Catherine Jacobson, FHFMA, CPA

Imagine revenue cycle management in a world with millions fewer uninsured patients.

Ever since we started managing the revenue cycle, we've been thinking about how to manage the growing number of uninsured patients. And the proportion of uninsured patients has increased dramatically at many hospitals since the economic downturn began in 2007.

Now, let's think about a different world. If healthcare reform legislation passes, and if it delivers on its promises, uninsured patients could become a vanishing breed. All told, some 95 percent or more of the population would be covered by health insurance by 2015 under current proposals. It's hard to fathom the implications of that number or how our work in the revenue cycle will change.

On July 15, one day after a reform bill was introduced in the U.S. House of Representatives, President Obama spoke to the nation about what healthcare reform would mean to us. "If you lose your job, change your job, or start a new business, you'll still be able to find quality health insurance you can afford," Obama said. "If you have a preexisting medical condition, no insurance company will be able to deny you coverage. You won't have to worry about being priced out of the market. You won't have to worry about one illness leading your family into financial ruin. That's what reform means."

As healthcare finance professionals, think about what a large-scale expansion in insurance coverage would mean to us as well. For one thing, we would no longer need to work out payment schedules with patients for bills in amounts equivalent to buying a car, a college education, or even a house. We could look forward to a healthier case mix with less deferred and foregone preventive and chronic-condition care. And we would be able to perform financial modeling without factoring in rising costs for charity care and bad debt write-offs.

But there would be challenges associated with the movement toward universal access. During the long transition period, there would be times when confusion would reign, when coverage expansions would lag behind payment cuts, and when the viability and wisdom of various reform measures would be called into question. That transition period would put our skills as healthcare finance leaders to the test.

We would need to hone our communication and educational skills to effectively convey the new order of things to our colleagues and to patients, some of whom would be learning about coverage options for the first time when they come to the emergency department in crisis mode.

We would need to develop a knowledge base to interpret and comply with what would inevitably be a complex web of new regulations and payment requirements and predict how our revenue streams would be impacted.

And we would need to become superb change managers to help our financial and clinical colleagues adjust to the most sweeping healthcare delivery system changes in our lifetime. Imagine that different world-challenges for our organizations but opportunities for our patients. What an amazing opportunity to show that we can make it count as healthcare finance professionals!

Publication Date: Tuesday, September 01, 2009

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