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Health IT Consulting Demand To Explode This Year

Posted on August 24, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As payment models shift from fee-for-service to value-based care, hospitals are having to adopt new technologies and tweak existing ones. The thing is, it takes a mighty team of IT pros to make all this happen. In some cases, a provider has enough resources to handle this kind of big transition, but most need some help, especially when they’re handling major infrastructure improvements or even switching out technologies.

This seems to be at least part of what’s driving a dramatic increase in spending on health IT consulting, according to a new study from Black Book Research. The study drew on input from 1,586 professionals with knowledge of the US health IT industry.

Black Book concluded that health IT management consulting spending has grown from $20 billion in 2016 to $45 billion last year. Not only that, the firm expects to see this number climb to nearly $53 billion for 2018. That’s a massive increase, particularly given that providers were already spending heavily on consultants as they beat their enterprise EHRs into shape.

According to the analyst firm, 64% of last year’s spending paid for implementation of software, information systems, systems integration and optimization and support for mergers and acquisitions. This summary covers a lot of ground, but it’s hardly surprising given the drastic changes underway.

Going forward, respondents expect three key forces to drive healthcare consulting spend, including a lack of highly-skilled IT professionals (cited by 81% of respondents), adoption of cloud technology in healthcare (74%) and growing industry digitalization (71%). (I’d also expect to see investment in new organizational infrastructures — for, let’s say, ACOs)  — will continue to increase in importance as well.)

Providers responding to the study said that they expect to hire health IT consultants for EHR and RCM system optimization (61%) and to offer expertise in software training and implementation (46%) next year. Other areas providers hope to address include value-based care (39%), cloud infrastructure (36%), compliance issues (33%) and a grab bag of big data, decision support and analytics projects (31%).

The vast majority of respondents (84%) said they expect to enter into a wide range of consulting agreements to include work with single-shop consultants, single freelancers, group purchasing organizations, HIT vendors, networks of freelancers, boutique advisory firms and traditional major consultancies, Black Book reported. In other words, it’s all hands on deck!

What Happened to Care Pricing and Provider Quality Transparency?

Posted on August 21, 2018 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

I’m on the Utah HIMSS board and we’re hosting an event called “Full Disclosure- Price Transparency & Provider Ratings in Healthcare.”

At the event on August 29, 2018, we’ll be talking about pricing transparency and physician outcomes. The Pricing Transparency question has multiple goals and remains a complex problem in healthcare IT and other areas. Leaders in Utah Health IT will come together to discuss resources and experiences from Utah.

Pricing in healthcare remains the number one concern for many different stakeholders. Informatics departments are still concerned with denials and claims administration. Patients are unsure of price of care. Physicians’ practices are not clearly aligned with billing codes and claims can account for up to 30% of healthcare spending waste. In April of this year, Seema Verma announced that requirements for hospitals to post standard pricing would be the start of a broad initiative to increase transparency about healthcare prices.

Can price transparency & provider ratings help manage the costs of healthcare?

Price transparency might have the single biggest effect in informing the public about healthcare costs and could support a more efficient health care delivery system in the United States. Utah HIMSS members and others are invited to submit questions for panelists.  

Please register for the event and follow the Utah HIMSS pages Linkedin and Twitter.

Here’s a look at the panel members that will be involved:

Moderator: Holly Rimmasch- Health Catalyst

Holly Rimmasch is an Executive VP/Chief Clinical Officer of Health Catalyst.  She currently leads population health, patient safety and improvement services.  Ms. Rimmasch has over 30 years of experience in clinical and operational healthcare management. She has spent the last 20 years dedicated to improving clinical care and better understanding how to sustain and achieve better value.

Holly has extensive healthcare and operational experience.  Prior to joining Health Catalyst, she was an Assistant VP at Intermountain Healthcare responsible for Clinical Services.  While at Intermountain, she also served as the system Clinical Operations Director for Cardiovascular and Intensive Medicine.  Holly co-founded and was a Principal in HMS, Inc, a healthcare consulting firm focusing on population health.

Ms. Rimmasch holds a Master of Science in Adult Physiology from the University of Utah and a Bachelor of Science in Nursing from Brigham Young University.

