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Shifts in healthcare industry require comprehensive approach to adapt

August 15, 2014

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Few industries face regulations, new trends and other developments as frequently as healthcare, but even so, the best organizations know how to handle these changes and adapt with the shifting environment.

As a member of the healthcare industry yourself, you understand what it takes on daily basis to ensure seamless operations and a fiscally sound future. However, you also have a lot on your mind, and this can make following along with current events harder than it needs to be. Because of this, we’ve dedicated a portion of our time to tracking these trends and bringing you up-to-date information on the healthcare sector. At the moment, a lot is going on in terms of the insurance climate, requirements for practices, the economy and much more, so now is the perfect time to get up to speed on these events.

To relieve some of the burden placed on you, we’ve gathered a few relevant new developments from around the healthcare industry:

ICD-10 implementation on the horizon for practices
Currently, healthcare organizations across the country rely on the ICD-9 code sets to define and clarify diagnoses of patients. The information included here helps practices document patients and gain a firm understanding on the types of illnesses they encounter on a regular basis.

However, a new set – ICD-10 – is on the way, and seamless implementation will prevent problems and ensure that healthcare organizations can stay on top of any new trend in the industry. This could prove tricky, though, and a recent survey from Black Book Rankings, part of Black Book Market Research, found that many U.S. hospitals are looking to consultants to help with the process. The survey noted that 71 percent intend to use outside assistance when switching from ICD-9 to ICD-10 in October 2015.

This transition is important for several reasons, including the overall fiscal security of an organization.

“There is no bigger provider opportunity on the horizon to maximize financial health than to improve the accuracy of provider clinical documentation,” Doug Brown, managing partner of Black Book, said in a statement.

Healthcare mergers could give way to ‘strategic alliances’
While the implementation of ICD-10 is on the minds of many in the healthcare industry, there are other economic trends that could also affect this sector. For example, the popularity of healthcare mergers could soon give way to a rise in “strategic alliances,” a subtle, albeit impactful, change in the way organizations gain traction in new markets.

Traditionally, mergers are the method of choice to grow and gain power in this industry. According to California Healthline, the number of mergers and acquisitions has actually increased since the Affordable Care Act went into effect. In relation, federal regulators have been keeping a close eye on the talks between healthcare organizations. This increased scrutiny has, in turn, caused some to look for other ways to get ahead.

Referred to as “strategic alliances,” they aren’t healthcare mergers, but instead a partnership where multiple firms can share knowledge, expertise or even assets, California Healthline reported. But, they aren’t in the same legal category as mergers, creating different rules and requirements.

“These are very interesting developments indeed, if health care providers are finding [ways] to come together and coordinate and offer better care for lower cost,” Martin Gaynor, director of the Federal Trade Commission (FTC) Bureau of Economics, told the news source.

No matter what, healthcare organizations should be careful when moving forward with either a merger or a strategic alliance. The FTC watches each case closely, California Healthline explained, and it is still too early to understand the total ramifications of this trend.

Many still adapting to narrow networking
Narrow networking, or collaborations of hospitals and physicians organized by patient outcomes, isn’t exactly a new thing in healthcare. However, its current iteration is gaining traction in the industry, and many providers and insurers are still working out how provide the best possible care for patients.

A recent panel discussion sponsored by the Alliance for Health Reform brought together a number of experts to speak on the matter of narrow networking, reported Modern Healthcare. At the conference, how to deliver high-quality care, handle new regulations and other topics were brought up.

For example, Katherine Arbuckle, chief financial officer of Ascension Health, spoke about how practices must help their patients learn about the changing insurance landscape to avoid complications.

“What we’ve learned is this counseling takes a lot of time,” Arbuckle said, Modern Healthcare reported. “This is especially important with these folks who don’t have experience with insurance and have cultural and language barriers as well.”

Most importantly, those dealing with narrow networks must consider all sides when adapting to the trend, including the patients’. Otherwise, it may be challenging to ensure effective and affordable care for those involved.

Healthcare remains a heavily regulated, unique landscape
Healthcare remains one of the most heavily regulated, unique industries in the country. As a result, organizations must be up to date with any new trends or changes to this sector, or else it may become difficult to grow and prosper.

Consulting with skilled advisors can be a benefit at this time. At Clark Schaefer Hackett, we have the expertise to navigate this tricky environment. Members of our team can work with you for tax purposes, including qualified plan administration, as well as for other consulting needs, such as healthcare mergers and narrow networking. Contact us today to discuss upcoming changes to this industry.

© 2014

All content provided in this article is for informational purposes only. Matters discussed in this article are subject to change. For up-to-date information on this subject please contact a Clark Schaefer Hackett professional. Clark Schaefer Hackett will not be held responsible for any claim, loss, damage or inconvenience caused as a result of any information within these pages or any information accessed through this site.

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