Is this the tipping point we’ve been hoping we wouldn’t see? Are you about to get audited by the OIG?

By  Al Brander, CSO

In the most direct terms, the Centers for Medicare & Medicaid Services (CMS) has been asked by the Office of the Inspector General (OIG) to increase their efforts when it comes to recouping Medicare overpayments from U.S. hospitals.

Do you work in healthcare? If so, then you are 100% on their list of targeted hospitals.

This isn’t exactly new news.  We’ve been reading about, and reviewing the results from CMS and OIG audits for the past several years.  The results are many but the story is always the same. Medicare overpays U.S. hospitals. Hospitals don’t always pay it back.

In the mid-teens, CMS and OIG put plans in place to audit U.S. hospitals in an attempt to recoup billions of dollars.  And then COVID-19 got in the way.  When the world returned to “normal” – whatever that is – and audits could resume, we quickly learned that the problem had gotten worse.  The response? CMS and OIG needed to the redouble their efforts and audit more hospitals and more diligently.

On October 27th, a federal watchdog agency found CMS has not been doing enough to claw back the Medicare overpayments. The watchdog reviewed audits for 12 hospitals between 2016 and 2018 that discovered 387 improperly paid Medicare claims totaling $82 million in overpayments. Of which, hospitals appealed 229, or 59% of claims.

OIG has recommended that CMS should enforce repayment of the claims, but that doesn’t seem to be happening. It their report the watchdog admitted they “could not identify the actions CMS had taken to ensure recommendations were implemented,” because CMS had not provided enough information on the status of the appeals, nor did they provide information on the reason for the appeals. The report further stated that if CMS did not follow all recommendations then they would risk, “not capturing all overpayments.”

The report has been submitted, but the matter is not finished, not by a long shot.  To me, the posturing and the messaging of both the watchdog agency and OIG makes it clear that there is a massive amount of overpayments outstanding and due the U.S. government – and the government wants it back.  And why shouldn’t they?  In many cases, a formal audit is all that stands between the vague knowledge of these dollars and the collection of these dollars. So you already know where this is going…

U.S. Hospitals need to be quite thoughtful about their response to the recent report. Considering the scale of this growing issue and the potential impact that these dollars could have on several governmental budgets, it is a very safe bet that The Department of Health and Human Services’ Office (HHS) and OIG are going to strongly recommend more audits and closer attention to recouping Medicare payments.

So if you’ve read this far then you might be wondering what does this mean to you? This is an important question to consider. An CMS/OIG audit of your hospital does not simply mean you may have to pay back some overpayments.  An audit is invasive and will require time from several members of your staff. Time that you don’t have.  The results may bring to light key non-compliance issues that can get your company placed on costly exclusion lists and may spur additional audits.  And if any overpayments are found then you will also face additional costs through fees, penalties and fines.

The best approach is to contact consultants about potential OIG audits and to put a defensive plan in place or to conduct a mock audit and gain a clear understanding of your vulnerabilities.

At this point we should be very clear that SpendMend cannot help with every facet of an OIG audit, but we have built out a number of tools that you can use to safeguard a particularly vulnerable area of your Medicare payment landscape – the warranty credits you receive related to medical device explants. Please reach out to a SpendMend rep for any questions about how we can help you company save time and avoid a costly audit outcome.

A Sincere Thank You to Our Team Members During A Month Dedicated to Appreciation and Recognition

October is quite meaningful for SpendMend and for our clients. Nearly every week of this month is dedicated to celebrating some population of our client base.  This year, October 2-8 was designated National Health Care Supply Chain Week; October 10-14 was assigned as Accounts Payable Recognition Week; and this week, October 17-21 is National Pharmacy Week.

Throughout the month we have dedicated time to celebrate, appreciate and recognize the superb professionals representing every one of these highly specialized groups. We’ve sent gifts, we’ve posted on social media; we even launched a month-long charity drive dedicated to client contacts from every one of these departments.

But there is still one group left to celebrate… and that group is our associates. We see our dedicated staff working right alongside our clients to serve the healthcare supply chain, the accounts payable office and the entire pharmacy landscape.

We are in awe of the work that our teams provide to constantly go above and beyond what is expected.  Our associates take pride in what they do, and they are committed to serving hospitals, health systems, pharmacies, and clinics to do our part to improve patient care.

SpendMend has enjoyed sustained success for the past several years.  We don’t take it for granted and we know that it is all due to the dedication and effort from our wonderful associates.

So… to everyone at SpendMend that serves, in any capacity, to support Health Care Supply Chain, Accounts Payable, Pharmacy or any other function in healthcare we appreciate the work that you do for our clients and for SpendMend.

SpendMend couldn’t do any of this without you!

