Ed Gaines serves as Chief Compliance Officer of Emergency Medicine Division for Zotec Partners.
On April 1st, Ed will speak at Becker's Hospital Review 10th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place April 1-4, 2019 in Chicago.
To learn more about the conference and Ed's session, click here.
Question: What is the biggest evolution you've seen among the hospitals/health systems you work with over the past 2-3 years?
Ed Gaines: Hospitals have greater appreciation for the high deductible health plan (HDHP) situation that a majority of folks are in and who receive health insurance via their employer. The revenue cycle management (RCM) platforms of the last decade were simply not designed to meet patients where they are today and expect to be dealt with as they interact with Amazon, Google and Netflix. CMS mandated “transparency” of hospital charge masters and state laws mandating communication regarding charges and patient out of pocket expenses for schedule physician services have accelerated “patient centric” RCM practices. Legislative and regulatory calls for “transparency” of hospital and physician charges are accelerating the trend that was well underway.
Q: What do innovators/entrepreneurs from outside healthcare need to better understand about hospital and health system leaders?
EG: Despite the characterization by many that healthcare systems and clinicians are not “tech savvy”, hospitals and physicians have been able to flourish because they are so adaptable to change. Change is a constant in healthcare from clinical protocols, treatments, CMS requirements and health plan reimbursement practices. Healthcare professionals figure out what the issues are, strategize solutions and implement—and if that doesn’t work, they try something else. They do not bury their head in the sand and play the victim—that’s one of the greatest attributes and rewards of working in healthcare.
Q: What one strategic initiative will demand the most of your time and energy in 2019?
EG: The OON activities at the federal and state level; failure to obtain appropriate protections for not only the patients but also their clinicians could have multi-decade ripple effects.