Price Transparency

A key question that Holly has focused on is “Are we making a difference in both quality and costs?”  “Does it translate into cost savings for those that are paying?” Part of her work involves bringing data sources together (clinical, financial, claims, etc.) to create transparency to services and care being provided and at what cost.  Over the last 6 years, Holly has been involved in developing a more accurate activity-based costing system. Accurate costing leads to more accurate pricing and more accurate pricing leads improved price transparency.

Panelist: Rep. Norm Thurston- Utah State Legislature

Personal & Professional

Dr. Thurston has a Masters and Ph.D. in economics from Princeton University, and an undergraduate degree in Spanish and Agribusiness Management from Brigham Young University.  His areas of specialty include insurance markets, health care provider markets, labor markets, and public finance/economics. 

Dr. Thurston has been a policy analyst and health economist for the Utah Department of Health since 2003. Currently, he is the Director of the Office of Health Care Statistics which is responsible for the collection, analysis, and dissemination of data related to health care cost and quality for the State of Utah.  In previous roles he has served as policy adviser and executive staff for health system reform efforts in the State of Utah. 

Before joining the state, Dr. Thurston worked for eight years as an assistant professor of economics at Brigham Young University.  He has published several articles on health care markets in nationally recognized economics journals.  He is a life-long resident of Utah, growing up in Morgan County.  He has native-level fluency in Spanish and was a Fulbright Scholar teaching economics in Argentina in 2001. He and his wife Maria have three children and two grandchildren.

Legislative

Rep. Thurston was elected to the Utah House of Representatives in 2014 from District 64 (Provo, Springville).  Currently, he is a member of the Government Operations Committee, the Economic Development and Workforce Services Committee, and the Social Services Appropriations Subcommittee.

Price Transparency:

“Norm Thurston is the director of the Office of Health Care Statistics (OHCS). The office collects, analyzes and disseminates data on health care utilization and costs for the State of Utah. Their two main data efforts include collecting information about patient encounters at hospitals and emergency rooms into the Healthcare Facilities Database and information about claims paid by health plans for all types of services into the All Payer Claims Database.

These data are used by a variety of entities, including healthcare facilities, plans, researchers, and public health programs.”

Panelist: Bob White- Intermountain Healthcare

Bob White, Vice President and Chief Operating Officer

Bob has over 27 years of experience in the Information Technology industry. He has been with SelectHealth for 20 years and currently leads member services, business systems support, program management, process improvement, business continuity, and information technology.

Previously, Bob was employed by the IBM Consulting Group. He attended Brigham Young University and holds a bachelor’s degree from DeVry University. He currently serves on the board of Trizetto Customer Group

Panelist: Katie Harwood- University of Utah Hospitals and Clinics

Patient and Financial Services Manager at the University of Utah Hospitals and Clinics

Katie Harwood is a Revenue Cycle Manager with University of Utah Health. She has been with the organization since 1995, most recently responsible for the admissions and financial counseling  teams. She is currently serving as the president of the American Association of Healthcare Administrative Management Utah Mountainwest chapter (AAHAM). She also participates with the National Association of Healthcare Access Management on the Certification Commission and is  a Certified Healthcare Access Manager. Outside of work she enjoys her two sons, dog, and Zumba.

Katie had the opportunity to participate in the development of the pricing transparency tool University of Utah Health. The goal was to create a tool that would have full care pricing available for consumers. She is excited to share what our experience in pricing transparency has been and how the consumer benefits from the use of it .

Switch From Epic To Cerner Comes With Patient Safety Questions

Posted on July 25, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Here’s a story in which no health system hopes to take a lead role — the tale of a Cerner installation that didn’t go well and the blowback the system faced afterward.

On October 1 of last year, Phoenix, Az.-based Banner Health switched its Tucson hospitals from Epic to a Cerner system, a move which reportedly cost the health system $45 million.

No doubt, the hospitals’ staff and physicians were trained up and prepared for a few bumps in the road, particularly given that the rest of its peers had already gone to the process. The Phoenix-based not-for-profit, which owns, leases or manages 28 acute-care hospitals in six states, had already put the Cerner system in place elsewhere, apparently without experiencing any major problems.

