If there’s one thing that became evident while attending HFMA’s Annual Meeting in Orlando, FL, it’s that the chief financial officers (CFOs) and revenue cycle executives of health organizations remain challenged in finding ways to maximize their revenue cycle. Changing regulatory requirements along with a push to be more patient-centric have left many health organizations actively searching for technologies that advance the quality, efficiency, and financial feasibility of care delivery.
In this evolving world of healthcare, hospitals must move the patient collections process to the front of the revenue cycle while ensuring that every patient touch-point drives loyalty—and that includes the pain point of patient billing. Patients demand more from their healthcare experience as they’re required to pay more out-of-pocket expenses. All it takes is one bad billing experience to lose a patient to a competing health organization.
With all of that in mind, data and analytics have never been more important in running a successful health organization. As an example, let’s consider a very common scenario. A patient with a high-deductible health plan will need to pay approximately $3,000 for a procedure. When the patient leaves the hospital, they’re sent multiple bills from the physician, the anesthesiologist, the radiology department, and the hospital. The bills show up randomly, and the patient has little explanation for the amounts on the bills—other than this is their “share” of the bill. Once a patient leaves the hospital, it becomes much more difficult to collect from them. And the frustration of receiving multiple high-dollar bills leaves the patient resenting their healthcare providers.
Now, imagine if we moved patient collections to the front of the revenue cycle process by working with the patient early on to help them understand what their financial responsibility will be for the procedure. Based on the patient’s financial data, we can understand both the patient’s financial situation and their propensity to pay. From the data insights we gather, we determine the patient can pay $250 per month for the next 12 months. Before their procedure is even scheduled, they are set up on a payment plan. They make their payments through a patient portal that has all their bills bundled. This new way of thinking treats patients as consumers—the same way they’re treated in the retail world.
Beyond patient billing, there’s also the need for health organizations to combine and link data across the enterprise. This is the only way revenue cycle teams can pinpoint where something went wrong in the documentation of patient benefits across the continuum of care so they can ensure payment on claims. With value-based care changing how providers are paid, providers need to understand care patterns and their associated financial risk. This information can be gleaned from analyzing claim and other revenue cycle data. As reimbursement declines, providers must look for ways to become more efficient, both clinically and administratively. National benchmarks like HFMA map keys and NAHAM patient access can help them measure their financial and administrative success.
As we move into this new era of healthcare, it’s exciting to see the progress made in technological advancements to help organizations and patients give and receive the best care possible. As new technologies are implemented, it’s critical to understand and plan for linkages across clinical and financial activities to optimize workflow and reporting in both environments. By adopting a holistic approach to technology evaluation and design, providers—and patients—should benefit from automation, scale, and process improvements to positively impact quality of care and financial outcomes.
