Curious about what the latest headlines in the health sector mean for you? Join us for a vital conversation with Jason Crosby & Aaron Higgins where we dissect the implications of the proposed HHS crackdown on information sharing and explore its potential to revolutionize patient data flow across different care settings. We delve into the consequences of non-compliance, especially for hospitals & practices participating in MIPS, offering insights that providers and other stakeholders will find incredibly enlightening.
In addition, we reflect on the first anniversary of the 988 suicide and crisis hotline, evaluating its impact and the challenges it faces. Our discussion uncovers the urgent need for more local resources for the hotline and the strides it has made in advancing mental health initiatives.
We also discuss the open enrollment of the ACA health plans. What are the things to be on the lookout for going forward as more people become eligible for these plans.
Wrapping up, we share a sneak peek into our upcoming interview with Craig Kilgore.
With subject matter that impacts us all, this episode is a treasure trove of essential health sector insights. Don’t miss it!
Guest: Jason Crosby, VP Network Integration & Strategic Planning
Jason currently serves as the Vice President of Strategic Planning & Network Integration for Strategic Healthcare Partners (SHP) of Savannah, GA, with whom he has been employed for 13 years. With SHP, he oversees the Clinically Integrated Network activity, as well as the Business Development and Strategic Planning function.
Prior to joining SHP, Jason served as Finance Director for Georgia Emergency Associates, Decision Support Manager at Memorial Health, and as a Finance Lead with Gulfstream Aerospace.
Guest: Aaron Higgins, Data Manager & IT Strategist
Aaron Higgins has worked with SHP since 2019 as the Data Manager and all around Quality Payment Program expert. In 2021, his role expanded to include IT Strategy to help SHP navigate the changing IT landscape in a post-COVID workplace. Prior to working at SHP, Aaron worked in various private practices starting in 2008, where he typically held dual roles as both the Health IT Administrator and Meaningful Use/PQRS Manager, and in 2015 he moved to the Savannah area to oversee the Quality Payment Program for a private practice. Every year, since coming to SHP, Aaron has provided a webinar series updating QPP eligible practices on the proposed & final rule changes coming to QPP (recordings of which can be found on the SHP website).
When not reading the annual Final Rule or answering questions about QPP, Aaron can be found serving on the board of Family Promise of the Coastal Empire, church committees, and on the Pooler city council. Aaron lives in Pooler, GA with his wife and golden retriever.
Transcript
Speaker 1:
Welcome to Beyond the Stethoscope Vital Conversations with SHP. I’m your host, Aaron Higgins. On today’s episode, Jason Krosby and I go over some of the latest news headlines. We discuss the opening for enrollment for the ECA exchanges, a proposed HHS crackdown on information sharing and the 988 one-year anniversary report. We’ll also discuss some of our thoughts on the upcoming interview with Craig Kilgore. Are you ready for this vital conversation? Let’s get started. Well, hey, Jason, how are you doing?
Speaker 2:
today. Hey, aaron, I’m doing great, man, how are you?
Speaker 1:
I’m doing okay. It’s busy, but life is good.
Speaker 2:
Yeah, you got a great fall. We’re past Halloween, we’re in a stretch run, so it’s good times.
Speaker 1:
Yeah, we got Thanksgiving coming up. I can’t wait to eat all that delicious food, because the calories don’t count on holidays. That’s right, that’s right.
Speaker 2:
Well, just as we’re always busy, I know there’s a lot going on online research-wise in the industry. What articles have caught your attention of late?
Speaker 1:
Well, this one came out with a lot of splashy headlines yesterday which I think was an appropriate day for it to drop at being Halloween but the new rules about the Health and Human Services non-compliance for information blocking. This is really important for any of our physician listeners, because if you’re in MIPS or you participate in an ACO under the Medicare Shared Savings Program, this applies to you. So HHS is proposing a rule and you can give a lot of feedback about it up until January, and what the rule is is saying that if you are not sharing patient data freely through the authorized methods, so if ACS doesn’t count through electronic means, you can actually be penalized for not doing it. This is a huge one because it also applies to hospitals, because a lot of hospitals do participate in MIPS in a limited way, and one of them is through information sharing, and they’re seeing a huge drop in data from patients going to hospital and then to other settings of care. And so HHS has long used the carrot right. You have the MIPS program, you have the Shared Savings Program and you’re supposed to be doing these things and you attest that you are, but the reality isn’t playing out. They’re seeing a huge loss in data, where something like 75% of patient data just isn’t shared, and so they want to put a stop to that. And so in the proposed rule is they’re going to de-incentivize providers so like, for example, a hospital could face almost $400,000 hit in their Medicare payments just simply not complying with this. So this is huge. Personally, I think this is great incentive. This is going to hit providers where it hurts the most, and that’s in already narrow margins. We’ve talked about Jason in the past about hospitals and practices not making enough money anyway to cover costs. This is going to hurt them even more, and that’s why I think this is a good thing, because this gives you every incentive to go out and actually do what the program set out to do, and that’s ensure that patient care is across the entire continuum, where it just flows from one practice to another, from hospital to practice and back again. So much for who being. It’s important to plan. Stay tuned on this. I think we’ll have a lot more to see. Some really hard numbers will probably come out if and when this rule is finalized. I would expect the final rule to appear in the spring, because they’re closing the comment window in January. Usually there’s a two to three month lag time between when they close comments on our proposed rule and when the final rule actually appears. So probably just in time for Easter is when we’ll see this MIPS update, and this is going to be separate from the MIPS update that we’re expecting to see any time now. Sometime here in November, december, we’ll see a MIPS update, so this is entirely separate of that.