But this time it wasn’t so lucky, according to an article in the Arizona Daily Star. According to the news item, there were “numerous” reports of medical errors filed with the Arizona Department of Health Services after Tucson-area hospitals in the Banner chain were cut over to Cerner.

The complaints included claims that errors were creating patient safety and patient harm risks, according to one filing. “Many of the staff are in tears and frustrated because of the lack of support and empathy [for] the consequences [to] patient care,” one stated.

Not only did the conversion lead to patient safety accusations, it also seems to have lowered physician productivity and shrunk revenue as doctors learned to use the Cerner interface. While predictable, this has to have added insult to injury.

Meanwhile, according to the paper, the state seems to come down on the side of the complainants. While hospital leaders denied there were any incidents resulting in a negative outcome for patients, “the hospital’s occurrence log for October 2017 showed numerous incidents of medical errors reported to be a result of the conversion,” state investigators reportedly concluded.

While the state didn’t fine Banner or issue a citation, it did substantiate two allegations about the conversion, the Star reported. The allegations were related to computer/printer glitches impacting patient care and an inability to reliably deliver medications and order tests as part of care for critically ill patients.

The article says that Banner responded by pointing out that it has made more than 100 improvements to the Cerner system, resulting in better workflows and greater information access for physicians and staff. But the damage to its reputation seems to have been done.

No, perhaps Banner didn’t do anything particularly wrong when it installed the Cerner platform. However, if its leaders did, in fact, lie to the state about problems it actually had, it was not a smart move. On the other hand, one of the biggest problems you can have during an EHR implementation is users who don’t want to cooperate and make it a success. It’s not hard to see users who were happy with Epic dragging their feet as they shifted to Cerner. Either way, this is an important lesson as hospitals continue to consolidate and they consider switching the EHR of the acquired hospitals.

Revenue Cycle Trends To Watch This Year

Posted on July 13, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Revenue cycle management is something of a moving target. Every time you think you’ve got your processes and workflow in line, something changes and you have to tweak them again. No better example of that was the proposed changes to E/M that came out yesterday. While we wait for that to play out, here’s one look at the trends influencing RCM strategies this year, according to Healthcare IT leaders revenue cycle lead Larry Todd, CPA.

Mergers

As healthcare organizations merge, many legacy systems begin to sunset. That drives them to roll out new systems that can support organizational growth. Health leaders need to figure out how to retire old systems and embrace new ones during a revenue cycle implementation. “Without proper integrations, many organizations will be challenged to manage their reimbursement processes,” Todd says.

Claims denial challenges

Providers are having a hard time addressing claims denials and documentation to support appeals. RCM leaders need to find ways to tighten up these processes and reduce denial rates. They can do so either by adopting third-party systems or working within their own infrastructure, he notes.

CFO engagement

Any technology implementation will have an impact on revenue, so CFOs should stay engaged in the rollout process, he says. “These are highly technical projects, so there’s a tendency to hand over the reins to IT or the software vendor,” notes Todd, a former CFO. “But financial executives need to stay engaged throughout the project, including weekly implementation status updates.”

Providers should form a revenue cycle action team which includes all the stakeholders to the table, including the CFO and clinicians, he says. If the CFO is involved in this process, he or she can offer critical executive oversight of decisions made that impact A/R and cash.

User training and adoption

During the transition from a legacy system to a new platform, healthcare leaders need to make sure their staff are trained to use it. If they aren’t comfortable with the new system, it can mean trouble. Bear in mind that some employees may have used the legacy system for many years and need support as they make the transition. Otherwise, they may balk and productivity could fall.

Outside expertise

Given the complexity of rolling out new systems, it can help to hire experts who understand the technical and operational aspects of the software, along with organizational processes involved in the transition. “It’s very valuable to work with a consulting firm that employs real consultants – people who have worked in operations for years,” Todd concludes.

3 Key Steps to Driving your Revenue Strategy

Posted on July 9, 2018 I Written By

The following is a guest blog post by Brad Josephson is the Director of Marketing and Communications at PMMC.

For healthcare providers struggling to accurately collect reimbursement, developing a revenue strategy based off a foundation of accuracy is the most efficient way to ensure revenue integrity throughout the revenue cycle.

