The next generation of revenue cycle tools should help you tackle today’s problems and speak directly to a vastly different landscape, but will deliverables meet expectations?
Much of the revenue cycle is evolving. ICD-10 is here, but it’s much too early to know how this affects receivables, physician productivity, coders, patient engagement, and patient satisfaction.
Some are pushing for centralized coding and billing, even when hospitals remain independent. Could this be part of a new type of value alliance where both are outsourced to a third party for several hospitals?
Bundled payments are here for orthopedic hip and knee procedures with more on the way starting with cardiovascular events. Anything that streamlines process and impacts patient outcomes should be on the table for discussion and assessment.
Doing this assumes a tangible benefit to hospital and physician providers, too.
Enhanced clinical documentation will uncover more billable services, therefore investments in software applications makes sense. The new absolute is that ‘you are leaving money on the table if you fail to capture all clinical treatment’.
Most hospital providers have implemented changes to ensure patients know their payment responsibility well before treatment. Collecting as much of patient deductibles as possible is another new necessity, yet how this is done can impact patient satisfaction, therefore this requires special sensitivity training in collections.
In addition, providing various financing options for patients with high deductibles is a ‘must’ for many providers.
The continuing migration of more services from the inpatient to outpatient setting has many providers scrambling to reinvent themselves to compensate for the serious reduction in inpatient revenues.
This trend is occurring nationally but unevenly since some hospitals are still able to grow select inpatient services where brand is dominant in their market. As always, community demographics, the provider brand, and other market variables determine the bottom line impact of this trend for each hospital and system.
Knowing your community, its employers, and your costs for each service are critical factors in positioning your hospital for continuing growth and greater profitability. This is especially true if you need to implement preemptive medicine to reduce ER recidivism.
Airlines reward frequent fliers with discounts and other perks because it’s smart business. You cannot afford to ignore those who visit your ER a disproportionate number of times during the year. Most of this speaks directly to population health management of lifestyle diseases like Type-2 diabetes, obesity, and cardiovascular disease.
Crafting customized programs for your hospital’s ‘frequent fliers’ will improve their health while reducing ER visits and the cost of their health care services.
ER’s are seeing more patients who need mental health services, most of whom are on Medicaid. There is no easy answer for this, especially since most acute-care hospitals have eliminated inpatient services for mental health short-term treatment.
The rapidly rising cost of mental health services in our society affects all of us. We are beginning to see Joint Ventures, affiliations, and Strategic Alliances between hospital providers and short-term psychiatric entities as well as MCO’s that specialize in peer professional services to those hospital providers that do offer short-term inpatient treatment.
Drilling-down to the actual cost of anything is never easy, and it is especially difficult for health care given its unique business model with most payments involving a third party payer. Revenue is never simply revenue when providers must negotiate terms of payment with a number of different payers.
Those hospital providers that still have a statistically significant charge-based payer component are more fortunate than those who have 97% or more fixed payer contracts, yet Medicare-dependent providers can also embrace much of the new change to streamline services and improve margins.
Industry experts say the University of Utah probably is the closest to having captured the specific cost of each cost data point in the patient care continuum. Others will follow since knowing the actual cost of care for each diagnosis is a giant first step to greater efficiency and pricing transparency.
Is there a one-size-fits-all solution for making sense of the new change, embracing it, and thriving? No, there is no single bullet for delivering optimal patient care while transitioning from the traditional FFS model to the new paradigm of value (patient outcomes).
Meeting patient needs and exceeding their expectations still is the goal and now it’s the measure, too. Winning starts with making a series of decisions based on the needs of the community you serve, your hospital’s unique strengths and weaknesses, and your vision for health care in the next ten to fifteen years.
Assessing mission, the community you serve, market niche, staff and employee assets, process, physical facilities, financial strength, and payer mix, are fundamental. Those leaders that think strategically as an entrepreneur have a much better chance of positioning their institution favorably for the mid and long term.
The national merger trend continues, yet some eschew this for strategic Joint Ventures or affiliations. In addition, several state AG’s and the FTC are pushing back against select mergers because of new data that confirms less competition means higher health care charges (and costs) for patients.
Despite the acceleration of change, challenges, and risk in a vastly different health care landscape, many believe this is the best time to be in health care. We agree.
We can help!