How 2 Michigan health systems revolutionized their revenue cycle process after COVID-19

Revenue cycle collections required extraordinary efforts before the COVID-19 pandemic, but as unemployment rates rise and the number of clinical visits fall, having affordable and self-service payment options that are flexible for patients is more important than ever.

The pivoting of hospital revenue cycle departments in the midst of the COVID-19 pandemic was the subject of a May 20 webinar, hosted by Becker's Hospital Review and sponsored by Flywire.

The speakers were:

  • Mike Marulli, senior director of revenue cycle at Flint, Mich.-based Hurley Medical Center
  • Acacia Holmes, senior director of patient financial services at Traverse City, Mich.-based Munson Medical Center

Through May 20, Michigan reported more than 51,000 cases of COVID-19, 1.7 million residents on unemployment and an uninsured rate around 5 percent. Mr. Marulli and Ms. Holmes shared insights into how their hospitals responded to the challenges of COVID-19:

1. Seventy-seven percent of Hurley Medical Center's payer mix consists of patients on Medicare and Medicaid. Forty percent of Flint's 96,000 residents live below the national poverty line, according to Mr. Marulli. Hurley started to see its normal case volume decrease in early March, as COVID-19 cases increased. The hospital responded proactively in both a clinical and in a patient support manner. Mr. Marulli and the Hurley team quickly realized the effect the pandemic was having on patients' ability to pay and wanted to work with them.

"The focus was looking at bad debt," Mr. Marulli said. … "As we got into COVID-19, we realized that wasn't good enough. …We weren't only dealing with COVID patients, while much of our focus was on COVID patients, ... we also had people in the community that were out of work, unemployed or furloughed."

Hurley relied on its technological partners to develop measures that would position the hospital to best assist these patients and ensure they could continue to seek care.

"We turned to our patient statement cycle and our payment plan program," Mr. Marulli said. We worked with Flywire to come up with some creative things that we felt were really beneficial. … We quickly realized that based on calls that we were starting to receive from our customers that we needed to focus on our self-pay patients. Our board and administration has been very proactive here at Hurley in terms of supporting our community and demographics...We’ve had a community in financial crisis in terms of their ability to pay."

Hurley pushed back the default date on its patient statements by 30 days giving patients 90 days to pay; reduced the obligations of its payment plans by up to 90 percent or $25, whichever figure is greater; and vowed to work with patients whenever possible to let them know the hospital will meet their needs.

2. The pandemic prompted Ms. Holmes and the Munson system to also find ways to thrive.

Munson, with the assistance of its technological partners, made a series of changes to accommodate its underinsured population, while keeping the health system in good financial health. Ms. Holmes said the system updated its financial policies to help the underinsured population and worked with its patient services staff to ensure customer needs were addressed during the pandemic. The system also pivoted its efforts to address old accounts or low balance accounts to help ensure the system's operations remained healthy.

"We worked one-on-one with our patients to look at their financial situation, review whether their financial issues were temporary or permanent and even deferred patient payments for up to two months," Ms. Holmes said.

How COVID-19 will change healthcare
As the aforementioned changes show, it's inarguable COVID-19 left its mark not only on clinical care but on all hospital departments as well. Ms. Holmes and Mr. Marulli had several predictions on how operations will be altered going forward, including:

  • Departments will need quick and accurate computer systems with the ability to make financial health reports as fast as possible;
  • IT departments need flexible technology solutions that are both easily adaptable and scalable in times of crisis;
  • Clinical, financial, coding and compliance teams will need to continuously communicate and collaborate frequently and whenever possible;
  • Systems need to continue to support patients and work to further develop telehealth options that are consumer-friendly and include digital communication tools and self service options; and
  • Systems will be dealing with financial claims due to COVID-19 far into the future. Whether it relates to shifting claim requirements, or increased denials. Payers are working to figure out how to handle COVID-19 claims as well, and while navigating the current reimbursement climate has been a difficult development, it is not impossible.

Not all of the changes the virus has made were external either. COVID-19 accelerated work from home programs, and has shown administration that hospital-based operations can be done outside of its four walls presenting a significant cost-savings opportunity.

Ms. Holmes elaborated on Munson's efforts. Although the system had a work from home program, the virus quickly caused the program to scale. While challenges naturally developed, Ms. Holmes said the system developed ways to support its employees, whether it be through team huddles, offering flex time or increasing individual touch points, the virus really showed Munson how work from home is possible.

"It's really exciting to see as a system how we've come together," Ms. Holmes said. "We're stronger now than we've ever been. … COVID-19 has really pushed us to work better together."

Watch the webinar here, learn more about Hurley Medical Center here and Munson Medical Center here.

More articles on revenue cycle: 
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6 insights into COVID-19 patient care patterns worldwide
COVID-19 is 13 times deadlier than flu, study suggests

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