Mary Caffrey is the Associate Editorial Director of AJMC/Managed Care for MJH Life Sciences. Her editorial responsibilities include 

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The COVID-19 pandemic provides an opportunity for organizations to think about how they can be proactive and monitor new regulatory changes in real time, said Ogi Kwon, a manager in the regulatory team at 

Kwon explains how he feels price transparency as a whole while be something that continues to be iterated upon going forward and how requirements could take different forms. 

R1 RCM is a revenue cycle management company that offers technology-driven solutions to transform health care providers' patient experience and financial performance.

Videos

Ogi Kwon, of R1 Revenue Cycle Management (RCM) offers insights on lessons learned from the COVID-19 pandemic and the future of price transparency. 

The Effects of COVID-19 on Patient Experience and Price Transparency 

More than 1 million tests and procedures that Medicare patients received in hospitals over a three-year period were likely not needed, according to an analysis released today.

The Lown Institute, named for Bernard Lown, MD, a Nobel Laureate who died earlier this year at age 99, released its 

 that measures how well they do in avoiding low-value care, based on established criteria for overuse.

Most of the top performing hospitals in the Lown Institute Hospital Index are not from large, well-known health systems that appear on the annual rankings of U.S. News and World Report—in fact, only Cleveland Clinic, which ranked 58th on the Lown list, is on the U.S. News honor roll, according to the a statement on findings.

But there were some patterns: of the 50 top performers, nine are in the Northeast and 10 were in the Pacific Northwest. By contrast, the South is home to highest number of poor performers—41 out of 50—and five of the 10 worst performers are found in Florida. The Lown Institute noted that 47% of Florida’s hospitals are for-profit enterprises.

The 2021 Lown Institute Hospital Index measured overuse at 3,100 hospitals from 2016-2018, using data from 100% of Medicare claims between January 1, 2016, and December 31, 2018. The analysis focuses on 12 low-value services, including four tests and eight procedures, with the index giving added weight to services that account for higher shares of overuse.

 at the University of Michigan, low-value care includes services “that provide little or no benefit to patients, have potential to cause harm, incur necessary costs to patients, and waste limited healthcare resources.” The Center estimates that low-value care costs the country more than $345 billion a year, and notes that there have been several initiatives to squeeze low-value care from the system.

“Overuse in American hospitals is a pervasive problem that needs to be addressed,” said Vikas Saini, MD, president of the Lown Institute. “Hospitals want to do better and these objective measures of performance can help them move forward.”

Services measured in the Lown Index are: 

 when patients have not had a meniscal tear; 

, which maps plaque buildup, if done on female patients who have no stroke symptoms or history; 

when performed on patients with stable heart disease; 

electroencephalography (EEG) for fainting

 if patients have not had epilepsy or seizures; 

 if patients have not had pulmonary embolism; 

 for patients without a diagnosis of fibromuscular dysplasia of the renal artery; 

The top 10 high-performing hospitals are as follows:

Scott County Hospital in Scott City, Kansas

Beth Israel Deaconess Medical Center in Boston, Massachusetts

West River Regional Medical Center in Hettinger, North Dakota

Mayo Clinic Health System in Lake City, Minnesota

Sidney Regional Medical Center in Sidney, Nebraska

Mary Hitchcock Memorial Hospital in Lebanon, New Hampshire

Healdsburg District Hospital in Healdsburg, California

Contra Costa Regional Medical Center in Martinez, California

CMS has tried to target low-value care in recent years through the use of alternative payment models (APMs), and efforts to eliminate wasteful hip- and knee replacements have been deemed largely successful. Other hospital safety organizations have zeroed in on unnecessary hysterectomies, which the 2021 Lown analysis found were unnecessary in 64% of the cases. In North Dakota and Wyoming, hysterectomy overuse was 90% and 94%, respectively.

The analysis also ranked states based on the overall record of its hospitals and found that Vermont did the best job of avoiding unnecessary procedures, while Alabama fared the worst.

Articles

The analysis by the Lown Institute measures hospitals based on their performance of 12 services performed over a three-year period.

Hospitals in South Fare Worst in Avoiding Low-Value Tests, Analysis Finds

Through their patient experience platform, R1 RCM helps ensure patients have a more seamless process for scheduling services and integrating technologies, said Ogi Kwon, a manager in the regulatory team at R1 RCM's advisory and assurance department.

However, another piece of the patient experience related to price transparency is patient satisfaction or dissatisfaction with high hospital or medical bills. In this interview with 

Kwon describes how it is incumbent on hospitals to take a hard look at their billing practices and bear the patient experience in mind when they decide the amount patients should pay for services. 

Ogi Kwon, of R1 Revenue Cycle Management (RCM) outlines issues associated with patient experience that have direct impacts on revenue cycle management. 

Why Health Organizations Should Take Ownership of Patient Experiences 

R1 RCM provides revenue cycle management services so providers can better focus on what matters— taking care of patients, said Ogi Kwon, a manager in the regulatory team at R1 RCM's advisory and assurance department. Issues that happen at the end of the revenue cycle process or near the end often could be prevented or mitigated by implementing processes early on, Kwon explained in an interview with 

Ogi Kwon, of R1 Revenue Cycle Management (RCM) describes how revenue cycle processes are interrelated. 

Mary Caffrey

Articles

The Effects of COVID-19 on Patient Experience and Price Transparency

Hospitals in South Fare Worst in Avoiding Low-Value Tests, Analysis Finds

Why Health Organizations Should Take Ownership of Patient Experiences

Ogi Kwon on the Impact of Revenue Cycle Management on Patient Experience