evaluated credit’s contribution to economic burden and self-rated health. Results Mean respondent age was 64 years. Mean year from diagnosis was 11.5. Forty percent of respondents were Black or Other and 60% were White. Twenty-four percent self-reported poor credit, and 76% reported good to excellent credit quality. In adjusted models, changing income, using savings, borrowing money, and being unable to purchase a health need since cancer were associated with poorer credit. Better credit was associated with 7.72 ([1.22, 14.20], p = 0.02) higher physical health t-score, and a − 2.00 ([− 3.92, − 0.09], p = 0.04) point change in psychosocial stress. Conclusions This exploratory analysis establishes the premise for consumer credit as a marker of economic burden and health for breast cancer survivors. Future work should validate these findings in larger samples and for other health conditions. Implications for Cancer Survivors Stabilizing and monitoring consumer credit may be a potential intervention point for mitigating economic burden after breast cancer.

Introduction New Brunswick (NB)'s Regulation 84-20 has historically restricted funded abortion care to procedures deemed medically necessary by two physicians and performed in a hospital by an obstetrician-gynecologist. However, on January 1, 2015, the provincial government amended the regulation and abolished the "two physician rule." Objectives We aimed to document women's experiences obtaining abortion care in NB before and after the Regulation 84-20 amendment; identify the economic and personal costs associated with obtaining abortion care; and examine the ways in which geography, age and language-minority status condition access to care. Methods We conducted 33 semistructured telephone interviews with NB residents who had abortions between 2009 and 2014 ( n =27) and after January 1, 2015 ( n =6), in English and French. We audiorecorded and transcribed all interviews and conducted content and thematic analyses using ATLAS.ti software to manage our data. Results The cost of travel is significant for NB residents trying to access abortion services. Women reported significant wait times which impacted the disclosure of their pregnancy and the gestational age at the time of the abortion. Further, many women reported that physicians refused to provide referrals for abortion care. Even after the amendment to 84-20 , all participants reported that they were required to have two physicians approve their procedure. Conclusions The funding restrictions for abortion care in NB represent a profound inequity. Amending Regulation 84-20 was an important step but failed to address the fundamental issue that clinic-based abortion care is not funded and significant barriers to access persist. Implications NB's policies create unnecessary barriers to accessing timely and affordable abortion care and produce a significant health inequity for women in the province. Further policy reforms are required to ensure that women are able to get the abortion care to which they are entitled.

OBJECTIVES To determine the mean, median and 10th and 90th percentile levels of fees and out-of-pocket costs to the patient for an initial consultation with a consultant physician; to determine any differences in fees and bulk-billing rates between specialties and between states and territories. DESIGN, PARTICIPANTS AND SETTING Analysis of 2015 Medicare claims data for an initial outpatient appointment with a consultant physician (Item 110) in 11 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, geriatric medicine, haematology, immunology/allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology). MAIN OUTCOME MEASURES Mean, median, 10th and 90th percentile levels for consultant physician fees and out-of-pocket costs, by medical specialty and state or territory; bulk-billing rate, by medical specialty and state/territory. RESULTS Bulk-billing rates varied between specialties, with only haematology and medical oncology bulk-billing more than half of initial consultations. Bulk-billing rates also varied between states and territories, with rates in the Northern Territory (76%) nearly double those elsewhere. Most private consultations require a significant out-of-pocket payment by the patient, and these payments varied more than fivefold in some specialties. CONCLUSION Without data on quality of care in private outpatient services, the rationale for the marked variations in fees within specialties is unknown. As insurers are prohibited from providing cover for the costs of outpatient care, the impact of out-of-pocket payments on access to private specialist care is unknown.

The Centers for MedicareMedicaid Services requires hospitals to give patients an array of documents to explain their rights, their status, and any financial obligations they may incur — and it’s usually up to case managers to see that the hospital complies. •The Medicare Outpatient Observation Notice (MOON) is the latest requirement, but the Important Message (IM) from Medicare also is required under the Medicare Conditions of Participation. In order to bill patients for services that are incurred but not covered, hospitals also must give patients a Hospital Issued Notice of Noncoverage (HINN). •If the documents are delivered at the proper time, they could affect the hospital’s reimbursement, increase the risk of audit, and affect patients’ understanding of their rights and responsibilities. •The entire treatment team should be aware of the documents and intentions. Education on delivering these documents should be part of case management orientation and regular education. •Hospitals should develop a process for delivering HINNs if the need arises. Before that happens, case managers should communicate frequently with the patient and family about the next level of care. •Patients may demand that their status be changed from observation to inpatient, but they can’t be admitted unless they meet inpatient criteria.

Now that Geisinger is confident in the payment process for providers, it will continue to innovate new ways to improve the member experience. The goal is to be not just one of the top companies for members and not just one of the top health care organizations, but one of top organizations among all the companies in the United States.