 

Dan Geelhoed                                                 Rob Heminger                                                 Rob Nahoopii

CEO                                                                   COO, President                                               SVP, Pharmacy

Five Lessons from Last Week’s Company Meeting

By  Tom Flynn, VP of Marketing

Last week several hundred SpendMenders descended on our home office in Grand Rapids for our annual all hands meeting. We packed ourselves into a large conference room for a couple hours and we split time reviewing the past year’s accomplishments as well as our ambitious plans for the coming year.

Along the way we discussed our mission, our vision and our values and we took quite a bit of time calling out the great work of co-workers as well as the valuable contributions from key clients.

It’s no secret that I am a proud employee of SpendMend. I’ve worked here for over three years, and I am impressed everyday by my co-workers and the effort they put forward –especially by how much they care about the work that they do and the impact they have on hospitals across the country.

In response to my quick trip to Michigan, I wanted to share “Five Lessons Learned from Last Week’s Company Meeting.”

  • This really is all about “Patient Care” – In every presentation from the CEO to the president, through pharmacy, clinical, marketing, development, operations, sales, and every space in between… every single department head talked about how the work we did is positively impacting “patient care” for our hospital clientele. We are not doctors (although a couple of us have been pharmacists and nurses) and we do not see patients, but the value of our solutions has a meaningful impact on supporting patient care – and we are proud of this fact. And that drives our work.
  • SpendMend is growing with no signs of slowing down – I have to give huge credit to our Senior Leadership Team. About five years ago, SpendMend pivoted, and at that time, we were viewed as the healthcare industry’s leading profit recovery solution. For many firms, that would have been enough, but our leaders had a grander vision. The team  decided that we could have a much larger impact on hospitals, and we began building a suite of solutions to help support the cost-cycle throughout all of healthcare. As a result, we have taken off like a rocket!  At our all hands meeting we reviewed several different charts and graphs marking our progress in revenue, margins, employees, solutions, and by every major marker we have been steadily moving up and to the right.
  • We have an amazing team! – I cannot stress this enough. I love our team. I had a chance to mingle with several co-workers before the company meeting. I presented for a small section, and I was able to look out over the crowd and take in all the attentive faces. I chatted with many new people at the cocktail reception before dinner and I bounced around from table to table as we ate each course. The final conclusion… my co-workers are amazing. They are conscientious, talented, funny, smart, and very committed to serving our clients. I should also add that although most conversations were positive, not every discussion was sunshine and roses. A couple issues bubbled up about how our company could improve. These conversations were my favorite because I was able to see firsthand how much my co-workers cared about the work we do and how we rally together to create solutions.
  • Face to face is more important than ever – We could not have done this meeting in a virtual setting. We could not have stared at a monitor at the digitized image of 300 smiling faces and conducted this meeting on a computer. We really needed to meet face to face, and shake hands, and hug, and smile, and look each other in the eye and clink glasses and laugh out loud. Yes, it was expensive, and yes it was a lot of coordination, (I see you Hannah and LeAnne) and yes there were some opportunity costs, but in the end, we were all together and that was worth it.
  • Downtown Grand Rapids is beautiful – As part of our team-building activities, the entire company took busses into downtown Grand Rapids, to walk the city streets and take in all the mind-blowing art from ArtPrize. For those who may not know, ArtPrize is an art competition and festival in Grand Rapids. Anyone can display their art, and any venue within the three-square-mile ArtPrize district can be a venue. I am a huge fan of art and ArtPrize did not disappoint, but more than the fantastic exhibits that were on display, the most impressive and vibrant attraction was the city itself and all the happy, pleasant people – and the overall vibe. If you haven’t ever been to this quaint little city in Western Michigan, I highly suggest putting it on your bucket list. You will not be disappointed.

So, there it is… five lessons that I learned from the SpendMend company meeting last week. It’s probably truer to say, five facts I had reinforced last week at the company meeting, but you get the point. It’s truly an understatement to say I am proud to work at this company. We have done a lot of great work to date and with that success comes the desire and expectation for more success. At times that can cause some stress, but I have to say there is no better cause then helping our wonderful clients deliver better patient care and there is no other group of individuals I would rather work with to achieve our mission.

 

Why We Created the “340B Unscripted” Podcast

By Robert Nahoopii, PharmD, MS, ACE, Senior Vice President of Pharmacy Services at SpendMend

You may have heard… and if you haven’t then you soon will.  We are launching the “340B Unscripted” Podcast.  Look for a much wider public announcement in a couple weeks!

As we have been sharing the news with clients and recruiting for guest speakers, we have encounter one very common question and I wanted to take a moment to address that in a blog.  The question is: Why did you created the “340B Unscripted” Podcast?

To properly answer this question, let me provide a little context.

Based on a recent report by the Center for Healthcare Quality and Payment Reform – a national policy center focused on designing and implementing payment systems that support affordable, patient-centered health care, hundreds of hospitals across the nation are considered to be “at risk.”

