ACA changes will increase risk in finance, tech areas

As provisions of the Affordable Care Act (ACA) come into play this year and for the next several years, the way healthcare is provided could change drastically, and that change has the potential for new or increased risks. At the same time, healthcare providers are taking on more risk through readmission penalties, bundled payments, and population health payments.

That change means risk managers should be actively looking for the new or heightened areas of risk facing their organizations, says Maria Gonzalez Knavel, JD, a partner with the law firm of Foley & Lardner in Milwaukee, WI. One of the biggest risks for hospitals comes from the recent change in how far back the government can go to collect overpayments, she says. Where the overpayment is the result of an error rather than fraud, the government can now go back five years instead of the previous three.

“That is definitely going to have an impact on all providers, but especially hospitals because of the volume of billing they have the subsequent chance of an error,” Knavel says. “Also, with the ACA stating that you have to disclose overpayments within 60 days or it becomes a false claim, all of these provisions make it difficult to stay ahead of things on front end so that you get everything right and don’t have to go back and have funds recouped.”

Knavel says risk managers will play an important role in preparing for and managing these new or elevated risks. That role could be good in terms of your visibility within the organization and demonstrating your value. “These are going to be challenging times for a risk manager in the next couple of years,” Knavel says. “You could shine if you step up and effectively manage these risks for your organization.”

Paul Osborne, director with the healthcare consulting company Berkeley Research Group in Tampa, FL, was working recently with a healthcare provider regarding ACA changes coming in the next two years. “All of the things in this bill are starting to become real now, and people are starting to get pretty nervous out there,” Osborne says. “We were talking about the excise tax that will be placed on all the covered lives, which kicks in later this year. A lot of the conversation is about how to adjust for that, with cost cutting or passing on more of the costs to employees through premiums.”

Health exchanges also bring lots of questions, Osborne says. Healthcare employers are trying to figure out which employees will be included in the exchanges and what the resulting fees will be for the employer. “There are lots of unknowns out there and people are scared, trying to figure out how to accommodate these changes and avoid the penalties,” Osborne says. “There is a lot of risk out there, and I don’t think a lot of organizations have a clear plan for how they’re going to handle it.”

Much of the potential risks will come from the sharing of patient information through accountable care organizations (ACOs), says E. Todd Bennett, director of market planning in healthcare for LexisNexis Risk Solutions, a consulting group in Alpharetta, GA. “Provider organizations need to be intentional about managing patient information across care settings. With unlinked technology platforms that are unable to identify unique patients at each touch point with the health system, siloed patient information gives rise to overutilization, unnecessary delays, increased opportunities for identity theft, and decreased patient satisfaction.”

To counter these challenges, Bennett says leaders of accountable care initiatives need to develop a strategy for managing patient identities across care settings and every mode of interaction with patients. “Whether patients receive care and information through a patient portal, telephonically, or face to face, a targeted approach to patient identity management provides is necessary to manage patient population health effectively,” Bennett says.

The changes coming from ACA will require coordination with many professionals, says Joe Bohling, principal with the healthcare consulting company Berkeley Research Group in Dallas.

“Make sure you are not going about this alone. You will need to interact with experts like your attorneys, outside law firms, insurance providers, insurance brokers, or consultants,” Bohling says. “You are going to need some help navigating all the implications of what the ACA is bringing forward.”

Sources

  • E. Todd Bennett, Director, Market Planning -- Healthcare, LexisNexis Risk Solutions, Alpharetta, GA. Telephone: (615) 942-7867. Email: todd.bennett@lexisnexis.com.
  • Joe Bohling, Principal, Berkeley Research Group, Dallas. Telephone: (214) 233-3061. Email: jbohling@brg-expert.com.
  • Maria Gonzalez Knavel, JD, Partner, Foley & Lardner, Milwaukee, WI. Telephone: (414) 297-5649. Email: mgonzalezknavel@foley.com.
  • Paul Osborne, Director, Berkeley Research Group, Tampa, FL. Telephone: (305) 984-1029. Email: posborne@brg-expert.com.
  • Ruselle Robinson, JD, Attorney, Posternak Blankstein & Lund, Boston. Telephone: (617) 973-6286. Email: rrobinson@pbl.com.