A new pilot program aimed at improving billing and collections at local health departments is beginning at a critical time — just as tens of thousands of Kansans are expected to get insurance coverage under the Affordable Care Act (ACA).
Currently, billing mistakes are costing many local health departments when it comes to collecting from private insurance companies and the Medicaid program. But that cost isn’t as significant as it could be because many of those now being served by departments are uninsured and so pay their bills directly.
The payer mix is expected to change as more Kansans obtain private coverage through the new online marketplace healthcare.gov, provided federal officials are able to solve technical problems that have plagued the website since its Oct. 1st launch.
A decision by Gov. Sam Brownback and the Republican-controlled legislature to expand eligibility for the state’s Medicaid program – known as KanCare – also would substantially increase the pressure on local health departments to improve their billing procedures. However, neither appear poised to authorize that expansion soon.
The pilot — spearheaded by the Kansas Foundation for Medical Care (KMFC), a Quality Improvement Organization — is beginning in this month in Douglas, Harper, Reno and Sumner counties.
Each of the four local health departments (LHDs) will receive up to $1,360 to train staff members on billing techniques that will maximize reimbursement for services provided to privately insured clients, said Stephanie Lambert-Barth, manager for KFMC's Immunization Billing Project.
“Training of LHD billing staff will streamline the billing processes and improve billing outcomes, resulting in a return on the training investment. Demonstrating this return on investment may help other Kansas LHDs make the case to fund training for their billing staff,” she said.
The Lawrence-Douglas County health department is one of the largest and best funded in the state. Nevertheless it only has one office assistant working two days a week on billing, said director Dan Partridge.
"For us billing has been a challenge because our capacity to dedicate and train staff has been limited," Partridge said.
Currently about 3/4 of his department's revenue comes from clients who pay their bills directly. The agency has an 85 percent collection rate among those clients. However, it collects only 57 percent of the amount it bills to Medicaid and only 20 percent of what it bills to clients covered by private insurance.
"Most of it is coding errors," Partridge said. "We feel confident our participation (in the pilot) will lead to improved collection rates. We also want to be prepared for whatever shift the ACA will create within our revenue streams as private insurance coverage increases."
KFMC’s Lambert-Barth said that, while the project is focused on improving reimbursement rates for immunization services, the plan is to evaluate all claims billed by the health department, including family planning services, for example.
"Our project's final product is a strategic plan report, which will include recommendations for how to move forward. It is not yet clear what those specific recommendations will be, but if the pilot goes well then expansion (of the pilot) would make sense,” she said.
The pilot project’s website contains links to billing resources, tools, project updates and other related information.
With millions of Baby Boomers at or approaching retirement age, university and city leaders here are looking at building from the ground up a new type of “intergenerational” neighborhood that they say could become a model for other college towns along the Interstate 70 corridor in Kansas and Missouri and perhaps spark a new approach to the way the aging process is studied and the resulting research is applied everywhere. Right now, most retirement centers or senior living developments in Kansas, Missouri and elsewhere in the U.S., are age-segregated, which means only old people live in them. But Dennis Domer, a University of Kansas architecture historian who is spearheading the New Cities initiative here, and others, say the predominant, current model doesn’t work well and it’s time to change it.
What Boomers want
“That doesn't work socially or economically and it isn't what the Boomers want,” Domer said. “They don't want to go someplace to die, they want to go someplace to live” in a way that doesn’t leave them “slowly trailing down the misery curve the last 10 years of life.” After three years of research drawn from various disciplines, the conclusion reached by Domer and others involved with New Cities is that most of the nation’s 80 million Boomers, those born between 1946 and 1964, want the following things in retirement, if not sooner:
- Proximity to nature
- Children, grandchildren and friends nearby
- Walk-able neighborhoods
- Continuing education opportunities
- Access to good health care and transportation
- Affordable housing
In addition, they want to leave a legacy, such as mentoring younger people and they don’t want to live out their days among only their contemporaries – they want to be surrounded by people of various ages. An off-shoot of the New Cities initiative is a planned residential development that Domer describes as a potential “living laboratory” for creating the optimal neighborhood for aging Boomers and for researchers to study the various effects and aspects of aging.
Called Campus Village, the proposed development would be on 60 acres in west Lawrence contiguous with the soon-to-be-built Rock Chalk Park, a $39 million sports complex being built by the KU athletics department with help from the city.
→ Continue reading at khi.org/newcities.
The Lawrence-Douglas County Health Department will be closed for two days this week in order to finish implementation of an electronic health record system.
