HealthLeaders Media Finance - August 3, 2009 | Lessons Learned: How Scripps Health Keeps Making $100 Million View as a Webpage | Subscribe for Free
Lessons Learned: How Scripps Health Keeps Making $100 Million
Michelle Ponte, Senior Editor-Finance

For a third year in a row, San Diego-based Scripps Health has surpassed the $100 million marker in operating income. During a time of unprecedented chaos in the economy and the capital markets, the system continues to see strong returns following an overhaul that began in 2001. CFO Richard Rothberger shares post-turnaround success strategies and challenges that worry him most over the next year. [Read More]

  August 3, 2009

Editor's Picks
Millions of dollars are lost because of miscoded durable medical equipment supply
Here's one more reason Medicare costs are continuing to go up: durable medical equipment. The federal government, private insurance, and individuals overpaid durable medical equipment suppliers by $42 million in 2006 due to bad coding, according to the Office of Inspector General. Medicare paid roughly half of that amount. The 309,626 claims were spread across 11,702 nursing homes. Right now, everyone involved is blaming the overpayments on a "nationally flawed system." However, CMS Acting Administrator Charlene Frizzera says the agency "plans to recover the overpayments identified consistent with the agency's policies and procedures." [Read More]
Voluntary refunds don't protect against RACs
Being proactive and performing a self audit may improve internal processes, but don?t expect it to get you anywhere with CMS. While internal audits can show you where to make important changes with coding, billing, and documentation practices, reporting errors and refunding identified overpayments to CMS won't protect those claims from a RAC review, according to a recently released FAQ on the CMS Website. According to CMS, there are two types of self audits. In scenario No.1, the claim information and payment are submitted to CMS, but the organization is still subject to a future review. The second type of self audit involves the use of extrapolation, in which case the claim processing contractor may accept or deny the extrapolation. It's confusing for sure and well worth the time to pay a visit to the CMS site for updated FAQs. [Read More]
Hospitals would get paid 32% less in public plan compared to private insurers
Hospital leaders have discussed many "what if" scenarios should a public plan become policy, with many saying they would be doomed if rates fall to the Medicare level. According to recent analysis by The Lewin Group, rates may indeed fall this low if the public health insurance plan proposed under the House healthcare reform bill passes in its current state. The plan calls for payments based on current Medicare payment methodology. Hospitals would see payments drop an average of 32% below private insurance rates, while physicians would be hit with a 16% drop. [Read More]
Hospital shares rise as Tenet, HMA results ease concerns
Hospital stocks are on the rise after Tenet Healthcare and Health Management Associates both raised their 2009 outlook. Tenet and HMA shares have risen 6.4% and 7%, respectively. Tenet Healthcare experienced a 4.5% increase in revenues in 2009?s second quarter, compared to the same period in 2008. President and CEO Trevor Fetter attributes the positive results to strong growth in outpatient volumes and solid pricing gains. Still, the company is projecting a $15 million loss for the quarter. HMA says it earned $32.6 million in the second quarter. [Read More]
Finance Forum
Small Business Set-Asides in Federal Healthcare Contracting: The Rule of Two
Scott Honiberg and Jeff Weinstein of Potomac Health Associates say federal contracting can create significant opportunities for all kinds of healthcare providers. However, be alert, they warn, for set-asides that seem unduly restrictive or, conversely, ones that are unrestricted but should be set aside based on facts known to you. [Read More]
Finance Headlines
It's official: house won't vote on health reform before break
Janice Simmons, for HealthLeaders Media - July 29, 2009
Democrats push healthcare plan while issuing assurances on Medicare
New York Times - July 29, 2009
Healthcare reform and the unpopular t-word
New York Times - July 29, 2009
Grady to repay Georgia $20 million in Medicaid overpayments
Atlanta Journal-Constitution - July 29, 2009
CBO says implementing Medicare advisory council could save money, but not as much as hoped
Janice Simmons, for HealthLeaders Media - July 28, 2009
Insurers and employers: bend your own cost curve
Rick Johnson, for HealthLeaders Media - July 28, 2009
Medical leaders wary of healthcare overhaul's cost
Boston Globe - July 28, 2009
Who will be the winners and losers in health reform?
Cheryl Clark, for HealthLeaders Media - July 27, 2009
Idea to tax insurers is gaining traction
Wall Street Journal - July 27, 2009
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Time For 'Dr. Next'?
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Service Line Management
Prepare for the Cancer Boom
Aligning the right cancer care team and utilizing the appropriate technology is essential for maintaining a patient-centered service line. [Read More]
Money Talk

A look at one hospital's struggles to improve

Southeast Georgia Health System, Brunswick, GA
Rating: A-
Outlook: Stable
Affected Debt: $166 million
Agency: Standard & Poor's
Remarks: Rating lowered from A due to operating losses in fiscal 2008, recent losses in unrestricted liquidity, and pressure on balance sheet metrics from additional debt.
[Read More]
Audio Feature

Planning for a Public Health Plan: Georganne Chapin, president and CEO of Hudson Health Plan in New York, says a public health plan is a critical part of healthcare reform, but fears a health insurance exchange will just create another layer of bureaucracy at an enormous cost. [Sponsored by Emdeon] [Listen Now]
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August 20: Service Lines Strategies Workshop 2009: Gastroenterology
August 18: Advanced Service Line Marketing: New Orthopedics Growth Strategies
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