Health systems across the country are facing rising levels of uncompensated care. Part of the challenge is due to payers increasing claims denials, while at the same time, federal and state regulations are making it more difficult for providers to pursue patients for their portion of payments due.
During a webinar hosted by Becker's Hospital Review and sponsored by Office Ally, a panel of healthcare revenue cycle leaders discussed the trend of rising uncompensated care. They also shared strategies and initiatives that organizations have implemented to address revenue recovery along with the role of technology in supporting those efforts.
Panelists were:
- Kemberly Blackledge, DSc, chief revenue officer, Nashville (Tenn.) General Hospital
- David Burton, chief revenue officer, IU Health (Indianapolis)
- Motti Edelstein, vice president, revenue cycle, Allina Health (Minneapolis)
- Chris Regan, vice president, enterprise sales, Office Ally
Some of the main ideas from the webinar are summarized below.
Uncompensated care is on an upward trajectory
During the COVID-19 pandemic, due to special protections, many healthcare organizations experienced a decrease in uncompensated care compared to pre-pandemic levels. However, with the expiration of those protections, levels of uncompensated care are starting to rise back up.
Rising levels of uncompensated care can be partly attributed to uninsured patients who lack the means to pay medical bills and to patients with some form of insurance that struggle to pay their share of care costs. The latter group is often deterred from seeking care or is unable to pay for received care due to increasing copays and deductibles.
"Even if you have a commercial plan, a patient's financial responsibility is very different today than it was years ago," Mr. Regan said.
He observed that in the past, revenue cycle departments have often been the last to receive additional resources, but in the face of increasing patient financial burden, their role now is more essential than ever. "It is time to get back to the basics and working self-pay management again and reinvesting in revenue cycle management systems and resources," he said.
Health systems are navigating uncompensated care with varying degrees of success
About a decade ago, IU Health decided that its revenue cycle priority was not how to collect better from patients, but how to not even need to collect from them in the first place.
In line with this priority, IU Health invested in staff whose job was to help people qualify for insurance coverage before they receive service, as well as in a billing system that delivered a zero-interest credit card-like experience. The system was optimized for flexibility, so that payment terms were calibrated to work for each individual patient. In that sense, IU had a plan that preempted much of what other health systems are now dealing with in terms of uncompensated care.
"For us, there were two main levers: minimize what you're trying to get out-of-pocket from folks and be as flexible as you can with how you help people resolve financial situations," Mr. Burton said.
Allina Health has also invested in a technology that promised to help address the challenge of uncompensated care, but that platform focuses on modifying how organizations communicate with patients in hope of improving collections.
"From a patient experience perspective, it's been great. But from a revenue cycle operations and IT support perspective, it's been a very heavy lift," said Mr. Edelstein, who noted the organization is still implementing the solution, one year in. He added that Allina Health is expanding its focus to doing as much as it can on the front end to maximize collections, including during patient pre-registration, pre-screening and pre-eligibility for Medicaid or charity care.
Partnerships with technology vendor can help organizations step up uncompensated care strategies
In the context of rising uncompensated care, one possible solution starts with getting a comprehensive understanding of patients, including of their insurance status and ability to pay, before they receive care. That way organizations can know which revenue cycle or what payment path makes the most sense to put those patients on.
At Nashville General Hospital, this is a question revenue cycle leaders are currently grappling with, Dr. Blackledge said. "How can we swim upstream further to get that entire patient whole well-being assessment in advance?"
Technology vendors that offer such solutions can provide much needed relief and direction to revenue cycle departments, but also help foster a culture of financial stewardship throughout the organization. "Our best effort — outside of purchasing technology — is going back to the staff and educating them," Dr. Blackledge said. "That's across all departments, not just revenue cycle: it's pharmacy, it's [clinical], it's any revenue-generating, revenue-producing department, because this is all about revenue recovery and understanding the impact of uncompensated care on our organization."
Another solution is technology that automates revenue cycle workflows, or at least parts of them — for example, by eliminating the need for staff members to make phone calls to patients who either owe money or are being pre-screened for ability to pay, or by helping patients fill in Medicare and Medicaid applications on their own time (instead of being accompanied by a staffer).
Conclusion
As hospitals and health systems ramp up their strategies for addressing uncompensated care, choosing a technology partner that can provide support is critical. The key when choosing a vendor, though, is to start with the end — not the tool — in mind.
"A vendor or a piece of software shouldn't be your strategy; your strategy should be led by the change you're trying to implement," Mr. Burton said. "So whatever vendor you might engage or software you might buy, you need to be really clear on how it's going to enable the change you're trying to implement."
Mr. Regan added, "By going with a single solution, you can miss a lot. The winning strategy is having multiple solutions."
To register for upcoming webinars, click here.