The implementation of the Affordable Care Act has led to tremendous changes in the healthcare industry, but for providers, the greatest change is the most obvious: more patients.
According to a May 2015 report from the U.S. Department of Health & Human Services, up to 16.4 million uninsured people gained insurance since the ACA went into effect.
All those new patients are causing health systems to grow – an exciting prospect for many organizations, but one that brings new challenges that could affect long-term profitability if not handled correctly. These challenges include managing the influx of new patients; assessing and activating the best payment options; and streamlining the organization's operating model to most efficiently serve the patients long-term. Below are top considerations for chief financial officers managing the challenges when healthcare organizations are ready for expansion:
Managing Influx of New Patients
The influx of new patients coming to health care systems now includes a number of people who have not had insurance in the past, which could create a backlog in demand for healthcare services among these patients. In the short-term that could mean a greater number of appointments, more procedures and additional follow-up to get ailments under control. But according to an Carolinas HealthCare System (CHS) of 5,000 U.S. doctors, about half said they lacked the resources to take on a higher volume of patients. This research indicates stress on the system, which could be compounded by the needs of the newly insured patients.
What to do? The most important step is to prepare staff for the higher volume of patients, in particular patients who need more medical care. On the administrative side, that means training staff on helping patients manage their insurance benefits and treatment. That's exactly what MemorialCare Medical Group in Southern California, which has more than 200 care sites, has done. The organization trained its administrative staff to work with new patients who may have not yet received their policy documents or who may be unfamiliar with their insurance plans. In addition, the group ramped up its customer service side in order to deal with the barrage of calls from new and prospective patients.
On the clinical side, healthcare organizations may need to add physicians and other providers. MemorialCare added more primary care physicians to handle the expected cases of people whose ailments had progressed because of a lack of access in the past. But healthcare organizations should consider adding mid-level professionals, such as nurse practitioners and physician's assistants, who can treat a broad range of patients but whose salaries are less than physicians. In fact, adding more mid-level healthcare professionals will assist in managing the shortage of primary care doctors, which is a concern for many healthcare groups.
Upgrading Payments Systems with Technology
With new patients come more payment issues. And that is especially true today, as the newly insured have options beyond the traditional HMO. In fact, a survey in 2013 by the Medical Group Management Association found that collecting from self-pay, high-deductible and/or health savings account patients was a top five issue for medical practices. To manage this process, organizations should evaluate their technology options to streamline the billing and claims processes, to reduce the time between service and bill collection.
Consider the case of the physicians' services group at Carolinas HealthCare System (CHS): The group experienced unprecedented growth in the past few years, doubling the amount of physicians they were providing billing services for. But the payments process for the increased number of physicians put a strain on the organization, requiring mandatory overtime for team members for two years as they worked to manage payer challenges. Through Bank of America's HealthLogic Technology, which was tailored to meet the specific needs of the group's operations, the group increased the rate of automatic payment posting from 60 percent to 100 percent across 250 practices. This change allowed the group to end mandatory overtime and reallocate resources.
Other changes that can upgrade the payment system include accepting credit cards in the office or using automation to verify insurance – a process that otherwise requires staff time to phone in each request. Upgrading technology is a big-ticket item that can lead to many concerns for a medical practice. But when done correctly, technology upgrades can literally transform an organization.
Streamlining Practice Business Operations
Because of rising costs for the healthcare industry, lower reimbursements for doctors and evolving federal regulations, physicians must run their practices more effectively and efficiently. These changes will improve the experience for the patients and in turn the bottom line for the practice, as satisfied patients become long-term clients and generate higher revenue for the practice.
First, consider ways to help patients manage appointments and other issues. Web-based patient portals can speed up the time to obtain referrals, make appointments, and refill prescriptions, giving staff more time to talk to patients in the office.
Additionally, look at the waiting room to determine what other changes are needed. For instance, if it is standing-room only most of the time, that suggests a need for a new approach to scheduling. Instead of automatically adding appointments three months out for some chronic conditions, consider sending out postcards two months after a visit, asking patients to set up another appointment. This allows office managers to schedule visits when they will have a better sense of staff availability and patient volume. At the same time, this process leaves more openings for same-day or urgent visits, as well as improving the flow of patients.
Practice leaders should also strategize about how they are utilizing their staff. As mentioned before, mid-level professionals can be a vital resource to practices, as they can offer a range of services while allowing physicians to focus on more critical cases. But it is important to determine what types of cases the physician's assistants will take on, but there is no right way to split up the duties; the important issue is that everyone in the office understands the strategy, in order to offer the best service to patients.
Going Forward
The ongoing implementation of the ACA is leading many healthcare organizations to become larger and more complex. As a result, finding ways to simplify operations and make the most of new technology will be key. The new processes will help organizations on-board new patients, manage payments and create processes that improve the patient experience.
By focusing on those issues, organizations will be able to address the needs of their patients while keeping up with continued growth in the healthcare industry's transforming landscape.
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