GreisGuide to LTACHs » Whitepapers

Strategies for Hospital Leadership – Identifying Strengths, Allocating Hospital Resources and Focusing on Profitable Niche Leadership

Jason Greis — Mon, 16 Aug 2010 23:16:02 +0000

There are several different frameworks that can be used to build a strategy. Hospitals need to assess their overall strategy. One concept as to strategic approach proclaims that an organization should make a clear choice as to (1) whether an organization wants to be a low cost leader, (2) whether it wants to be dominant in a specific niche or area, or (3) whether it wants to be a leader in being customer centric. Michael Porter, noted author of Competitive Strategy, uses a similar framework and groups strategies into three generic strategies (i.e., strategies that are applicable across industries): cost leadership, differentiation, and focus. Porter argued that to be successful over the long term, a firm must select only one of these strategies. Otherwise, a firm will be “stuck in the middle” and will not achieve a competitive advantage.

Eleven Things to Know about the False Claims Act

Jason Greis — Mon, 29 Mar 2010 22:44:27 +0000

In today’s era of increased fraud and abuse enforcement, it’s imperative that all individuals working in any facet of the healthcare industry be familiar with the basics of the False Claims Act and its recent evolution into a powerful regulatory tool for the government and private citizens. The McGuireWoods white paper “Eleven Things to Know About the False Claims Act” is a useful primer to help individuals identify potential violations of the False Claims Act. It will also help individuals better understand how the Act is enforced against and applied within the healthcare industry, including individual providers, medical device manufacturers and pharmaceutical companies. Read More...

To Bundle or Not to Bundle: Lawmakers Explore the Question

Jason Greis — Wed, 03 Jun 2009 05:52:24 +0000

The current fervor to overhaul the nation's health care delivery system has legislators discussing how to change the way post-acute care providers, including long-term acute care hospitals, home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities, are reimbursed for treating Medicare beneficiaries. One potential solution endorsed by both President Obama and the Senate Finance Committee entails bundling payments for acute and post-acute care services provided within the first 30 days after a Medicare beneficiary is discharged from an acute care hospital. This proposal is gaining increasing attention in Washington D.C. as both Senators Baucus and Kennedy appear poised to release bills this month to enact substantial healthcare reform. Carefully crafted bundling legislation that takes into consideration the reimbursement needs of post-acute care providers and the potential pitfalls of a bundled payment model could produce a new and tenable model for the provision of post-acute care services.

Medicare Recovery Audit Contractor (RAC) Update – Spring 2009

Jason Greis — Tue, 07 Apr 2009 03:51:40 +0000

Members of the McGuireWoods RAC Response Team recently authored a primer on RAC appeals. The article provides a short overview of the RAC demonstration program results related to appeals and provides a useful overview of the RAC appeals process. Once providers receive a demand letter claiming an overpayment, the timeframes for appealing are short and providers need to be prepared to proceed through the appeals process if a solid basis for such appeal exists. The RAC appeals process mirrors the five-level Medicare claims appeals process through which fee-for-service providers appeal payment decisions and the article walks providers through the requirements of each level.

Exploring the Potential Benefits and Drawbacks of Acute-Care and Post-Acute Care Payment Bundling

Jason Greis — Fri, 03 Apr 2009 14:55:38 +0000

The current Congressional fervor to overhaul the U.S. health care system has some policy makers discussing how to change the way post-acute providers, including LTACHs, home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and outpatient-based hospital rehabilitation facilities are compensated for treating Medicare beneficiaries. One solution proposed by President Barack Obama, the Congressional Budget Office, and certain congressional leaders is to bundle payments for acute care and post-acute care services provided within the first thirty days after being discharged from an acute care hospital. This bundling model has been proposed many times since the early 1980s as a measure to control escalating post-acute care costs, decrease the number of preventable acute-care hospital readmissions, and increase Medicare cost savings but has never received broad support-until now. Read More...

LTCHs, RACs and Medical Necessity Update

Jason Greis — Sat, 28 Mar 2009 01:06:53 +0000

By Carol Burkhart, RN, MS, CNP, CPHRM, William Hammock, RN, BSN, CMC, ACM, and Stacey Donegan, CPC Read More...

11 Key Concepts from the Stark Law

Jason Greis — Sat, 07 Mar 2009 02:34:00 +0000

The Stark Law prohibits physicians from ordering designated health services (DHS) for Medicare patients from entities with which the physician, or a family member, has a financial relationship unless an exception applies. This white paper reviews 11 key concepts under the Stark Law, in the context of changes to the Stark Law made by CMS.

Medicare Recovery Audit Contractors (RACs): What Providers Need to Know and How to Prepare

Jason Greis — Thu, 05 Mar 2009 04:59:21 +0000

RAC audits are on their way in 2009 and all providers should strive to be prepared. In a depressed economy in which most providers are experiencing decreased or stagnating reimbursement, an additional hit to the bottom line from a RAC audit is especially unwelcome. There is, however, much providers can do to proactively prepare in advance of receiving a RAC demand letter or medical record request.

Strategic Considerations for Physician Call Coverage Arrangements

Jason Greis — Mon, 19 Jan 2009 17:06:12 +0000

I have recently spoken with a number of LTACH administrators and CEOs interested in entering into compensated call coverage arrangements or expanding the scope of their existing compensated call coverage programs with hospitalists, intensivists, and other physicians. Call coverage arrangements generally provide an excellent opportunity for LTACHs to align hospital and physician patient care objectives and for creating strategic long-term relationships with physicians in the community. These arrangements, however, also have the potential to adversely impact a hospital’s bottom line and raise a number of practical legal and business considerations discussed below that should be carefully considered. Read More...

Why Recessionary Pressures and State Medicaid Cuts Will Create a Challenging Environment for Many LTACHs in 2009

Jason Greis — Wed, 31 Dec 2008 04:39:29 +0000

Conventional wisdom holds that hospital profitability follows the income and revenue trends of the communities in which a hospital is located. If such wisdom holds true, 2009 could be a challenging year for Long Term Acute Care Hospitals (LTACHs) generally, and particularly for those LTACHs that rely heavily on state Medicaid reimbursement. Read More...