Background: In recent years, the UK debt collection industry has taken steps to improve its policies and practices in relation to customers with mental health problems. Little data, however, have been collected to evidence change. Aims: This paper examines whether the reported attitudes and practices of debt collection staff when working with customers with mental health problems have changed between 2010 and 2016. Method: This paper draws on descriptive and regression analyses of two cross-sectional surveys of debt collection staff: one conducted in 2010 and one conducted in 2016. Results: All variables analysed show statistically significant changes between 2010 and 2016 indicative of improved reported attitudes and practices. Conclusions: While results suggest an improvement in attitudes and practice may have occurred between 2010 and 2016, research is required to understand this potential shift, its likely causes, and concrete impact on customers.

Trinitas Regional Medical Center generated more than $1 million by identifying missed billing opportunities.

Novant Health’s zero-interest loan program allows patients to add new healthcare service fees to existing balances.

Data evolution is forcing revenue cycle silos to crumble. And that's a good thing.

The Houston-based health system has implemented new workflows and technology in 14 of its hospitals and across its care delivery network to make the payment process more patient-friendly and build consumer loyalty.

Messages specific to balance due amounts allow hospitals to tailor wording and payment options based on high or low balances.

By using the same income threshold for charity care eligibility across health system partners, one system isn't being favored because of its generous charity care policy.

Extensive testing and strong analytics helped one Alabama health system stay on top of collections when it converted to a new EHR.

Part of the hospital's strategy is to focus on small balances that make a big impact on the bottom line.

Preparation is key to limiting revenue dips.

This study, based on a survey conducted in 2008, examines how combining microcredit, microinsurance, and health care provision can improve access to quality care in the health zone of Bandalungwa, in Kinshasa. The bivariate analysis showed a significant association between increased purchasing power and earnings (p = 0.001), between earnings and savings (p = 0.000), and between health insurance and improved access to health care. These results show that 68.8% of borrowers reported an increase in their purchasing power, of whom 82% reported profits. Those with savings were 24.7 times more likely to purchase health insurance than those without; and 72% of those who regularly made health insurance payments improved their access to care. Combining microcredit, health microinsurance, and health care can improve access to quality health care at lower cost. This suggests that health insurance could usefully be integrated into the primary health-care system.

New Internal Revenue Service rules that ostensibly limit harsh hospital billing practices provide inadequate protection for many patients by excluding for-profit hospitals and allowing hospitals to determine eligibility for financial assistance.

HIV has disproportionately affected economically vulnerable populations. HIV medical care, including antiretroviral therapy, successfully restores physical health but can be insufficient to achieve social and economic health. It may therefore be necessary to offer innovative economic support programs such as providing business training and microcredit tailored to people living with HIV/AIDS. However, microfinance institutions have shown reluctance to reach out to HIV-infected individuals, resulting in nongovernment and HIV care organizations providing these services. The authors investigate the baseline characteristics of a sample of medically stable clients in HIV care who are eligible for microcredit loans and evaluate their business and financial needs; the authors also analyze their repayment pattern and how their socioeconomic status changes after receipt of the program. The authors find that there is a significant unmet need for business capital for the sample under investigation, pointing toward the potentially beneficial role of providing microfinance and business training for clients in HIV care. HIV clients participating in the loans show high rates of repayment, and significant increases in (disposable) income, as well as profits and savings. The authors therefore encourage other HIV care providers to consider providing their clients with such loans.

The purpose of this study was to measure the effects of use of a structured physician order entry system for trauma CT on the communication of clinical information and on coding practices and reimbursement efficiency.This study was conducted between April 1, 2011, and January 14, 2013, at a level I trauma center with 59,000 annual emergency department visits. On March 29, 2012, a structured order entry system was implemented for head through pelvis trauma CT, so-called pan-scan CT. This study compared the following factors before and after implementation: communication of clinical signs and symptoms and mechanism of injury, primary International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) code category, success of reimbursement, and time required for successful reimbursement for the examination. Chi-square statistics were used to compare all categoric variables before and after the intervention, and the Wilcoxon rank sum test was used to compare billing cycle times.A total of 457 patients underwent pan-scan CT in 2734 distinct examinations. After the intervention, there was a 62% absolute increase in requisitions containing clinical signs or symptoms (from 0.4% to 63%, p0.0001) and a 99% absolute increase in requisitions providing mechanism of injury (from 0.4% to 99%, p0.0001). There was a 19% absolute increase in primary ICD-9-CM codes representing clinical signs or symptoms (from 2.9% to 21.8%, p0.0001), and a 7% absolute increase in reimbursement success for examinations submitted to insurance carriers (from 83.0% to 89.7%, p0.0001). For reimbursed studies, there was a 14.7-day reduction in mean billing cycle time (from 68.4 days to 53.7 days, p=0.008).Implementation of structured physician order entry for trauma CT was associated with significant improvement in the communication of clinical history to radiologists. The improvement was also associated with changes in coding practices, greater billing efficiency, and an increase in reimbursement success.

