In the face of mounting Medicare Advantage denials, rapid advancements in artificial intelligence, and escalating cybersecurity risks, Michele Napier, senior vice president and chief revenue officer at Orlando (Fla.) Health, is charting a proactive path forward.
As healthcare's financial landscape grows more complex, Ms. Napier is prioritizing data-driven decision-making, strategic investments in AI, and robust defenses against cyberthreats to safeguard the health system's revenue cycle.
In a conversation with Becker's, Ms. Napier shares her insights into the trends shaping Orlando Health's strategies and how the system is adapting to ensure resilience and innovation in the years ahead.
Question: What are the top three revenue cycle trends you're paying close attention to this year? Why?
Michele Napier: The three top revenue cycle trends Orlando Health is watching are:
1. Medicare Advantage denials. CMS required Medicare Advantage plans to follow the 2-midnight rule admission criteria that deems a Medicare beneficiary as inpatient if the patient is expected to be in-house for more than two midnights, and there has been a noticeable increase in denials from Medicare Advantage plans. In addition, there is a significant variance among Medicare Advantage plan denial ratios from the previous year overall and among the plans. Many hospitals are using the data to make participation and contracting determinations with Medicare Advantage plans. Given the upcoming regulatory changes impacting Medicare Advantage plans, this is a critical time for determining participation.
2. Use of artificial intelligence. Although the buzz of AI appears to be everywhere, there are a lot of beta tests promising results. Balancing the return on investment with regulatory, operational, and privacy concerns are on the forefront of reviewing the AI technology offerings.
3. Cybersecurity. Last year, with the Change Healthcare cyberattack that caused an industry shutdown of claims and remittance advice transmissions along with one hundred million of impacted patients, the vulnerability of systems including vendors who access the systems continues to be a major concern.
Q: What role does automation and AI play in streamlining your revenue cycle operations? Where have you seen the greatest impact?
MN: There has been AI and built-in automation in the Epic EHR that handles task-oriented functions that allow team members to evolve to more critical thinking roles. There has also been a great impact with self-service features available to patients in scheduling, registration, medical record requests and payment functions.
Q: How are shifts in payer contracts, outpatient migration and value-based care impacting your revenue strategy going forward?
MN: Orlando Health continues to invest in ambulatory strategies, including building freestanding emergency departments, imaging centers and extending primary care practices.