The clinic and staff offices will be closed from 8:30 a.m. to 1 p.m. on Dec. 4 and 5, as well as Dec. 26 while it trains staff on the new system.
Douglas County is now the fifth in the state to have its health department transition from paper health records to an electronic system. The others are Johnson, Wyandotte, Shawnee and Lyon counties, according to the Kansas Association of Local Health Departments.
Since 2009, use of electronic health records (EHRs) has been surging among hospitals and doctors, thanks to federal incentives to make the costly transition.
But of Kansas' 100 health departments, only Shawnee and Lyon qualified for the incentives because they are also Federally Qualified Health Centers.
In Lawrence, it made sense to implement an EHR even without the incentives, said Jennie Henault, director of Administrative Services. She said the new EHR system also will include new staff scheduling and reporting systems, both of which will greatly improve efficiency.
She said scheduling had been done in Excel, software made for spreadsheets. Consequently it was cumbersome to schedule a single appointment that spanned two program areas, such as immunizations and family planning. It also was not uncommon for staff members to double book or delete appointments scheduled by others.
"It was just very very easy to make mistakes or overwrite each other," Henault said.
Likewise, she said the reporting system will save staff members countless hours of manually compiling reports due to limitations of the current system.
"That was one of the biggest things we thought about, even after we found out we wouldn't be eligible for the incentives," Henault said. "Especially for time-sensitive information. For some grant funding and some mandated reporting, you have to be able to get that information quickly. And our health board wants more information, our director wants more information. It just doesn't make sense to keep wasting time manually counting things and going through pages and pages of reports."
An added benefit, she said, would be the capability of connecting to the statewide Kansas Health Information Exchange, which began exchanging patient data this summer. The exchange allows connected health care providers to use a private, secure network connection to quickly transfer digital health records instead of relying on fax machines or patients to deliver paper records.
When the health department would connect to the exchange, Henault couldn't predict — but when it does it will primarily be useful for immunization records and family planning records, such as Pap test results or medications lists, she said.
It makes sense for the state's largest health departments to implement EHR systems, said Michelle Ponce, executive director of the Kansas Association of Local Health Departments. But it doesn't for most smaller health departments because of their lower client volume and limited budgets.
As the home of the University of Kansas, a thriving business community and many high-paying jobs, the city of Lawrence might not seem like the kind of place where hunger is a problem. And yet, it is.
Last week, hundreds of low-income residents of Douglas County lined up to receive free food and essentials, which were donated by the Oklahoma City-based international relief agency Feed The Children. The two-truckload donation — 38,000 pounds of cargo — is enough to provide 800 families with a 25-pound box of nonperishable food, plus a 10-pound box of personal care items.
Terry Claybrook, of Wichita, is one of the agency's truck drivers. He considers it the best job he’s ever had.
"Because I get to do what Jesus said — 'Feed me, clothe me and give me water when I’m thirsty,'" said Claybrook, while using a box-cutter to open a cargo box of food.
"Well, there’s cereal. There’s spaghetti. There’s rice. There’s all kinds of canned goods. Here’s some potatoes, and green beans, spaghetti sauce for this spaghetti. Here’s some macaroni and cheese — oh yes, All-American food there. Smart Balance popcorn. Skippy peanut butter. Diced tomatoes. That sounds good!" Claybrook said.
More than food
Jeremy Farmer is in charge of Just Food, the food bank serving Douglas County. He said the personal care items may be just as important to the recipients as the food.
"You know, if you’re a family, and left over at the end of the month you have $15 to spend, what are you going to spend it on? Are you going to spend it on toothpaste, or are you going to spend it on food?" Farmer said. "There are a lot of things that one can’t get on food stamps. Toilet paper being one of them, toothpaste, laundry detergent, feminine hygiene products, those are all things that are difficult to get on food stamps. One of the things that Feed The Children does is they provide hygiene items to people."
Not only that, this distribution includes hardcover children’s books and a special treat: bags of miniature candy bars.
"There was a kid that we met with a couple of months ago who ate a chocolate bar for the first time in his life, as a 10-year-old kid. That just blew me away. I could not believe that a 10-year-old kid had never had a chocolate bar. But some of these kids, that’s their story," Farmer said.
"And so, to be able to do this — to provide food and hygiene products, to be able to provide books, to be able to provide maybe a little sweet for them, for those that never had it before — it’s just a great opportunity."
The families in need
As volunteers continue to set up for the distribution, a line of cars begins to form at the entrance to the Just Food parking lot. Soon, the line stretches for blocks. Talking to the people in these cars, nearly all are raising children — either their own or their grandchildren.