HFMA: 11 notes from the press room

The triple-digit heat index was one conversation-starter at HFMA's 2015 National Institute in Orlando.

Here are a few things to note about the event so far. It wraps up Thursday afternoon.

5 hot topics

1. Up-front collections. Patients are shouldering greater financial responsibility for the medical care they receive as high-deductible health plans become increasingly popular. Improving the revenue cycle to make it more front-driven is a strategy for improving collections that was the source of chatter at HFMA. Cleveland-based The MetroHealth System Senior Vice President and CFO Craig Richmond said high-deductible health plans complicate collections and the key is to have transparency with patients regarding cost and "to begin the education process prior to care."

2. Predictive analytics. Which claims will most likely be denied? Which patients will pay their bill two weeks late and who will not pay at all? There were plenty of mentions of hospitals and health systems using historical patient and claims data to better forecast a patient's propensity to pay or the likelihood that a payer will reimburse. This ties into the next point, patient experience, as well. If you are a patient who will pay the bill two weeks late, it's not the best patient experience to end up in collections.

3. The patient experience. Patient loyalty, advocacy, satisfaction and education were cornerstones of the meeting, and several sessions explored the connection between a sound financial strategy and content patient. A sampling: Yvonne Chase, unit manager of patient access at Rochester, Minn.-based Mayo Clinic, spoke about an improved patient experience from admission to discharge, while David Newman, PhD, JD, executive director of the Health Care Cost Institute, touched on consumer access to pricing and quality data in his session. The terms "patient-centric revenue cycle" and "retailization of the revenue cycle" were heard more than once.

4. Millennials. While those ages 18-34 may not represent the bulk of hospital patients over the next decade, they first made up the majority of the U.S. workforce this past spring. For as much abstract chatter he hears about millennials, Joe Fifer, president and CEO of HFMA, said this statistic hit him "right between the eyes" and will drive different management tactics than what worked for Baby Boomers.

5. Physician involvement. Neal Shah, MD, founder and executive director of nonprofit Costs of Care, and Grace Terrell, MD, CEO of Cornerstone Health Care, both brought the physician perspective to their keynote sessions Tuesday and Wednesday, respectively. Several breakout sessions were devoted to physician leadership and involvement in finance and its the link between financial performance and never events, clinical variation and cost awareness. 

3 lesser-discussed topics

6. King v. Burwell. Aside from a few mentions in passing, not many hallway conversations were devoted to King v. Burwell. The Supreme Court is expected to issue one or more opinions Thursday and Friday.

7. ICD-10. More than one person expressed doubt ICD-10 would even take effect Oct. 1. There were a few mentions of ICD-10 preparation, but very little discussion around Oct. 2 onward.

8. Staff education and talent development. There was a lot of high-level discussion about financial strategy and the hospital revenue cycle, but not much discussion devoted to the staff members who actually answer patients' questions and collect co-pays. How can hospitals support them and equip them with the knowledge they'll need in light of high-deductible health plans, ICD-10 and price transparency?

Food for thought

9. There will be no more than 200 "clinical integration organization systems" that account for 60 percent to 80 percent of healthcare in the next five to 10 years, according to futurist Ian Morrison. He forecasted a decline in the number of U.S. hospital brands, but the change doesn't necessarily translate to hospital closures. ("One of the hardest things to do in healthcare is close a hospital," said Mr. Fifer.) Instead of losing hospitals, Mr. Morrison expects them to be repurposed.

10. Another prediction for 2025? More substantial income disparity. What does this mean for disparities in healthcare? Several thought leaders (and they weren't with safety-nets or low-performing hospitals) remarked that an unintended consequence of pay-for-performance and incentive programs may be "the rich getting richer" while community hospitals with a greater proportion of Medicare and Medicaid patients become more disadvantaged.

11. A technology bubble about to burst? Although the vendor floor at HFMA was much smaller and less dense than that of HIMSS (356 versus roughly 1,200), a wander through was still a reminder of the number of companies vying for the same type of business and offering similar products and services. One consultant said he expects the number of vendors in this ecosystem to shrink by one-third in the next four years due to consolidation and as healthcare providers seek more standardized technology platforms and applications. 

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