Currently, many hospitals operate under multiple systems running for their different departments within the organization. This type of internal structure can threaten the accuracy of the analytics because data is forced to come into multiple systems, increasing the chances that the data will be misrepresented.

By maintaining revenue integrity, not only does it give hospitals assurance that the data they’ve collected is current and accurate, but it also provides invaluable leverage with the payer when it comes time to (re)negotiating payer contracts.

Let’s begin by starting from the ground up…

Here are the 3 steps needed for maintaining revenue integrity:

  • Creating a foundation backed by accurate analytics
  • Breaking down the departmental siloes
  • Preparing ahead of time for consumerism and price transparency

Accuracy Drives Meaningful Analytics

The first step toward maintaining revenue integrity is to assess whether your data is accurate. We know that accurate data drives meaningful analytics, essentially functioning as the engine of the revenue cycle.

And what happens when you stop taking care of the engine regularly and it no longer works properly? It not only costs you a lot of money to repair the engine, but you may also have to pay for other parts of the car that were damaged by the engine failure.

What if, however, you were able to visualize pie charts and bar graphs on your car’s dashboard that showed the current health of the engine to inform you when it requires a maintenance check?

You would be better informed about the current state of your engine and have a greater urgency to get the car repaired.

This same principle applies to healthcare organizations looking to increase the accuracy of their data to drive meaningful analytics. While some organizations struggle to draw valuable insight from pieces of raw data, data visualization tools are more efficient because it allows the user to see a complete dashboard with a drill-down capability to gain a deeper and clearer understanding of the implications of their data analytics.

Data visualization allows healthcare providers to quickly identify meaningful trends. Here are the 4 key benefits of implementing data visualization:

  • Easily grasp more information
  • Discover relationships and patterns
  • Identify emerging trends faster
  • Directly interact with data

Figure 1: Payer Dashboard

Removing Departmental Siloes  

While data visualization does generate helpful insight into current and future trends, it begins with storing the data in one integrated system so that different departments can easily communicate regarding the data.

System integration is crucial to maintaining revenue integrity because it dramatically lowers the likelihood of data errors, missed reimbursement, and isolated decisions that don’t look at the full revenue picture. Here is a list of other issues associated with organizations running revenue siloes:

  • No consistent accuracy metrics driving performance and revenue.
  • Different data sources and systems drive independent and isolated decisions without known impact on the rest of the revenue cycle.
  • Departments cannot leverage analytics and insight into contract and payer performance.

In the spirit of the recent international World Cup games, think of revenue siloes like playing for a professional soccer team.

Similar to the structure of a hospital’s revenue team, soccer teams are large organizations that need to be able to clearly communicate with each other quickly in order to make calls on-the-spot. These quick decisions can be the difference in turning the ball over to the other team or scoring a goal in the final minutes so it’s crucial that everyone knows their role on the team.

If other players don’t understand the plays that are being called, however, then mistakes will be made that could cost them the game. Each player on the team needs to study the same playbook so they stay on the same page and decrease the chances that a costly mistake will be made.

A hospital’s Managed Care department works in a similar way. If Managed Care is preparing to renegotiate payer contracts, they need to fully understand and have insight into underpayment and denial trends across multiple payers.

Preparing Now for Consumerism and Price Transparency

Now that we know the reimbursement rate is accurate, how do we communicate an accurate price to patients in order to encourage upfront payment?

Studies have shown that by increasing accuracy in pricing estimates, it increases the likelihood that patients pay upfront, which can help your organization lower bad debt.

In an effort to migrate to a more patient-centric approach, these accurate online estimates also enable hospitals to address the patient’s fear of the unknown with healthcare of ‘how much is this procedure going to cost?’ By giving the patient more control over their financial responsibility, hospitals can become a leader in pricing transparency for their entire community while expanding on their market share.

At the end of the day, what this all comes down to is maintaining accuracy to help drive your revenue strategy. By integrating all data into a single system, the hospital is positioned to identify trends more quickly while increasing the accuracy of their patient estimates, ultimately driving your revenue strategy to new heights.

With many healthcare organizations still making the transition away from the traditional fee-for-service model, now is the time to prepare for consumerism and value-based care. Take some time to evaluate where your organization currently stands in the local market as well as any pricing adjustments that need to be made.

