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What to Expect in 2019?

12/21/2018
In the coming year, we expect to see continued industry pressures related to squeezes on reimbursement and pressure for improved outcomes and efficiency.  This will be compounded by increasing costs for labor and benefits, as well as increased supply costs.  Increased crack down on fraud, waste, and abuse schemes is expected, as government seeks more return on their oversight dollars. Providers should keep in mind that the government has the ability to monitor and analyze claims data at a macro level, and can identify providers who have irregular coding and billing patterns.  The pain management sector will especially feel the pressure as efforts to address the opioid crisis are stepped up.

In the reimbursement arena, expect documentation and coding requirement changes, including streamlining evaluation and management coding.  These changes are expected to decrease provider burden, but we need to watch for payment impact. 

Expansion of Telehealth specifically for treating Substance Abuse and Mental Health is an exciting area to watch.  Starting July 1, CMS will remove the "originating site geographic requirements and [add] the home of an individual as a permissible originating site for telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder," according to guidance.  This should expand opportunities for the use of telemedicine tremendously.

Medicare reimbursement for post-acute nursing home stays is going to change dramatically on October 1, 2019.  The emphasis will be on reimbursement based on assessment and identified needs of resident, and not on the services provided.  Skilled nursing facilities will need to realign their care delivery processes to accommodate these changes.

Healthcare investment activity will continue the trend of the last year or so of moving toward interest in service models rather than technology, although service businesses that have a strong technology component will be especially attractive to investors.  Private equity will lean toward services that are scalable and can be replicated across new geographies, while family office investment will be available to smaller organizations who look to expand.

Consolidation will continue to be the theme of healthcare business.  In situations where acquisition or consolidation has been achieved through high practice valuations, there will be considerable pressure to grow volume.  When these goals are not met, organizations may become distressed and we expect to see continued need for turnarounds and unfortunately some bankruptcy activity.  This may be accelerated by increases in interest rates.

Grassi Healthcare Advisors (GHA) provide a 7-step strategy  for our clients in order to help them prepare for the New Year:
  • Be aware of reimbursement changes in your segment of the healthcare industry
  • Continually review your revenue integrity and make cetain you are billing accurately
  • Improve documentation to support coding and medical necessity
  • Seek opportunities to drive improved quality and outcomes
  • Look for ways to reduce, or at least contain expenses
  • Be passionate about the patient experience in your business
  • Use analytics to understand your patient population and your business to drive profitability
For more information, contact Joseph Tomaino, CEO of GHA, at jtomaino@grassihealthcareadvisors.com.