Speaker 2:
Pretty substantial. Especially you mentioned on the hospital front which I’ve seen where on the critical access hospitals, a good bit of our client base. Obviously it’s going to impact their cost reports. They’re going to see a reduction there on the reasonable cost side of things and their meaningful use status. So you’re right, this is kind of like on the MIPS front. You’re certainly incentivized by way of financial cuts and such. So hopefully the smaller hospitals, hopefully they’re paying attention.
Speaker 1:
Yeah, gone is the carrot, here comes the stick.
Speaker 2:
That’s right, that’s right Great article, great timing. What else you got?
Speaker 1:
Well, the other one is maybe not necessarily as happy as that one and I say that adjust. But we are now one year into the 988 suicide and crisis. They call it the lifeline, so obviously we’re all familiar with 911. You call that, you get emergency services. 988 was introduced last year. There was a lot of advertisement about and in conversation around this. This is, if someone is in some sort of mental health crisis or maybe they’re contemplating suicide or self harm, that they can call. And when you’re into it, they’ve had, they’ve had a lot of calls I’m looking for the exact number here About 500,000 calls and texts and chats a month since launch, which which is great. But the outcome so far is that a vast majority would never use the service again and you would think that, well, that’s kind of the point, right, like it’s a service that is designed to be used in an emergency situation. Hopefully you only ever have one event like that and then you get the help that you need. But what they’re finding in the study is that it’s not quite. It’s not quite hitting the mark. It’s as close to it, it’s helpful and has helped. But really the biggest problem that 988 has is lack of access to local resources. You know, just like 911, you pick up 911 and you report a fire or a heart attack, someone from your local fire station shows up to help you, not someone from Peoria when you live in Atlanta, right? So, and that’s that’s what they’re saying here is that 988 is it’s a national hotline and so the access to local resources just may not be available there yet. So I think that the report is positive in the sense of it’s being used and that’s that’s great. It’s certainly. This is one year. It’s a very beginning of, I think, something good. I think we can start to see local 988 centers popping up. Just like we have 911 dispatch, in the future we can have 988 dispatch that’s more local, to be able to provide those local resources, those local psychologists and psychiatrists and therapists, and local knowledge about what sort of healthcare facilities can help provide proper mental health care, depending on what the the person’s calling needs are. So, yeah, it may not mean that a local psychiatrist comes pulling up to your house, but at least they can point you in the right direction with a little more local knowledge. So I think that’s what we need to be working on. It sounds like that. That is certainly the goal with this. So yeah it’s. It’s a mix of good news and bad news. It’s not as resounding of a success as they had hoped, but it’s being used and it is helping people.
Speaker 2:
There is a way to go though Fully agree the fact that to year one this wasn’t in place. A couple of years ago folks used it as a win Point blank. Like you said, it’s not perfect. It’s not meant to be perfect. Another great point you made at some point you can see the local centers created and this thing will continue to evolve. But one phone call that helps one person to me sounds like a success story. And you’re saying there’s hundreds of thousands, that’s a great story. Yeah, it’s not the positive spin we had here after Halloween, but that’s actually a kind of heartwarming positive story when you think about it so well it’s great stuff.
Speaker 1:
It’s really nice to see that we have started to take on mental health. It’s something that’s been for the last 20 years that I’ve been in this business. We’ve been always talking about the importance of mental health. Well, here’s a new tool and, yeah, it’s not the perfect tool, but I think it’s going to take a lot of tools and this is just one of them. So very excited. So, Jason, switching gears, I think you had something that you wanted to talk to us about today.
