Becker’s Hospital Review recently spoke with Matt Hawkins, CEO of Waystar, about the outlook for healthcare organizations as winter approaches. Many worry that pockets of the country that have already seen declines in COVID-19 cases may experience latent surges of the virus this fall and winter. The good news is that technological innovations can help healthcare organizations deliver services safely, as well as streamline billing and reimbursement processes.
Now is the time to embrace modern billing and telehealth solutions
As the pandemic gained momentum in the United States, demand for elective health procedures and preventive care plummeted. This contributed to significant revenue losses for health systems. At the same time, administrators were grappling with rising costs for personal protective equipment as providers turned their attention to treating patients infected with the novel coronavirus.
Additionally, during the first few weeks of the pandemic, payers struggled to update billing codes and policies. This prolonged the reimbursement cycle, creating additional financial concerns for health systems. Although payers have now published reimbursement codes, the financial effects of the pandemic can still be felt across the healthcare industry. A recent survey by the American Hospital Administration suggests that around half of all U.S. hospitals are now in the red financially and many will operate at a loss in the second half of 2020.
Waystar works with over 800 hospitals and health systems nationwide. At those organizations, reimbursement is top of mind for healthcare executives. Organizations using up-to-date technology systems have fared the best. “Providers that have embraced the new billing codes, updated billing software and new approaches to care, like telehealth, have tended to weather the storm better than those that did not,” Mr. Hawkins said. “Those providers were reimbursed more quickly. We’ve seen time and time again that organizations who adopt and use modern technology tend to adapt more easily to a shifting environment.”
In fact, claims for telehealth visits on the Waystar platform have been reimbursed 40% faster—and COVID-19-related claims 37% faster—on average, than other claims. These claims are largely clean, with 98.99% of telehealth claims and 97.92% of COVID claims being free of errors and rejections.
Moving forward, it will benefit all healthcare organizations to evaluate their billing software and integrate telehealth into their care delivery strategy.
The pandemic presents healthcare organizations with valuable improvement opportunities
Acknowledging the many losses associated with COVID-19, this is an important time in the healthcare sector. Although the environment is challenging, it offers healthcare organizations the chance to update payment processes, improve the patient financial experience and take the next step toward modernizing healthcare.
“There are some silver linings to be found in our current situation,” Mr. Hawkins said. “We have the opportunity to create more effective interactions between providers and patients. Imagine a world where a patient can access preventive and other important health services via a telehealth visit. Whether pre-visit or immediately postvisit, patients can understand price for the healthcare service, insurance eligibility and coverage, and payment responsibility. Modern technology, like Waystar’s, makes simplifying healthcare payments a reality. We believe a re-imagined healthcare payment experience is good for patients, providers and payers.”
Health systems and providers may also want to use this time to prepare for the inevitable demographic shifts occurring in the United States. As the American population ages, CMS has become the largest healthcare payer in the country. By 2030, experts predict there will be more than 80 million Americans on Medicare.
From a reimbursement perspective, providers must be prepared to work with Medicare as a major payer, as well as with commercial payers. To do this in an efficient fashion means using a single technology platform that can process both commercial insurance reimbursements and Medicare-related payments. To address this need, Waystar recently announced plans to acquire eSolutions and will be integrating its Medicare-specific solutions into its platform.
“We’re excited about uniting both commercial and government payment processing onto the Waystar platform,” Mr. Hawkins said. “This will solve a major pain point for providers, eliminating unnecessary administrative inefficiencies and enabling providers to focus their resources on improving patient care.”
Keys to speeding technology adoption in healthcare
Traditionally, the healthcare sector has been slower than other industries to adopt new operational technologies. There are a number of factors that may contribute to this, including the complexity of healthcare rules and regulations. These complex regulations and a heterogenous technology environment create a need for industry standards and integration of systems. In addition, security and standardization are critical when dealing with sensitive healthcare data.
One potential solution to help accelerate adoption while enabling integration and data security is cloud technology. According to Mr. Hawkins, this is something healthcare decision-makers should absolutely consider, given the urgent mandate for transformation. Many healthcare providers still rely on on-premise software that requires manual updates, which consumes considerable time for IT teams.
In addition, frequent payer reimbursement rule modifications and regulatory or policy changes can create unnecessary delays on the billing and administrative side of the house. Cloud software solutions, such as Waystar, automatically update reimbursement rules and other regulations for end users.
Another obstacle to technology adoption in the healthcare sector is a lack of true enterprise-quality solutions. “A CIO at a major U.S. hospital told me last year that she wanted an end-to-end software partner to manage reimbursement,” Mr. Hawkins said. “In her organization, they were using more than 20 different point solutions to address the reimbursement needs of their health system. At Waystar, we are focused on building an end-to-end, enterprise-class platform so that health organizations like hers can work with one software vendor to best meet their goals.”
Conclusion
How the next few months will unfold is uncertain. There are, however, some reasons for optimism. CMS has moved quickly, for example, to support provision and payment for telehealth services. This has improved access to care for Medicare beneficiaries, including those in rural areas.
On the technology front, there have never been more solutions available at a lower price point. It’s a good time for healthcare organizations not only to take advantage of the tools and platforms that exist today, but to establish a culture of innovation. Those organizations that are ahead of the curve in terms of technology adoption will be much better positioned to stay afloat in the months and years ahead.
“In this space of uncertainty about a second wave of COVID-19, now is the time to be agile,” said Mr. Hawkins. “The call to action for healthcare organizations is to invest the resources in technology and expertise that will more than pay for themselves in faster, fuller reimbursement— and patient satisfaction—in the long term.”
