(May 19, 2023) – Kansas hospitals and health systems continue to face intense operational pressure while dealing with rising expenses for supplies, drugs and equipment, as well as the health care workforce. Increasing challenges relating to reimbursement and regulations with government and private commercial insurance payers over the past several years add to this pressure. The relationships between health care providers and insurance payers are growing strained as health care providers balance providing quality, accessible health care at a fair reimbursement.
An American Hospital Association survey published in November 2022 showed that 75 percent of hospitals have seen their relationship with insurance payers worsen. Ninety-five percent of hospitals are dedicating more staff resources to prior authorization and denial management requests.
In early 2022, the Kansas Hospital Association started reviewing options for an All Payers Scorecard. Many hospitals have lacked critical data to benchmark and measure themselves on payer issues such as prompt pay, denials and clean claim rates. Understanding the need for this information, KHA established a membership committee comprised of hospital reimbursement and finance leaders to evaluate the different solutions available to assist hospitals. In the end, the KHA membership committee recommended the AHA Vitality Index Program. The AHA Vitality Index helps hospitals, health care systems, and state hospital associations understand the current payer environment and the impact it is having on Kansas hospitals and health care systems. Learn more about the AHA Vitality Index Program in this recorded webinar. It also provides insight into the practice habits of the public and private insurance carriers operating within the state. On a statewide level, the information collected can be used to aid in state policy and advocacy issues. With the scorecard, hospitals and health systems will now be able to identify which payers have prompt pay and denial issues, compare how other health care providers fair with the same insurance payers, and identify which insurers have claims processing challenges.
With the complete picture of the environment, hospitals will be able to help identify internal process improvements such as recurring coding errors and documentation inefficiencies. It also will highlight medical necessity denials with payers, and ultimately open the door to better communication with the payer industry.
The Kansas Hospital Association is committed to utilizing the data on your behalf by connecting with payers and sharing the data results with policymakers and state officials. Together we are a stronger organization and a stronger voice for change. We encourage you to take advantage of this opportunity to collaborate and share resources. If you have any questions regarding the AHA Vitality Index, please feel free to reach out to Shannan Flach, KHA, at (785) 233-7436. Thanks!
--Chad Austin