Speaker 2:
Yeah, I’m just going to toss that again kind of to your previous point. Timing wise, we’re recording this on November 1st. Today. The marketplace, the exchange opens up today, runs through January 15th, so we just wanted to. We know, by the time you’re listening to this it’s probably about a weekend, so I’m sure we’ll hear more as this gets launched. This episode gets launched. But just some stats behind this. So the Kaiser Foundation did an early survey of 3600 adults. One thing that stood out was 35 percent of the people enrolled in the marketplace found it somewhat or very difficult to find the right coverage. That’s twice the percentage for Medicare or employer-sponsored plans or Medicaid. So that tells you a lot right there that the technology still isn’t there from a user-friendly platform perspective. So just be heads up, we’re going to hear a lot about that. Some other stats Last year for the 23 plan we saw a record-setting number of just under 16 million. They’re expecting that to go up again this year. A few different reasons. Again, this is by Kaiser Foundation. You’ve got obviously the big chunk of it’s going to come from the eligibility determinants of Medicaid. There’s nine plus million people there being booted from Medicaid and CHIP, so expect all of those folks to go through the marketplace. You’ve, of course, got inflation, economic factors that are going to contribute to it, so they’re expecting a pretty high number, another record-setting year for 24. So for those that are listening to the provider side, be heads up, be knowledgeable on it. Aaron and I don’t pretend to be brokers. We didn’t stay out holiday in last night, so we’re just trying to put the information out there. But from a reporting front desk perspective, have your staff educated on there. Make sure your reports, your payer tables, things of that nature, updated to capture these new entrance into the markets Obviously there’s payer movement. Some states, some payers, are leaving certain markets. North Carolina is expanding Medicaid here on December 1st, so there’s some transitory data taking place during this open window as well that you’re going to take effect while the plan through January 15th that is. So there’s going to be different market shifts there. There’s other data points that they’re really worried about. What’s it going to look like, for example, in 24,? One of the other new roles is the age barrier 26. If you turn 26 mid-year, you do not automatically just come off of your parents plan. You’re still able to stay on through the end of the calendar year. So a nice shift there for those that are in that. What do I do after I turn 26 next month? Or if you have a child turning 26 and they’re on your plan in exchange, it’s okay. They can stay on there through the end of the year. So just some nuances there. As the exchange opens up, I’m sure we’ll talk about it some more, but expect that as well. There’s some higher premiums. Obviously it’s going to take effect because of some inflationary factors. So just be heads up practices. We’ll probably cover this over the coming months until the plan runs out January 15th.
Speaker 1:
Now I seem to recall seeing something too about smaller businesses also in some states being allowed to participate in in these plans as well. So I think we’re going to see that influx of people where you have the smaller 10, 20 people shop, leave their current private plan and enroll into these plans as well. So that’ll be very interesting. I haven’t seen any data on how many people are expected to do that, but I think, jason, we can speak from personal experience. The cost of healthcare for our organization and we’re not huge it’s just it’s going up and up and up, and some of these plans start to look pretty tempting for small business like ours to say, hey, you know, you got all these plans out here, you can use those instead. So it’ll be interesting to see how that shapes the market going forward. And, like you said, you all need to be aware of what else is in your market in terms of these ACA plans. Are you enrolled in them? If they’re coming online in January, what patient population could you potentially pick up if you’re enrolled in these plans as a provider? So that’s something to be aware of too.
Speaker 2:
So I’m interesting chefs, there’s a new auto reenrollment criteria taking place this year, but that’ll be new. Premiums are only rising five, six percent on the more popular exchange plan. So I agree with you 100%. I think numbers are going pretty astounding for 24.
Speaker 1:
Yeah, no doubt. Well, I know we’re wrapping up here running out of time. I think we have a pretty exciting guest coming up on the show next week. What can you tell us?
Speaker 2:
Yeah, so next week we have a two-partner, craig Kilgore. Craig is currently the CEO of Cold Stole Vascular and Vane Center in Charleston, where he recently transitioned to that role after overseeing an orthopedic practice also in Charleston, where he’s been for about the last 10 years. Craig previously that had some leadership roles up in Kingsport, tennessee, with the Holston Medical Group. So we talked to Greg about the challenges of an independent practice administrator and barriers to overcome. Some success stories great conversation, besides the fact that he had this gaudy hat behind him with this orange T on it Great, great time. Great conversation though, but in all seriousness, craig’s a great insight gives some input into other administrators. So, yeah, great interview with Craig.
Speaker 1:
Yeah, I had such a good time. We went a little longer than we usually do, so we split it up into two parts. So folks stay tuned for parts one and two to drop next week. So with that, Jason, I think we are right at time. Anything else you wanna share with the folks before?
Speaker 2:
we go home. No, no again, we appreciate everybody here. As we start season three, We’ll line up some more interviews and we look forward to the next new segment.
Speaker 1:
All righty. Thank you, jason and listeners. You all have a great day.
Speaker 2:
Thanks everybody. You’ve been listening to Beyond the Stealth School about our conversations with SHB. This has been our production of Strategies at Keathcare Partners.
Speaker 1:
Your hosts are Jason Crosby and me, Aaron C Higgins. This episode was produced and edited by Nile and Weaver. Our social media content producer is Jeremy Miller.
Speaker 2:
The transcribers Heather McLean, and our executive producers are Mike Scribner and John Currie.
Speaker 1:
For more information about SHP, the services we offer, including the back library of episodes, episode transcripts, links to resources that we discussed, and much more, please visit our website at shbllccom. Slash podcast. Thank you for listening.