How Nicklaus Children's revamped its revenue cycle amid the pandemic

Miami, Fla.-based Nicklaus Children's Hospital launched its partnership with Ensemble Health Partners, a revenue cycle management company, in late 2019. The relationship proved invaluable when the pandemic hit.

 

In a Feb. 22 webinar presented by Ensemble Health Partners, Matthew Love, president and CEO of Nicklaus Children's Hospital joined Ensemble founder and CEO Judson Ivy to discuss the revenue cycle challenges affecting children's hospitals.

Five takeaways:

1. Children's hospitals often have significantly higher Medicaid payor mix and are not able to offset Medicaid losses with higher volumes of commercial patients, and therefore rely on state funding, cost management, and donations for operations. Lower reimbursement rates and claims denials are significant financial challenges for these institutions.

2. During the COVID-19 pandemic, children's hospitals saw a rapid decline in patient volume. Nicklaus' inpatient surgeries dropped 8 percent, and admissions were down 15 percent year over year in 2020. Unlike many adult hospitals, which have recovered 98 percent of pre-COVID-19 volume on average, Nicklaus Children's outpatient volumes remain lower than pre-COVID-19 volumes at the end of 2020.

The sudden shift in volume made it crucial for Nicklaus Children's and Ensemble to implement a new revenue cycle strategy ahead of schedule.

"In an environment where almost overnight business volumes deteriorated substantially, the ability to react and implement quickly was an underlying key theme between our two organizations," said Mr. Love.

3. While children's hospitals incurred extra costs to expand COVID-19 screening, provide necessary personal protective equipment and develop new visitor policies, the increased payment for COVID-19 patients did not apply to children’s hospitals as COVID-19 primarily effects adults and the elderly.

4. Nicklaus redesigned its approach to revenue cycle by overlaying Ensemble's EIQ Operating Platform, a cloud-based, analytics-driven revenue cycle operating platform, on top of the hospital's existing EHR.

"The need to ensure a high-functioning revenue cycle was not just a wish, it was actually a requirement when you think about the razor thin operating margins and/or losses that children's hospitals operate under," said Mr. Ivy. "The need for a high-functioning revenue cycle and speed to value was super important."

5. The partners aimed to lower denials and underpayments and shorten the revenue cycle process without disrupting workflows. Ensemble worked with the team at Nicklaus to implement more than 100 new policies and 300 standard operating procedures to transform the revenue cycle, prioritizing areas to provide the most net patient revenue boost, improve the hospital's balance sheet and positively affect patient experience.

Click here to view the full webinar.

Click here to learn more about Ensemble Health Partners.

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