You are coping with enormous change, including the reality that in many cases you have to do more to receive the same amount of revenue. The delay of the individual and employer mandates delayed some of this, but the new reality of high deductible plans, skinny insurance, narrow networks, and growing bad debt is here.
Senior leadership is focused on how to improve process, enhance patient engagement, create a more patient-centered environment, use analytics to hone Best Practices and patient outcomes, and employ telemedicine where possible.
Securing staff buy-in to embrace this change has never been more important, including partnering with physicians to effect change and enhance deliverables wherever possible.
Indeed, hospital senior executive teams are analyzing each element and component of their delivery systems to uncover new opportunities, efficiencies, and top-line revenue-generators.
Hospitals continue to invest in IT systems since MU stage 3 and ICD-10 both kick-in this year, and the migration to the cloud given better encryption and protection will be a major growth sector this year.
CMS seeks to accelerate the paradigm shift to patient outcomes (value), and has introduced a new plan to incite more hospital and physician providers to participate in population health management. This is an improvement from the Pioneer ACO program, yet much more remains to be done.
In the interim, we believe volatility will be a reality, especially if hospitals reduce their charges in a reach for greater pricing transparency without using the power of statistics to ensure they do not forfeit net dollars.
Indeed, how you set charges in the charge master will continue to determine a significant portion of most hospitals top-line net revenue.
Some employers seem to be moving in the direction of sending their employees to the private insurance exchanges where there are more choices, broader networks, and a greater variety of insurance plans.
Therefore, knowing your natural market’s businesses, both large and small, is vital.
There still will be millions of uninsured Americans, some of whom may visit your ER in the future.
Utilization and case mix are changing, again, reflecting the continued shift of services from the Inpatient to Outpatient Setting.
What else?
Most CFO’s are focused on tightening the revenue cycle to ensure deductibles are collected up-front if possible and their hospital is paid what it is owed by insurers. Keeping score has never been more important.
CMS continues to push for greater consumerism and pricing transparency, and three major insurers are launching a web portal that shows what they actually pay providers for services in several major cities.
Some states are joining the pricing transparency crusade as well, yet their published data does not include a quality factor (in their algorithm), thereby their data is skewed.
Greater pricing transparency speaks to defensibility of pricing. Our defensibility of pricing module, based on big data, Best practices, a market comparative, a cost-to-charge ratio element, and a quality component, will help you set charges and position your hospital or system strategically.
Indeed, generating more top-line net revenue and positioning your hospital or system strategically need not be mutually exclusive.
Those who attack this year’s change (and embrace it) with an entrepreneurial mindset will thrive. It is an exciting time to be in our industry.