by Kevin (Michael) Harrington
Friday, January 16, 2015
Background on high-deductible plans or otherwise known as “consumer-driven healthcare.”
According to the Leapfrog Group, 1 in 5 are now utilizing plans that are high-deductible or consumer-driven healthcare plans. One of the characteristics of these types of plans are that the patient is responsible for the first $1,000 or more. As stated on HealthCare.gov, the annual out-of-pocket maximum/limit can go up to 6,600 for an individual or $13,200 for a family. The benefit for a higher out-of-pocket is a lower monthly premium, but even with the best planning, one cannot truly prepare for the costs associated with an unexpected illness that may require a hospitalization or outpatient services.
What is this doing to the healthcare consumer? How do they pay for services that fall into this valley of co-pays and deductibles? Well, there are an increasing amount of finance options to help out. For example, there is one called Healthcare Finance Solutions that can offer short term loans for as little as 0% for the consumer and the provider can be paid within 48 hours. In addition, they offer infrastructure that will support the registration clerks and admissions staff as they are meeting with a patient or their family that will enable them to access the system and process their application in no time at all. Everything is integrated into the EMR or as a stand-alone that has easy access for the registration clerk or admissions staff. Now, the facility can collect upfront these large deductible plans, give the patient peace of mind that their financial responsibility is taken care of, and their focus can now be centered on getting better. More importantly, this can take the question of should I get this procedure done to when do I want to get this procedure done.
Most people, if not all, sign up for the high-deductible plans base on the monthly premium. I hope that over the next year a more robust education process is afforded to the purchaser of healthcare so as to avoid, this seemingly, one dimensional decision process.
HealthCare.gov. 2014a. Out-of-pocket maximum/limit. Retrieved from https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
Leapfroggroup.org. 2013. High Deductible Health Plans & The New Era of Consumerism in Healthcare. Retrieved from http://www.leapfroggroup.org/media/file/AnnualMeeting2013Program.pdf
Posted by Twila Weiszbrod at 2:05 PM
Monday, December 01, 2014
Saint Joseph's College is an integral part of the local community here in Maine. Each year the college prepares pies to be given out at local food pantries. This year the staff took it up a big notch and made 1,548 pies, breaking the existing Guinness World Record for pie-making! The finished pies were donated to over 100 area food pantries! Click the link below for more detailed information and pictures:
We are proud of our college and proud to be part of this college community!!!!
We are proud of our college and proud to be part of this college community!!!!
Posted by Twila Weiszbrod at 3:20 PM
Wednesday, November 05, 2014
In celebration of National Radiologic Technology Week, Saint Joseph’s College would like to recognize all Registered Radiologic Technologists for the vital work that you perform. The week of November 2nd is set aside to recognize and applaud the work of all Radiologic Technologists and to thank you for the role that you play in providing safe, quality exams and great patient care. Patient retention is the result of having qualified professionals, like you, who provide compassionate health care. This is critical in today’s health care environment.
In light of the recent Ebola virus outbreak, it is important that all healthcare providers be aware of how the Ebola virus is transmitted, self-protection, and proper waste disposal. In response, the Center for Disease Control (CDC) provides important information for the safety of health care workers. Please visit www.cdc.gov/vhf/ebola/hcp/. In addition, all hospitals and health facilities have established policies and protocols with instructions for putting on, removing, and disposing of personal protective equipment. Safe handling of potentially contaminated materials, such as blood, sweat, emesis, feces, and other body secretions is crucial in containing the spread of this virus. Familiarize yourselves with them.
Another problem area that has arisen is how to dispose of the medical waste that is generated. The disposal of Ebola-associated waste is subject to state and local regulations. Please visit
http://www.epa.gov/waste/nonhaz/industrial/medical/programs.htm for additional information.
Early recognition of the Ebola virus is critical for survival. Pay particular attention to the symptoms of your patients and fellow staff members. Be vigilant in wearing protective gear.
Stay safe and celebrate National Radiologic Technology Week!
Brenda M. Rice
Posted by Twila Weiszbrod at 12:02 PM
Tuesday, October 14, 2014
The Affordable Care Act (ACA), as we are all well aware, has been rolled out and operational. There has been over 8 million people that signed up for the coverage through the different Marketplaces throughout the country. The end result, or the plan, is to provide affordable care to individuals and to reduce the overall count of uninsured that some say is over 40 million people currently in the United States. Moreover, the ACA is also trying to bring high quality, affordable coverage to all individuals, regardless of their gender or pre-existing conditions that may be present in an individual’s health history.