About Brad Josephson
Brad Josephson is the Director of Marketing and Communications at PMMC, a provider of revenue cycle software and contact management services for healthcare providers. Brad received a Bachelor of Arts, Public Relations and Marketing Degree from Drake University. He has worked at PMMC for over three years and has a deep knowledge of hospital revenue cycle management tools which improves the financial performance of healthcare organizations.

Mobile App Streamlines Physician Query Process

Posted on June 28, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most physicians would tell you that they already spend too much time on documentation and coding. Adding insult to injury, after the coding job is done we often have to explain their decisions to medical coders, a process which can take as long as 20 minutes, according to vendor Artifact Health.

Artifact hopes to take the pain out of the burdensome physician query process. It offers a mobile app allowing doctors to answer coding queries which it says allow them to resolve problems within just three clicks. Physicians can also access the platform on the desktop.

Its approach bears some relationship to a new product from vendor Change Healthcare, which has just launched RCM technology which helps doctors address claims documentation requests. Change’s Assurance Assist Module, which is part of its Assurance Reimbursement Management suite, can anticipate the documentation needs of eight payers, the company said.

I am interested in both of these approaches because I know that physicians are already struggling to manage medical coding within their own practices. Hospital queries are a challenging part of that mix and feels like a major chore for providers. In fact, if Artifact’s research is correct and each traditional query takes 20 minutes to resolve, physicians could conceivably end up a little time to do anything else.

So far, Artifact seems to be rolling along impressively. The vendor says that more than 50 hospitals have come on board with its technology, including five institutions from Johns Hopkins Medicine. According to the vendor, these hospitals solve physician response rate of almost 100% and average response time within 48 hours for all periods.

Meanwhile, the hospitals found that the time it took for claims to get paid (days in Accounts Receivable) fell substantially, Artifact reports.

Lest it sound like I’m an Artifact investor, let me raise the questions I ask every time I get a look at a new health IT startup:

  • What does the software cost?
  • How long does it usually take to go live with the platform?
  • How much man- or woman power will it take to install and maintain the software?

At the moment I don’t know. As we all know, not only the initial investment, but also implementation and maintenance can catch hospitals by surprise.

The truth is, it’s likely any vendor addressing aspects of hospital RCM will be somewhat expensive and somewhat complex to install. I wish there were workable benchmarks giving hospital leaders a preliminary sense of their potential investment.

Regardless, this is a worthwhile area for RCM vendors to attack. Even if all this technology did was give doctors some relief, it might reach ROI over time. When you consider that tools like these can help coders get clean claims out of the door, it’s even better.

Hospitals Still Grappling With RCM Tech Infrastructure

Posted on May 18, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While revenue cycle management isn’t the sexiest topic on the block, hospitals need to get it right or they won’t be able to pay their bills. One key element needed to accomplish this goal is a robust tech infrastructure that helps RCM specialists get their job done.

However, it seems that many hospitals are struggling to manage RCM data and pick out the right vendors to support their efforts, according to a report published by Dimensional Insight in collaboration with HIMSS Analytics. To conduct the research, the two organizations reached out to 117 senior-level decision-makers in hospitals and health systems.

According to the survey, more than two-thirds of health systems use more than one vendor for RCM. But that might be a bad idea. The research also found that organizations using more than one RCM vendor seem to face bigger issues with denials than those using only one RCM solution. Regardless, the execs said that denials were the biggest RCM challenge for health systems today.

Pulling together RCM data is a struggle too, respondents said. More than 95% of health systems reported that the way data is collected is a challenge. Also, nearly all respondents said that collecting RCM data from disparate sources is also difficult.

One reason why it’s tough for hospitals to put effective RCM technology in place may be that health information management directors and managers aren’t at the top of the influencer list when it comes to making these decisions.

When asked who the key stakeholders were in RCM. 91.5% said that the CFO was the most important, followed by the head of revenue cycle, who was ranked as important by 62.4% of respondents. Meanwhile, only 48.7% of respondents saw the health IT leaders as key stakeholders in the RCM environment. In other words, it looks like tech leaders aren’t given much clout.

