Healthcare finance leaders say these ethical concerns are top of mind today.
Delaying care to obtain prior authorization for certain medical services to ensure costs are covered. This issue often creates conflict between clinicians and finance or revenue cycle staff, said Mike Szubski, chief financial and system services officer at University Hospitals. In some cases, seven- to 10-day wait times for prior authorization are not uncommon. “Health system/physician and insurer interactions must become more efficient. Prior authorization has its place, but it has gone too far in my judgment, especially based on relatively low final denial rates,” he said. “We must take the patient out of the middle of this friction and administrative burden.”
Providing nonemergent care to undocumented patients. Such patients “may have no means to pay for services and are likely not covered by our state Medicaid program,” said James Grigg, CFO of Greater Hudson Valley Health System. During a recent visit to Washington, D.C., with colleagues, Grigg discussed this issue with congressional aides and representatives of the Health Resources and Services Administration.
Pricing transparency. “Healthcare costs can be lowered by making prices available to patients. This can be done,” said Aaron Beam, former CFO of HealthSouth (now Encompass).
Improving access to care. “Organizations are really thinking outside the box for new delivery and access models, whether it is telehealth, telemedicine, new therapy technology or artificial intelligence, and varying types of partnerships,” said Christine Hogan-Newgren, chief compliance and internal audit officer at University of Kansas Health System. “The challenge is creating the structure and expending the resources in a way that meets regulatory, contractual and billing requirements.”