Changes in Healthcare Means Limiting Freedom

Gregg Phillips

Healthcare providers have limited freedom to run their businesses due to rate cuts, price fixing and needless regulations.

AutoGov is a typical small software company. Our customers are healthcare providers such as nursing homes, hospitals and home health companies. We are entangled in the never ending struggle balance scarce resources against the needs of our customers to ensure high service levels are maintained while offering a disruptive product.

We are free to charge whatever we choose is the optimum price for CaseVue. We spend weeks analyzing our costs against feedback we receive from our customers. If we are right, the market rewards our decisions. If we are wrong, we are punished. But, they are always our decision.

Troubling trends have emerged for our customers, however. They are increasingly hamstrung by government sponsored price fixing - eliminating a key freedom that business leaders require to be successful. For many of these providers (aka businesses) the inability to set prices as they see fit requires doors to close, further limiting capacity in this $3 trillion industry.

We watch as politicians, faceless bureaucrats and and the well meaning healthcare advocates make decisions that ultimately stifle their ability to survive. The basic laws of supply and demand are ignored.

Price fixing and monopolies are always bad in free market economies.

Businesses, including healthcare businesses will fail. Hospitals and nursing homes will close. Home health providers will struggle to recruit quality care givers. Drug companies will discontinue key research.

Our customers are watching helplessly as decisions are made and rates are set, or rather fixed, that ensure their rights and freedoms to run their businesses are reduced or eliminated.

Fair warning to all involved, this will not end well.

We all deserve the opportunity to succeed.

AutoGov Releases Updated Risk Management Software for Medicaid and Healthcare Reform

Taylor Phillips

Leveraging analytics driven by more than 30 million cases, CaseVue allows healthcare providers, states and insurance companies with a comprehensive solution to managing risk in eligibility, enrollment and insurance exchanges.

CaseVue v5.0

Quote startCaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility, enrollment and exchange decisions.Quote end

Austin, Texas (PRWEB) January 14, 2013

AutoGov Director of Technology and Analytics, Taylor Phillips; announced today a major release of his company’s flagship healthcare risk management software, CaseVue 5.0. This important version introduces improvements and tools designed to ensure that information necessary for Medicaid eligibility and enrollment is available in real time on a caseworker’s desktop.

Business office managers and caseworkers are often saddled with making decisions without the benefit of data necessary to prevent mistakes or errors. In these times of rate pressure and uncertainty in the healthcare reimbursement structure, mistakes and errors often mean money – significant write-offs and even fines. Phillips says, “CaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility and enrollment decisions.” CaseVue gathers case data and fuses information from third party data providers to feed an algorithm designed facilitate decisions. A remarkably fast turnaround…this process takes less than one second.

Thanks to AutoGov’s new financial partner, Ontario, Canada based Fusebill (; CaseVue can now be priced to suit our client’s needs – by the score, in packages or on a monthly basis! AutoGov’s specialists can create a custom pricing structure to support any healthcare business.

The software also features new self-service sign-up, administration, training and reporting designed by Phillips and an amazing development team at Rochester, NY based Netsmartz (

CaseVue is part of a comprehensive platform used by healthcare providers and government agencies to provide decision support solutions with a base in predictive analytics. CaseVue provides users with fast, accurate decision support tools that improve both the timeliness and quality of eligibility, enrollment and exchange related decisions.

AutoGov’s CaseVue software has provided scores to healthcare providers and government organizations since its launch in 2005. AutoGov’s algorithms are informed by data mining and statistical analysis of more than 30 million Medicaid, Food Stamp and TANF cases. The company’s firm belief is that solutions for its clients must be affordable, practical, and harness technology to support day-to-day operations without major disruption or unnecessary expense.

Contact one of AutoGov’s CaseVue specialists for a demonstration at 512-439-2900 or sign your company up today at

Resources For Finding an Assisted Living Facility

Cherish Morgan

                The search for the perfect Assisted Living facility for your loved one can be time consuming and confusing. With so many options, it’s hard to know where to start or how to begin to narrow down the search. There are many resources on the web for you to be able to check out and do research. We have gathered 3 websites that have important information to be able to make this process easier for you. -

This website offers a rating system of 16,000+ Medicare/Medicaid- certified nursing homes across the United States. You can also look at a national watch list they have compiled. This can help you build a list of possible facilities and know which ones you should steer clear of.


AARP is a valuable and respected site for senior citizens. The link above will take you to an article on “The “Do’s” of Due Diligence” concerning choosing a nursing home. Before you start the nursing home selection process, you should know what it is you are looking for and how to find it. - has compiled a detailed check list for you to be able to take it with you on your assisted living search. It offers questions to ask, reminders of what to look for, a detailed area for recording information gathered, and a rating system.


Hopefully these websites answer any questions you may have on choosing the best assisted living facility and make the process less confusing and less time consuming.




SNF Medicare Reimbursements

Rose Hayden

Doug Walker from Caring Forward offers a very helpful perspective to the Nursing Home Industry regarding SNF Medicare reimbursements.  A must read for our clients.  Visit his site at

When 11.1% isn't really 11.1%: What will Medicare cuts actually cost SNFs?

Many smart folks in the SNF industry have spent a lot of time analyzing and discussing the pending Medicare SNF reimbursement cuts, including some dire predictions about pushing SNF operators to the "economic brink."

We have talked to many SNF providers that are putting projects on hold and deferring strategic decisions while they sort out the impact of the cuts. These cuts present yet another challenge for providers trying to provide exceptional care in a competitive environment with already thin margins.

But I just ran across a sharp analysis by Luke Fannon on the LTL Magazine blog that SNF providers should consider. The key point here: This is not a uniform 11.1% cut in Medicare reimbursements. With the "panic number" of 11.1% continuously kicked around, folks seem to overlook this important fact.

Fannon's analysis points out that, although the reimbursements for rehab RUGs will take a big hit (north of 18% in some cases), the non-rehab RUGs will actually reimburse at an average of 2.6% higher than before. Because of the way the cuts are distributed, your mileage will vary as to how it affects your facilities. It will depend on current and future case mix.

It seems doubtful, though, that any facility would take an overall reimbursement hit of 11.1%—it would represent a disproportionate existing level of rehab patient and reimbursements. For many facilities, because of the distribution of the case mix, overall Medicare reimbursements actually stand to increase under the new rules.

We also agree completely with Fannon's recommendations for SNFs seeking to offset the Medicare rate cuts:

  • Stay focused on increasing your Medicare census--even with the cuts in the rehab RUGs, boosting Medicare census will significantly increase the revenue for your SNFs. (We would add to that: If your payer mix is OK, but your overall ADC is in the 80s or low 90s, then you also need to focus on marketing and increasing your overall admissions.)
Even with the cuts in rehab RUGs, keep focusing your efforts on bringing in those high-therapy, high rehab patients--those RUGs still reimburse at the highest rates. Especially you historically haven't been admitting a lot of those types of patients, you'll still increase overall revenue even with the new reimbursement rates.

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