As hospitals and health systems eye the transition to value-based care models, simplifying and investing in revenue cycle workflows is key.
At the Becker's Hospital Review Annual Meeting in Chicago April 28, healthcare leaders shared their unique insights on the challenges and opportunities facing hospital revenue cycles during a panel moderated by Molly Gamble, editor-in-chief of Becker's Hospital Review.
Process standardization is imperative as health systems begin the transition to value-based care models, panelists agreed. "Functions across the Health System must be uniform before an organization can start to take on risk," said Emad Rizk, MD, CEO of Chicago-based Accretive Health.
But standardization can be difficult to achieve across a multi-hospital system. The recent surge in merger and acquisition activity means a greater number of organizations are faced with the challenge of combining disparate processes and information databases into a seamless workflow. Bruce H. Ziran, MD, orthopaedic surgeon and orthopaedic traumatologist with Gwinnett Hughston Trauma in Lawrenceville, Ga., recommended health systems focus on eliminating redundancies and collapsing revenue cycle workflows to improve efficiency. This can be done by standardizing coding, claims submission and reporting practices and centralizing front- and back-end operations.
Cheryl Sadro, CPA, executive vice president and chief business and finance officer at Galveston-based University of Texas Medical Branch, said her organization brought in a third-party consultant to help pinpoint bottlenecks and address discrepancies in its revenue cycle across the system. "For us, it was about getting back to the basics," said Ms. Sadro. "It's not the sexiest stuff in the world, but it's had the greatest impact."
There are other ways hospitals and health systems can benefit from consolidating their revenue cycle functions. With the rise in high-deductible health plans, patients are shouldering greater responsibility for healthcare costs, and hospitals and health systems are increasingly focusing on patient engagement, said Dr. Rizk. The payment landscape has shifted from business-to-business transactions to mainly business-to-consumer ones, and hospitals need strategies to engage the patient both clinically and financially. This means making "the front end of the revenue cycle more robust, with information traditionally delivered at the back end of the cycle being presented to patients on the front end," said Dr. Rizk.
Dr. Ziran and Ms. Sadro described ways their respective organizations are getting patients engaged earlier in their financial responsibility. Methods include educating patients about their insurance eligibility, understanding patients' respective risk and presenting payment options tailored to the patients' unique context.
At Houghston Memorial Hospital, "we have financial counselors in place to help those who are newly insured become financially literate," said Dr. Ziran. Houghston has also invested in improving its online patient portal to make the financial element of care more transparent to patients from the start. "We engage patients online to help them understand their obligations before they even walk through the door," said Dr. Ziran. Similarly, Ms. Sadro said UTMB is taking steps to be able to present patients with an accurate cost-estimation upfront.
A hospital's billing process has a direct effect on patient satisfaction, largely because billing is the first and last interaction a patient has with the provider, from registration to collections. Negative billing experiences also affect how and when patients fulfill their financial obligations. Ms. Gamble cited a report by Availity that found about 74 percent of satisfied patients paid their medical bills in full compared to 33 percent of their lesser-satisfied counterparts.
UTMB is working to simplify its patient billing process, which historically involved separate bills from physicians and the hospital. The lack of coordination around payment posting confused and frustrated patients, which negatively impacted their overall experience, said Ms. Sadro. UTMB standardized its payment practices by consolidating previously discrete operations within a single Epic billing office. This way, patients understand exactly what they owe, who they have to pay, how much they have pay and when they need to pay it. "We have since seen the number of dissatisfied patients dropping off," said Ms. Sadro.
As the panel came to a close, Dr. Ziran described how his personal battle with cancer emphasized the financial importance of the patient experience. A negative experience at a relatively prestigious health system caused him to seek treatment at, and take his business to, another healthcare organization. "I left a very major institution and went to a smaller practice where I was treated much better," he said. Patient-centered care is not simply a buzzword, but real-world concept that can affect a hospital's bottom line.