November 2017 Volume 19 Issue 11
Providing Current Information on

Health Insurance Industry Issues and Legislation

Alternative Payment Models Surging
The movement to alternative payment models (APM) accelerated rapidly in 2016.
The market share of healthcare spending for pay-for performance plans almost
doubled while savings/shared risk plans share grew by 26%. In contrast, fee-forservice
and other legacy payment models saw their share plummet from 62% to
43% versus the prior year.
Telehealth and Micro-Hospitals, the Future of Healthcare Is Here
Micro-hospitals are popping up all over the country. These 8 to 10 bed short-stay
facilities offer a wider range of services than urgent care centers and faster, more
personalized service. Likewise telemedicine is exploding as a lower cost, more
patient friendly alternative. Now telemedicine specialists are teaming with nurse
practitioners and physician's assistants at Micro-hospitals to diagnose and treat
patient quickly and cost efficiently.
Kidney Disease Cases, Costs Mounting
124,111 new cases of end-stage renal disease were reported in the US 2015 and
almost 500,000 people received dialysis treatments that year. Medicare spending
for all dialysis cases approached $100 billion. ESRD beneficiaries alone cost Medicare
$34 billion that year. The number of patients and cost will continue to skyrocket in
the future unless action is taken now.
Flat Rate ESRD Treatment Repricing Why Pay More?
The cost of dialysis treatments for a single End Stage Renal Disease patient can
run $600,000 a year or more, much more. For qualifying patients, Medicare
becomes the secondary payer in the fourth month and insurers are only
required to pay the Medicare rate for their treatments. Some cost containment
companies charge a % of billed charges or a % of savings for repricing the
claims to a multiple of the Medicare rate. That's too much. HHC charges only
$200 a treatment for repricing hemodialysis claims and only $75 a treatment for
repricing peritoneal dialysis claims. Why pay more?
THREE STAR PREFERRED PROVIDER PROGRAM ADDITIONS
Genotox Laboratories, LTD
Austin, TX 78744

Infectious Disease Associates
Ellicott City, MD 21041

Genoptix Medical laboratory
Carlsbad, CA 92008

Seacrest Dental Services LLC
Miramar Beach, FL 32550

Dean Butler, PT
Hope, AZ 71801

ACC-Q-Data Network LLC
North Palm Beach, FL 33408

NYU Hospitals Tech Center
New York, NY 10016

Harrold's Pharmacy Infusion Center
Wilkes Barre, PA 18702
W. Sand Lake Medical Group LLC
Orlando, FL 32809

NYU Hospitals Center Tisch
New York, NY 10016

Northeastern Nevada Regional Hospital
Elko, NV 77573

Rolling Hills Hospital
Franklin, TN 37067

Neuro Rehab Connection
Temecula, CA 92590

Tri County Hematology & Oncology
Canton, OH 44718

First Choice Medical Group
Melbourne, FL 32901