Pamela Ott, CFO, Northwest Indiana Region, Franciscan Alliance: When it comes to the uninsured, we’re preparing for an increase and managing that from a revenue cycle perspective in similar ways as others have mentioned, but we’re also recognizing the need for “all hands on deck” when it comes to revenue recovery. We’re continually seeking new opportunities to increase revenue or reduce expenses. There is an increased level of pressure on financial performance. From a finance perspective, the impact of the pandemic on revenue has been devastating. We’re projecting some relatively significant increases in bad debt and charity care, probably more than we believed we would [at the start of the pandemic]. We have to continue to prepare ourselves for the ripple effects of the pandemic’s impact and identify strategies to offset that impact.
Bittner: I do think that health systems that are investing in value-based payment models are seeing reductions in total cost of care. For us, it’s not just about providing an upfront office-visit component. We’re also expanding care capabilities in the home so we can discharge patients sooner but monitor them remotely and provide access to specialists via telehealth capabilities. Those efforts, in totality, will help reduce overall cost of care. And if you’re participating in a value-based program that rewards reductions in total cost of care, it does provide opportunities from a revenue perspective.
What other types of innovations are you considering for cost reduction and/or improved performance of your revenue cycle operations?
Johnson: We’re identifying opportunities to reduce the costs associated with each of our revenue cycle vendors so that we don’t pay millions of dollars to companies to perform tasks we are capable of doing. For example, we have a vendor that manages our emergency department [ED] denials. We created a bot that grabs the patient’s records from the ED, creates the clinical appeals letter in response to the payer and uploads the letter to the payer’s website. We have also been able to automate repetitive tasks we used to pay a vendor to do based on volume.
Limbocker: We’re starting down a project with one of our large commercial payers to try to knock down barriers and create efficiencies between ourselves. We’ve formed a working group to identify ways to reduce bad debt and invest in technologies and processes that reduce the administrative burden around payer rules that create unnecessary cost for us. We’re seeing great examples of gains made in these areas by healthcare organizations across the country. It’s a dream, but we have to get there together — payers and providers — if we want to reduce total cost of care.
Peterson: As a system, we’re moving to a single IT platform for all six of our hospitals to gain efficiencies in the revenue cycle — even in the middle of the COVID-19 pandemic.
Gallagher: We’re examining opportunities to increase visits that do not have a billing or collections component, similar to Amazon, where consumers pay upfront. For example, in the future, our patients may be able to pay cash for a CT scan at a much lower rate. In an era of consumerism, I think the market is going to shift this way.
How are the economic and operational pressures of the pandemic changing the healthcare finance system today? Post-pandemic? What would you like to see on the other side of the pandemic? What would revenue cycle look like?
Peterson: Clearly, managing expenses, especially labor expenses, is going to be one of our biggest challenges. So will having the ability to flex our revenue cycle staff up and down based on volume. We also need to make sure we’re able to manage our risk, but not adding costs to the organization in doing so. It’s a process that requires us to look at everything differently and to consider: How can we do things in a simpler, more effective way? Where can we squeeze costs out of our processes?
Ott: I agree. We need processes that are not only simpler, but also more patient friendly. If we can continue to move the dial on consumerism, that will be critical — not just in offering self-service technologies, but also developing innovations that improve the patient financial experience at every point of the patient’s spectrum of care.
Bittner: What the pandemic has allowed us to do is develop a stronger team, virtually, by drawing on our cultural competencies and investing in our talent in ways we wouldn’t have been able to do outside of the pandemic. We’re able to hire colleagues from all over the country, versus relying on a geographical area for talent, with people who have 20 years of experience in healthcare revenue cycle rather than six months of experience. That has increased our level of sophistication in approaching revenue cycle challenges. Ultimately, these investments will increase operational efficiency and drive revenue cycle success.
Johnson: I definitely agree: The revenue cycle of the future is at home. We first saw that shift to remote work with coders: They live everywhere, so why can’t a biller? Today, we provide all of our staff training and orientation sessions at home, and it is happening in half the time that it did when staff worked in the hospital.
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