Children’s Medical Center in Dallas, with two-thirds of patients covered under Medicaid, used to be paid on a fee-for-service basis and life was good, says Katherine Lusk, senior director of information management and exchange.

The three-campus, 595-bed system had the money for new technologies and more. Then, the state of Texas informed Children’s that it would move to an inpatient prospective payment system in September 2013 with reimbursements cut considerably--and the hospital already was giving away $40 to $60 million in charity care annually. With the reimbursement cuts, the organization put a hard freeze on hiring--employees could transfer to new positions but no new FTEs were permitted. Further, an outpatient prospective payment system is coming in September 2014. Consequently, a primary goal the past couple of years has been to identify ways to get as much payment as possible.

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