If you feel like a broken record preaching the importance of revenue cycle management improvements within your healthcare organization, you’re not alone.
Before the American College of Healthcare Executives’ latest survey results were released, it was a foregone conclusion what would top the list of hospital CEOs’ concerns in 2018: Financial challenges (the same concern that has topped the list each of the past 15 years).
And it should not surprise anyone in the industry if that trend continues for years to come.
Not only is the financial health of an organization a prerequisite for achieving all other critical goals (patient safety and quality care to name two), but it’s also a wide-ranging category that encompasses everything from salaries and supplies to pricing and reimbursement.
Streamlining the Revenue Cycle
Although the breadth of the financial challenges category may seem daunting, the good news is that it doesn’t take a variety of solutions and vendors to achieve results across many of the criteria. Efficient, strategic, and intelligent revenue cycle management can address several of the top concerns within the financial challenges category.
A streamlined solution that takes a holistic strategy to tackling systematic revenue cycle challenges across a healthcare organization can alleviate concerns and financial pressures in a range of critical revenue-related areas, including overall revenue cycle management (converting charges to cash), which was identified as a top financial challenge by 43 percent of the CEOs surveyed in 2018.
Sixty-eight percent of surveyed hospital CEOs chose Medicaid reimbursement (including the adequacy and timeliness of payments) as a top financial challenge facing their hospitals, with an additional 49 percent saying the same for Medicare reimbursements.
Commercial insurance payments and managed care payments (HMO, PPO, and POS plans) were also a concern for 50 percent of CEOs.
Getting paid on time and in full is the ideal outcome for every medical bill, but it is a lofty goal and one that in reality will never be achieved. What financial leaders can achieve, however, is helping patients pay for their healthcare services to the best of their ability.
Payment abilities vary drastically from patient to patient. The key to tapping into each patient’s highest ability to pay is understanding their differences. Just as consumer-driven industries, such as retail, make significant investments in understanding their target audiences and offering customized communications to each segment, healthcare must also personalize the patient experience.
With more patient-specific data at our fingertips than ever before, we have the opportunity to tailor every patient interaction based on concrete things we know about each individual. From communication preferences (phone, email, and text) to payment profiling (propensity-to-pay and financial assistance qualification), hospitals can do more to have meaningful conversations with patients and provide the best payment options.
By setting the proper expectations, healthcare organizations can achieve reimbursement and payment goals.
Reducing Bad Debt
Bad debt is another concern consistently appearing at the top of the list of healthcare challenges, with 56 percent of CEOs identifying this as a top concern in 2018. So how do you collect from the “uncollectable?”
The best thing you can do to prevent balances from going into bad debt is to make payment options clear and repetitive.
- Be transparent with pricing and patient payment obligations at the point of service to avoid surprise medical bills.
- Make print and electronic statements as simple as possible, using colors, fonts, and images to highlight desired calls to action.
- Provide the best payment option to each patient based on his or her propensity-to-pay analysis whether it’s a one-time payment in full, enrollment in a payment installment plan, or financial hardship/charity options to make payments more manageable.
- Do whatever you can to encourage and empower patients to pay to the best of their abilities.
Competing for Consumers
Today’s healthcare consumers have more choices than ever before. From urgent care facilities to health systems in neighboring cities, hospitals are becoming increasingly competitive for patients, and it’s causing them to adapt.
No longer are patients defaulting to the nearest hospital or making their healthcare decisions based on a clinical encounter alone. Patients are savvy consumers and consider things like convenience, past experiences (positive and negative), communications, technology, and transparency when selecting their healthcare provider.
Successful healthcare organizations will be those that adapt to these changing circumstances and compete to provide the best holistic patient experience that starts with streamlined appointment setting, continues with quality clinical encounters, and culminates in efficient, respectful, and convenient payment processes pre-, at-, and post-service.
Fifty percent of surveyed CEOs listed competition from other providers as a financial challenge in 2018. Look for this trend to increase in the coming years as patients are given more choices.
More Insights from the 2018 ACHE Survey
The top 11 concerns were relatively unchanged from the previous two years, except for newcomer behavioral health/addiction issues. Here’s the full top 11 list with average rank in parentheses (lower average rank means higher concern to CEOs):
- Financial Challenges (2.8)
- Governmental Mandates (5.1)
- Patient Safety and Quality (5.1)
- Personnel Shortages (5.2)
- Behavioral Health/Addiction Issues (5.3)
- Patient Satisfaction (6.1)
- Access to Care (6.2)
- Physician-Hospital Relations (6.2)
- Technology (7.7)
- Population Health Management (8.1)
- Reorganization (8.3)
This article was originally published on RevSpring and is republished here with permission.
Check out our HIMSS Highlights interview with Marty Callahan as he talks about the ideas outlined in his book, Reinventing Revenue Cycle Management, and the response to the book from healthcare organizations. His company also recently received two #1 rankings from Black Book for their work in patient communications and revenue analytics, and Marty discussed key aspects of their success.