How data and vendor consolidation can help hospitals preserve revenue in the challenging post-COVID era

As revenue becomes more challenging to capture in a post-COVID environment, hospitals must streamline and consolidate data collection and vendor relationships to remain competitive.

During a webinar sponsored by TransUnion Healthcare, three of their leaders discussed the current revenue landscape and evolving payer mix as well as opportunities available through data and vendor consolidation: 

  • John Garcia, vice president, enterprise product
  • Tammie Jackson, vice president, go-to-market strategy and sales
  • Jonathan Wiik, principal, healthcare strategy

Five key takeaways     : 

  1. The fallout from COVID-19 creates revenue headwinds for U.S. hospitals. Even under an optimistic scenario, hospitals could face a $53 billion revenue loss in 2021, largely due to lost outpatient revenue. Although the world is beginning to open up following the rollout of the COVID-19 vaccine, the combination of residual fear and the rise of alternative care options will negatively affect hospital profitability. "Although hospitals may recover some deferred elective procedures, there's also a migration to alternative settings of care," Mr. Wiik said. "Patients are saying, 'I'll go to a clinic, independent diagnostic facility or a lab, but I'm not going to present at a hospital.'"

  2. This shift in payer mix creates more headwinds for hospitals. The payer mix is shifting from commercial insurance patients to more patients with Medicare and Medicaid. The aging population adds 10,000 new Medicare enrollees per day, and legislation is expanding Medicaid in several states. "In addition, [Medicaid's] eligibility criteria have been widened with the public health emergency," Mr. Wiik said. "This all leads to shrinkage of commercial insurance, which typically reimburses between 50 and 60 cents on the dollar. With Medicare and Medicaid, hospitals typically receive only 10 to 30 cents on the dollar. It becomes very important to capture every last dollar from each of these entities."

  3. While having best-of-breed vendors can be beneficial for individual departments, it can be chaotic for the hospital, creating IT challenges leading to revenue loss. About 70 percent of hospitals surveyed say they use more than one vendor to provide revenue cycle management      services. In a previous experience, Mr. Wiik mentioned having 26 RCM vendors. "I can tell you those vendors are not talking to one another," Mr. Wiik said. "That auspice is left to the hospital, which lacks resources and expertise to manage a comprehensive data acquisition strategy. Those with more vendors have more claims denials."

  4. To maximize reimbursement, hospitals must routinely run eligibility checks throughout the revenue cycle. According to Ms. Jackson, it's critical to run eligibility checks using tools and technology "that can not only verify eligibility as presented, but also find that which is not presented." By searching for eligibility in real time throughout the revenue cycle and continually monitoring coverage for up to three years, hospitals can maximize reimbursement. "The further upstream you can identify coverage, the more you can increase your claim rate and reimbursement," she said.

  5. Consolidating vendors and data can lead to greater efficiencies, better information delivery and enhanced operational approaches. "When hospitals can bring together the disparate nature of data and their vendors to a single platform, they can take that data and reuse it very efficiently and effectively across the full spectrum of the revenue cycle," Mr. Garcia said. "In addition, this consolidation delivers the actionable insights hospitals want — when and how they want them."

Listen to the on-demand recording of this webinar by clicking here, and register for upcoming webinars by clicking here.

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