Although regional variations in Medicare spending are known, it is not clear whether regional variations exist in hospital charges for total joint arthroplasty. Data from Centers for Medicare and Medicaid Services (CMS) on Diagnosis Related Groups 469 and 470 (Major Joint with and without Major Complicating or Comorbid Condition) from 2011 were analyzed for variation by region. Drastic variations in charges between institutions were apparent with significant differences between regions for hospital charges and payments. The median hospital charge nationwide was $71,601 and $46,219 for Diagnosis Related Groups 469 and 470, respectively, with corresponding median payments of $21,231 and $13,743. Weak to no correlation was found between hospital charges and payments despite adjustments for wage index, cost of living, low-income care and teaching institution status.

Maternity care in Ukraine is a government priority. However, it has not undergone substantial changes since the collapse of the Soviet Union. Similar to the entire health care sector in Ukraine, maternity care suffers from inefficient funding, which results in low quality and poor access to services. The objective of this paper is to explore the practice of informal payments for maternity care in Ukraine, specifically in cases of childbirth in Kiev maternity hospitals. The paper provides an ethnographic study on the consumers' and providers' experiences with informal payments. The results suggest that informal payments for childbirth are an established practice in Kiev maternity hospitals. The bargaining process between the pregnant woman (incl. her partner) and the obstetrician is an important part of the predelivery arrangement, including the informal payment. To deal with informal payments in Kiev maternity hospitals, there is a need for the following: (i) regulation of the "quasi-official" patient payments at the health care facility level; and (ii) improvement of professional ethics through staff training. These strategies should be coupled with improved governance of the health care sector in general, and maternity care in particular in order to attain international quality standards and adequate access to facilities.

Maternity care in Ukraine is a government priority. However, it has not undergone substantial changes since the collapse of the Soviet Union. Similar to the entire health care sector in Ukraine, maternity care suffers from inefficient funding, which results in low quality and poor access to services. The objective of this paper is to explore the practice of informal payments for maternity care in Ukraine, specifically in cases of childbirth in Kiev maternity hospitals. The paper provides an ethnographic study on the consumers' and providers' experiences with informal payments. The results suggest that informal payments for childbirth are an established practice in Kiev maternity hospitals. The bargaining process between the pregnant woman (incl. her partner) and the obstetrician is an important part of the predelivery arrangement, including the informal payment. To deal with informal payments in Kiev maternity hospitals, there is a need for the following: (i) regulation of the "quasi-official" patient payments at the health care facility level; and (ii) improvement of professional ethics through staff training. These strategies should be coupled with improved governance of the health care sector in general, and maternity care in particular in order to attain international quality standards and adequate access to facilities.

Millions of uninsured Americans rely on hospital emergency departments (EDs) for medical care. Throughout the United States, uninsured patients treated in or admitted to the hospital through the ED receive hospital bills based on what hospitals call "billed charges." These charges are much higher than those paid by insured patients. In 2006 California approved "fair pricing" legislation to protect uninsured patients from having to pay full billed charges. We found that by 2011 most California hospitals had responded to the law by adopting financial assistance policies to make care more affordable for the state's 6.8 million uninsured people. Ninety-seven percent of California hospitals reported that they offered free care to uninsured patients with incomes at or below 100 percent of the federal poverty level. California's approach offers a promising policy option to other states seeking to protect the uninsured from receiving bills based on full billed charges.

The American Cancer Society's Health Insurance Assistance Service provides callers to its National Cancer Information Center with detailed knowledge to help them access or maintain health insurance coverage for which they might be eligible. Demographic data from April 2009 to June 2011 show that 76 % were uninsured and between the ages of 40-60; 65 % were Caucasian, 17 % African American, and 12% Hispanic; and monthly incomes were $1,999 or less. Current trends indicate that callers are similar to those identified in various health care reform publications: callers are unable to afford co-pays; facilities are requesting cash upfront; callers report loss of coverage, less adequate or less affordable coverage from employers; large out-of-pocket expense or high deductibles are needed; and modification of the CDC's Breast and Cervical Screening Program's eligibility guidelines create challenges. Six lessons that have been learned while initiating and managing this program are presented.

This article describes findings from ongoing research and analysis of current literature in addition to discussions with leaders in the field, communications with lawyers and administrators of advocacy and government agencies pertaining to integrated primary care (IPC). Standards of care are established based on a myriad of factors, including professional codes of ethics, case law, state and federal laws, professional standards, existing best practices, current professional guidelines, administrative rules and regulations, and licensing board regulations. Regulations may differ for behavioral health and medical providers, posing challenges in IPC settings. This article provides a review of these regulations, particularly 42CFR Part 2, a federal law governing confidentiality for substance abuse programs, Health Insurance Portability and Accountability Act (HIPAA), and state laws relevant to patient care in IPC settings. On the basis of findings from the study, the authors make recommendations related to patient care practices concerning informed consent and release of information procedures, treatment and warm hand-off protocols, documentation and electronic record keeping, agreements with other providers, and billing.