Lyman Sornberger serves as Chief Healthcare Strategy Officer for Capio Partners LLC.
On Saturday, September 23, Mr. Sornberger will give a presentation at Becker's Hospital Review 3rd Annual Health IT + Revenue Cycle Conference. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place September 21 through September 23 in Chicago.
To learn more about the conference and Mr. Sornberger's session, click here.
Based on experience with two healthcare systems of $6B+, Mr. Sornberger found the following to be true.
Question: Please share the state of revenue cycle management at your organization. What is your payer mix? What about your revenue cycle is working well, what needs improvement and what do you find yourself spending more time on?
Lyman Sornberger: RCM is in constant flux but the challenge is the obvious one-constant change. Overall, we are keeping pace with changes, but it is difficult between regulatory changes and keeping pace with the required technology. Our payer mix is 35 percent government, 23 percent state, 26 percent commercial and 16 percent self pay.
Our organizational structure is in our opinion the best practice. We align management around insurance versus patient responsibility and have a robust denials and appeals process. The focus is on shifting the back-end changes to the front either through technology, staffing and/or training. More time is spent on creating more patient-friendly processes, while maximizing reimbursement. Sometimes it can be a double-edged sword, but it's the nature of the beast.
Q: How have alternative payment models affected your line of work? Can you share three specific steps, if any, has your organization taken to adapt to bundles and ACO payments?
LS: It's anticipated that 90 percent of hospitals will be under a bundled payment model by 2020. Current technology platforms and operational process are not prepared for this major change. In some respect, the provider becomes a payer or distributor internally and sometimes externally. In addition, healthcare staff is not educated to the single business office to the extent to support a bundled payment model. I will stress that a bundled payment does not mean a full payment! There will be carve-outs, somewhat to the extent of defining clinical pathways. That simply is not an easy pathway for providers. Therefore, there are probably three focuses: 1) Transition to a new payment model and adoption, including the charge master, contracting, financial exposure, cost and training. 2) Technology integration, since today's systems do not communicate well, and it's a requirement for future payment models. 3) Education is paramount throughout the organization since the change has an undefined expense and impacts every aspect of the health system.
Q: Percent-wise, roughly how much of your revenue cycle is automated? Do you plan to maintain that percent or increase in the next one to two years? What effects have you seen from automation, good or bad?
LS: Automation can have a strange definition since many organizations will proclaim they are automated, but really have a band-aid with some manual intervention. Automation for me is A-Z. For others it could be A-L and require some human action. It is inevitable health systems invest in technology. In my opinion, they will need to double their cost to support this inevitable future healthcare change.
Q: What is one investment you've made in RCM that has surprised you in terms of ROI? How so?
LS: Education/training, building the association to a positive clinical relationship, promoting the financial health of the organization and — maybe most important — the patient experience. That is a broad-brushed approach to meet the healthcare regulatory and technical requirements to support the process. If you take on a patient-centered approach, the end game drives the decision-making for the health system's brand and quality of care.