CMS provides individuals and businesses with tools to educate everyone that is purchasing healthcare and is making sure that 80 cents out of every dollar generated in premiums goes to the healthcare that you receive. There are checks and balances here, in that, if health insurance companies do not spend 80 cents for every premium dollar, you get a refund. In 2012 the average refund was around $100.00 per family.
When we look at health insurance rates we sometimes wonder why they are so high or where do we find posted rates that one can compare. Now the ACA has provided the consumers with a layer of protection when it comes to rate increases. Insurance companies in every state must follow the rule that if they increase any rate over 10% they must publicly justify this change in premium.
There are also administrative measures being taken to protect the individuals who may get ill or make a mistake on their application. Also, there are no more denials for pre-existing conditions. But one of the more appealing things that came out of the ACA, at least in my opinion, was that young adults can stay on their parent’s plans until the age of 26.
All of this sounds good, but there also needs to be an administrative change, and this has been addressed as well. The Donut Hole has been shrunk for individuals and this will save the average beneficiary money with regards to their pharmacy spending. Maybe our elderly will someday not have to worry about the decision, do I buy my medicine or do I buy food. Some other items of interest, and maybe of great interest, is that CMS is fighting fraud at a much higher level and they are trying to strengthen the Medicare Trust Fund. This fund supports so many programs, and without it, there will be many people impacted throughout the country.
Overall, the goal of our health system is access, cost and quality. This is a step in the right direction and with everyone’s help maybe we can continue to make positive changes in our healthcare system.
Contributed by Kevin Harrington, Faculty Member
Monday, September 29, 2014
National Assisted Living Week is celebrated every September. This year, the theme was “The Magic of Music.” Numerous assisted living communities across the country participated and celebrated in various ways.
For those who have observed long term care for the past 20-30 years, you may have noticed this trend: nursing home residents of today were on hospital medical/surgical units 20 years ago, and those in assisted living today were in nursing homes 20 years ago. This shift has resulted in adjustments for the nursing home and assisted living professions.
Factor in the aging of the consumer-oriented Baby Boomer generation. These folks are accustomed to being able to buy whatever they want, whenever they want, wherever they want. They are far more likely to seek a second opinion and make their own clinical decisions than previous generations were. Their microwave mentality values instant results. They want choices and options; they don’t accept “no” for an answer. They want convenience, even if they have to pay a little bit more. They may ask why they have to move locations and change lifestyles in order to access care; why can’t the care come to them? As they enter long-term care systems, they still want these expectations to be met.
These trends are leading to the creation of many new models of senior living. Licensed facilities that rely upon government funding (Medicare/Medicaid) are remaining stagnant in population, while other senior living arrangements are growing. Baby Boomers want to have medical care available, even if it’s not needed routinely. Senior living communities now often have medical services available on campus. Social workers may be available for some degree of case management. Concierge services may meet other needs. These seniors may want a condo-style home with a spa, a golf course, and other amenities on the property, with a nurse available in case they sprain an ankle playing tennis.
As new models of senior living are developing, stay tuned to see how Saint Joseph’s College is keeping up with new trends. A degree program specializing in Senior Living Leadership is under development. We are planning to remain on the cutting edge of leadership in aging services!
Posted by Twila Weiszbrod at 8:45 AM
Monday, September 08, 2014
Saint Joseph’s College Online would like to congratulate Constance Noble for successfully completing a Bachelor of Science in Radiologic Science Administration degree (May 2014) and for having an excerpt from her Senior Seminar (Course: RS 412) paper published in the National Professional Journal of the American Society of Radiologic Technology (ASRT).
Connie's paper is on “Service Quality in Mammography” and is published in the September/October issue of Radiologic Technology. Please join me in congratulating Connie on her accomplishments. If you’d like to read her article online and are a member of the ASRT, please visit their website at
This is an amazing example of our our programs provide a quality education and result in benefits to the entire industry! We are proud of your work Connie!
Posted by Twila Weiszbrod at 3:29 PM
Friday, August 08, 2014
Often times a healthcare administrator will be questioned, or be the one questioning:
What will we get paid from Medicare if we start doing a certain procedure/ provide a particular service?
