Vermont considers health care cost regulations

Oct 15, 2014 | Healthcare Industry News

During a medical emergency, the last thing on a patient's mind is the cost of care. They simply want to be returned to a healthy state as quickly and comfortably as possible. 

However, this can cause significant problems for accounts receivable management professionals at the health care facility providing treatment. With the soaring popularity of high-deductible insurance plans, patients are increasingly unprepared to address the cost of their care. 

To make matters more difficult, the cost of treatment can vary dramatically from one facility to the next. A new report performed by the University of Massachusetts Center for Health Law and Economics for the Green Mountain Care Board illustrates the extent of the issue in Vermont.

The report found that prices at Vermont's 14 hospitals vary between 72 percent and 132 percent of the average price received. Now, the Green Mountain Care Board is charged with setting "reasonable rates" for health care services in the state. 

However, the Board has experienced difficulty due to Vermont's population distribution. One hospital, Fletcher Allen Health Care in Burlington, serves from one-third to one-half of the state's population, according to the Brattleboro Reformer. This allows it to receive equal rates from the state's major insurers.

The remainder of the state's hospitals are more rural, and serve a much smaller patient base. Like many other rural care facilities in the country, these hospitals have been encountering difficulties with healthcare revenue cycle management as a result of shrinking insurance reimbursements and patients seeking care services in major urban hospitals. 

To address this issue, the report suggests that the Green Mountain Care Board "develop uniform service groupings."  Payments for these groupings can then be adjusted for demographic differences, and the type or services offered, the source reports. 

The groupings standard payments could also be tied to the rate of growth in the state's economy, helping to keep health care costs from inflating too rapidly.

While the Green Mountain Care Board continues to explore solutions to address the lack of price consistency at Vermont Hospitals, care facilities that are suffering from complications caused by bad debt may seek accounts receivable outsourcing to improve cash flow and forge stronger provider/patient relationships.