These hospitals are just barely solvent and are on the brink of going out of business.  What’s worse than this already troubling fact is that millions of people who live in the areas served by these “at risk” hospitals will be directly affected – and lose access to healthcare – if the hospitals were to close.

Sadly, this is nothing new.  Agencies and organizations have been trying to make healthcare more affordable for decades.  In 1992, Congress passed bipartisan legislation which established the drug pricing program that granted select hospitals and clinics – specifically those serving vulnerable patient populations – access to discounted medications to combat rising healthcare costs.

This law (which is outlined in Section 340B of the Public Health Service Act) serves as the genesis of what we know today as the 340B drug pricing program. Our entire team at SpendMend Pharmacy is passionate about the 340B Program and the positive impact that the Program has had on delivering affordable medications to underrepresented patient communities.

At present we serve over 300 pharmacies and health systems across the country and dozens of those hospitals would confess that without the 340B Program they may not be able to stay open.

Unfortunately, as the healthcare delivery has grown in complexity over the last 30 years, so has participation in the 340 B program. The increase complexity often challenges a hospital’s ability to take part in the Program and that leads to an overall decrease in the widespread positive impact of the Program.

We are bringing a new podcast to you called “340B Unscripted” where we dive into the complicated and sometimes contentious aspects of the 340B Program, as well as other hot topics in the pharmacy and healthcare space. Our goal with this podcast is to help inspire and educate pharmacy professionals so they may take full advantage of everything the 340B Program has to offer, and in so doing they can better serve patients.

Tune in to hear from our experts as they share insights from the field. We will cover a wide range of topics from HRSA audit readiness; to innovative strategies for managing pharmacy operations; to developments in the healthcare landscape that may impact covered entities.

We will also welcome special guests and industry experts from time to time so that you can hear thoughts and perspectives from all sides of the discussion. For more information check out our website at SpendMend.com or follow us on Instagram, Facebook, LinkedIn, Twitter and YouTube.

You can catch the “340B Unscripted” Podcast on Apple Podcasts, Google Play, Spotify, and Amazon Music.

The Top Five Things I’ve Learned (so far) at the 2022 Trade Shows

By Alan Brander

We’re almost halfway through June (can you believe it?) and the SpendMend team has been busy traversing the map and meeting clients and colleagues at trade shows and industry conferences across the country.

At this point in the year our team has already attended ten separate trade shows and I estimate we’ve had hundreds of meaningful conversations with clients and other industry experts.

A few patterns are beginning to come into focus, and I wanted to spend a moment to lay out my top 5 things I’ve learned so far at the 2022 trade shows.

  • We’re ready to mingle. One thing is for sure… we’ve all been cooped up long enough and although some of us already started returning to shows in 2021 – most of us have not.  Being out on the conference floor and among peers is a welcome relief from working from home and spending countless hours on video calls.
  • The emphasis on “Cautiously.” I’d say, for the most part, the colleagues and peers I’ve been meeting with are fairly optimistic about the market and supply chains, and COVID-19 cases getting better.  Many people acknowledge that we are in the middle of a downturn, but there seems to be a sense of cautious optimism.
  • Dance cards are full. The past few shows have been like nothing I’ve seen in the past.  I am a 30-year veteran of the healthcare industry and I spent most of my career serving on the healthcare provider side.  My most recent hospital gig was as a Chief Nursing Officer where I was responsible for 2 hospitals.  Nowadays, I attend conferences as a service provider, in that new capacity I’ve gotten used to working a little harder to get the attention of VPs and C-level officers.  So far, this year has been different, I find that the hospitals are seeking us  I barely leave the booth and there is often a line of people queuing up to talk with us.
  • Cost savings, cost savings, cost savings… There are many things on the minds of hospital leaders at present. Supply Chain, Data Security, COVID-19, Nursing shortages, and more.  All that said, the most common pain point that we observed was in the area of cost savings.  Or more to the point – hospitals and healthcare systems are asking, how can I get better visibility into: What I am spending? How can I spend more intelligently? How do I avoid profit loss? How do I negotiate better terms? What cost metrics should I be tracking… and on, and on.  They used to say, “Cash is King.” Right now, I feel like “Costs are paramount!”
  • There simply isn’t enough time. As we return back to a semblance of normalcy, I see hospital leadership with much longer “to-do lists” than ever before – with the same number of hours in the day to do it all. The world has become more complicated so there has been an increase in new initiatives.  At the same time, the hospitals are still obligated to maintain their usual operations and add to that there is a daunting backlog of items that have been ignored since March of 2020.  Leaders throughout the healthcare industry are working overtime to balance all these different sets of priorities and trying to settle on… what are the real

So that’s my Top 5 list for the time being, but we still have another 7 shows on our calendar for the balance of the year.

I’ll check in again in six months to tell you how everything turns out!