How to improve revenue cycle processes under value-based care

Investing in front-end revenue cycle improvement is a top strategic priority for all hospitals during value-based reform.

Leaders from three different hospital systems shared key thoughts on improving revenue cycle processes during a panel discussion on July 27 at the Becker's Hospital Review 2nd Annual CIO/HIT + Revenue Cycle Conference in Chicago.

Hospitals' role in the patient-provider relationship has expanded to include more than just clinical care, said Kelly Clasen, senior director of business operations at MiddleParkMedicalCenter in Kremmling, Colo. With the shift to value-based payment models, clinical outcomes and patient satisfaction bear equal weight in determining hospitals' prospective reimbursement. This means that what happens to patients in the billing department or at the registration desk is just as important as what happens to them in the operating room.

During an episode of care, patients often touch hospitals' revenue cycles more than they interact with clinicians. "It's critically important hospitals resolve instances where patients report great clinical treatment and negative financial interactions," said Brad Cook, vice president of revenue cycle management at Presbyterian Healthcare Services in Albuquerque, N.M. Patient financial dissatisfaction often stems from not fully understanding their insurance benefits or hospital bills. This can be especially true for patients who purchased health insurance for the first time on Affordable Care Act marketplaces and are unfamiliar with how healthcare works, according to Mr. Cook.

To help patients manage the full continuum of their healthcare experience, it's important revenue cycle leaders re-evaluate their alternative patient financing options. "Most patients don't have the scientific knowledge to differentiate exceptional clinical care, they just know their health improved," said Karen Shaffer-Platt, vice president of revenue cycle and patient concierge services at UPMC in Pittsburgh. "As consumers, though, patients have a ton of experience in customer service and billing, and that's where many hospitals fall apart." Alternative financing and payment options, such as installment plans and loan programs, are simple ways hospitals can show they are invested in helping patients afford the care they need, according to Ms. Shaffer-Platt. 

To improve patient financial experiences, hospitals should invest heavily in recruiting, educating and training frontline revenue staff with a higher professional skill-set than they are used to hiring, all three panelists agreed. This includes hiring specialized financial aid counselors, insurance eligibility counselors, registration staff and other personnel capable of educating patients about complex topics with compassion.

Under value-based contracts, it is also vital for hospitals to improve back-end revenue cycle processes by strengthening inter-department collaboration. Specifically, hospital leaders can engage physicians in revenue cycle operations to drive improved charge capture through clinical documentation improvement initiatives, said Ms. Shaffer-Platt. By marrying clinical and financial strategy, hospital leaders better align incentives for improved operational efficiency.

Like a moth to the flame, data moves physicians to action. Revenue cycle leaders should present clinicians with statistics that illustrate how their everyday practices affect the hospital's business. Data on revenue leakage and denial rates can be powerful motivators for physician change, said Ms. Shaffer-Platt. Getting physicians on board with infection control and patient satisfaction initiatives may become easier as physician compensation is increasingly tied to clinical outcomes.

As reimbursement is increasingly tied to quality, a hospital's survival depends upon its ability to manage both the clinical and financial aspects of medical treatment. "Health systems don't reap benefits from layering new technology over broken infrastructure," said Ms. Clasen. "Meaningful improvement is about going back to the basics and focusing on your process and your people."

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