Each year, HBI hosts get-togethers of revenue cycle leaders from across the country—and among organizations large and small, from rural to urban—to help our members parse out proven successes, lessons learned, and actionable takeaways among top-performing peers through a variety of networking opportunities, learning sessions, panels, and breakout discussions.
Our latest event, our 2018 Spring Member Retreat in Chicago, likewise featured a range of organizations and explored topics ran the full gamut of revenue cycle operations (by design, of course), there were a few prominent themes that permeated the entire two-day event:
Typical Approaches to Patient Payment and Assistance Are Vastly Outdated
Perhaps the most urgent trend that came to light: Revenue cycle leaders are realizing that they are indeed competing with the conveniences and customer service offered by giants such as Amazon, now in the process of entering the U.S. healthcare market. “As a patient, I welcome this,” said speaker Laurie Hurwitz, executive director of revenue cycle for Gundersen Health System. “But if Amazon and Walgreens ever get into the primary care business, we need to think about how we’re going to match what it is that they’re providing to patients. Long gone are the days when patients have a distinct loyalty to their provider. They will switch providers over their financial experience, over the convenience provided.”
Realizing this, as well as results from recent studies showing that the average American cannot afford an unexpected $1,000 bill, Gundersen Health System knew change was needed. An already-offered payment plan program was adjusted from a strict 10-month repayment term per balance (after which, a collection agency was engaged) to a 24-month repayment term. Patients can also self-enroll or adjust their payment terms, as well as add new balances to existing accounts, online.
In another presentation by Klare Wagner, manager of financial assistance for Intermountain Healthcare, research by the organization was shared that indicated patients who pay something toward their care, no matter the amount, are more likely to follow their doctor’s orders and care plan. Therefore, to make it easier for patients to pay, Intermountain has made clarifications and modifications to its financial assistance program, including but not limited to:
- Medical bills owed to other providers are calculated as if they were part of their total Intermountain bill
- Patients may be asked to pay 20% of the difference between their total bill and available liquid assets, so as not to wipe out their savings
- Eligibility for financial assistance was adjusted to 200% of the federal poverty level after an assessment of renting costs in the local market, which is a significant factor in patients’ accessible income
Revenue Cycle–Wide Education Is a Money Saver
Shannon Lingwall spoke exclusively about University of Utah Health’s new hire training approach, which integrates revenue cycle training with training on IT systems. Videos, reviews that mimic game shows, and practice environments are mixed in with revenue cycle basic training to give a holistic view of how each role is completed and impacts others.
Sitting on a leadership panel regarding how data analytics is being applied in the revenue cycle, Cindy Somosko, director of patient financial services at Alliance Community Hospital, noted that it was important for her organization to teach front-line staff about the metrics being measured on its standard scorecard. “I once realized my staff didn’t know what A/R meant, or if it should go up or down—nobody ever explained those concepts to them,” she said. “Leaders need to ensure staff understand those terms so they can be part of the success plan for everything you measure.”
Getting Paid Necessitates Expanding Partnerships
A number of presentations also told of cross-departmental collaborations—often between clinical and financial camps, but also between nonaffiliated facilities—that allowed otherwise lost reimbursement to be recovered. At University of Missouri Health Care, care coordination, health information management, and revenue management are all housed under the revenue cycle. Working together, these groups analyzed 80 visits with a discharge disposition to home health, re-educated staff on documentation guidelines, and implemented points of contact with home health agencies to the tune of $2 million in recoveries.
Recognizing that surrogacy has grown in national prevalence by 89% since 2014, and by 166% at Idaho’s own St. Luke’s Health System, speaker Melissa Ward—a former nurse and nursing leader—helped to build best practices, education, and policies and procedures pertaining to a variety of patient populations from both the clinical and financial experience perspective. More recently, she helped to break down silos and designate a revenue cycle champion to address the needs of surrogacy-related patients and visitors through more effective revenue cycle workflows; a new guarantor financial form; a button in the EHR that financially separates the birth mother from the newborn; as well as deposit, self-pay discount, and bundled payment arrangements.
Lastly, in providing a playbook for payer contract renewals and negotiations, Heather Clark, patient accounts manager at Fulton County Health Center, emphasized the need to have all stakeholders at the table. “If you’re not communicating with the different areas within your organization, you may end up committing to something that then makes it really difficult … or maybe you get really close to a settlement, and because you were not united on all fronts, the payer can go back on some key items,” she said. As one specific example, Clark noted experiencing the tactic of payers attempting to “divide and conquer” between the hospital and physician organizations within a single health system. To stay united, Fulton County Health Center has representatives from both sides meet every month to review contracts.
She further adds that forums such as HBI’s member retreats allows providers to come together to discuss their pain points and triumphs with similar payers, using those as leverage in future conversations and renegotiations.
JOIN US FOR OUR NEXT RETREAT, IN NASHVILLE THIS OCTOBER!
For the full, tentative agenda, click here. We hope to see you there!
To be a part of these sessions and discussions at our next event October 24–26, please register to attend via the form below to reserve your spot. For current HBI members, the registration fee is waived.