Sometimes we know what our business model is focused on, but do we really know how to build a solid proforma to direct the efforts of our staff and financial resources to be successful in targeting what will truly benefit our facility?
There are so many acronyms such as RBRVS, PPS, IPPS, CPT, IRF PPS, GPCI, HOPPS, IPF PPS, ASC, MS-DRG, SNF PPS, HCPCS, and DRG just to name a few. But there is one acronym that can be very helpful from CMS. Oh, another acronym! The Centers for Medicare and Medicaid Services (CMS) is a repository of information that can help just about any practice, group practice, Ambulatory Surgical Center (ASC), or other healthcare organization to breakdown the reimbursement for any service or procedure to help identify the appropriate reimbursement from CMS.
This tool is called the Searchable Medicare Physician Fee Schedule (MPFS).
It has over 10,000 services listed and each is broken down by all elements of reimbursement including pricing, payment policies, and Resource Based Relative Value Scale. This tool allows healthcare professionals to find out the Medicare payment for any code that is part of the MPFS database. It will identify the payment for those providers that are a “Participating Provider” under CMS. Moreover, it will identify for those providers that are “Nonparticipating” what the limiting charge is for a particular code. This will put a ceiling on the charge for a code that the provider cannot exceed when billing Medicare and this will also limit the out-of-pocket expense for a beneficiary.
Overall, the MPFS is an excellent tool to see if Healthcare Common Procedure Coding System (HCPCS) codes are affected by the place in which the services are performed and if there are any modifiers that are available.
The payment procedure is that there are many codes available for reimbursement. CMS will reimburse 80% of the allowed charges for an approved code and the patient will be responsible for the remaining 20% (plus any annual deductible that may be due). There are reductions that are identified in the MPFS that include a 16% reduction of the MPFS rate for an assistant surgeon. There are other reductions such as nurse practitioners (NP), physician assistants (PA), and clinical nurse specialists are paid 85% of the allowed rate and clinical social workers are paid 75% of the allowed rate from Medicare.
The MPFS will take the user through several steps to identify the appropriate codes, locality, and reimbursement. To start the search you click on the “Physician Fee Schedule Search” or the “Start Search” button. You will need to accept the terms and conditions of using the Current Procedural Terminology, Fourth Edition (CPT©).
Then you will need to select:
- · The year
- · The type of Information that you are looking to search
- · The pricing information
- · Payment policy indicators
- · RVU
- · Geographic Practice Cost Index (GPCI)
- · Specific Locality (each area has a unique locality code, like Metropolitan Philadelphia Pennsylvania is 12502)
- · All Carriers or specific MACs
· Then you can enter the HCPCS code that you are looking for and if you want specific modifiers or “All”
· Click Submit
The MPFS tool will help the healthcare administrator and their staff to better forecast revenues based on actual reimbursement. Moreover, having the ability to find out all payment rules and requirements will allow for a successful and compliant billing process for the new or existing service that your facility provides.
To locate the searchable Medicare Physician Fee Schedule you can go to http://www.cms.gov/apps/physician-fee-schedule/overview.aspx
-Kevin Harrington, MSHA, RHIA, CHP
Posted by Twila Weiszbrod at 11:45 AM
Monday, August 04, 2014
Wednesday, July 23, 2014
The faculty members that teach in the health administration programs at Saint Joseph's College met on campus on July 11th. We discussed ways to enhance our courses and the programs in general! What an amazing group of dedicated teachers! No wonder our program is excellent!
Posted by Twila Weiszbrod at 9:53 AM
Wednesday, July 02, 2014
Just a reminder!!!!!
Warm weather draws people outside to participate in summer activities for a greater duration throughout the day. Skin exposure to the sun has benefits, as well as risks. The health benefits from limited exposure to the sun are vitamin D production, it helps to support the immune system, strengthens teeth, decreases symptoms of asthma, etc.
However, unprotected, over-exposure to the sun can result in the development of skin cancer or melanoma. This condition is curable, if treated in the early stages of development. As skin cancer grows on the skin, there are early warning signs to help identify melanoma.
The ABCD rule is used by health professionals.
A = asymmetrical (irregular in shape)
B = bigger in size
C = color change (color variation – tan, drown and dark brown)
D = diameter (larger than ¼ “)
After self-examination, if you find a mole or skin growth in question, please seek medical attention. Have fun in the sun, but stay protected.
Posted by Twila Weiszbrod at 12:56 PM