When it came to technical infrastructure for RCM, respondents were all over the map. For example, 34.5% were working with an EMR and 3+ vendors. Another 12.1% used in EMR with one vendor, followed by 11.2% with 3+ vendor solutions, 6.9% using an EMR plus two vendors and 4.3% using two to vendor solutions. Clearly, there’s no single best practice for managing RCM technology in hospitals.

Not only that, some hospitals aren’t doing much to analyze the RCM data they’ve got. According to the survey, 23.9% said that 51 to 75% of the RCM process was automated, which isn’t too bad. However, 36.8% of hospitals reported that less than 25% of the revenue cycle process was driven by analytics. Also, roughly a third of respondents said that collecting data from diverse sources was extremely challenging, which can cripple an analytics initiative.

Taken as a whole, the report data suggests that hospitals need to improve their RCM game dramatically, which includes getting a lot smarter about RCM technology. Unfortunately, it looks like it could be a long time before this happens.

Despite EMR, Revenue Cycle Management Costs Were Still Substantial

Posted on April 26, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While they may not say so out loud, most healthcare organizations bought EMRs largely because they believed they could use them to lower revenue cycle management expenses. If so, they may be somewhat disappointed. A new study has concluded that at least in one case, the presence of a certified EMR didn’t make much of a dent in these costs.

­To conduct the study, researchers conducted interviews with 27 health system administrators and 34 physicians at a large academic medical center. The interviews took place in 2016 and 2017. The research team used the feedback to create a process map charting the path of an insurance claim through the RCM process.

Using this data, the researchers calculated the cost of each major billing and insurance-related activity, as well as a total cost of processing a claim from end to end. The data included costs for five types of patient encounters, including primary care visits, discharge ED visits, general medicine inpatient stays, ambulatory surgical procedures and inpatient surgical procedures.

The team concluded that estimated processing times and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged ED visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure and 100 minutes and $215.10 for an inpatient surgical procedure.

To put these numbers in perspective, the research team noted that billing costs represented an estimated 14.5% of professional revenue for primary care visits, 25.2% for emergency department visits, 8% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures and 3.1% for inpatient surgical procedures.

There are more than a few unfortunate things to be seen in these numbers.

One is that primary care practices spent a very high percentage of revenue on RCM, which could be crushing given their typically low margins. Given that PCPs are already being squeezed by patients who can’t afford to meet their high deductibles, this is a recipe for financial disaster.

It’s also troubling to see that that the academic medical center in question was spending more than 25% of its ED revenue chasing insurance payments. I found myself wondering whether ED prices might drop to a reasonable level if it was easier for these departments to collect from insurers.

It’s scary to think that these numbers might’ve been higher before the academic medical center installed its EMR. As things stand, if the EMR is lowering RCM costs, it doesn’t seem to be having a major impact. But I’m just guessing here — what do you think?

RCM Tips And Tricks: To Collect More From Patients, Educate And Engage Them

Posted on November 1, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Hospitals face particularly difficult challenges when trying to collect on patient bills. When you mix complex pricing structures, varied contracts with health insurers and dizzying administrative issues, it’s hard to let patients know what they’re going to owe, much less collect it.

Luckily, RCM leaders can make major progress with patient collections if they adopt some established (but often neglected) strategies. In short, to collect more from patients you need to educate them about healthcare financial issues, develop a trusted relationship with them and make it easy for them to pay that bill.

As a thought exercise, let’s assume that most patients want to pay their bills, but may need encouragement. While nobody can collect money from consumers that refuse to pay, you can help the willing ones prepare for the bills they’ll get. You can teach them to understand their coverage. In some cases, you can collect balances ahead of time. Toss in some smart patient engagement strategies and you could be golden.

What will that look like in practice? Check out this list of steps hospitals can take to improve RCM results directly, courtesy of a survey of hospital execs by Becker’s Hospital Review:

  • Sixty-five percent suggested that telling patients the amount due before they come to an appointment would be helpful.
  • Fifty-two percent believe that having more data on patients’ likelihood to pay could improve patient collections results
  • Forty-seven percent said that speaking to clients in different ways depending on the state of the finances would help improve patient collections.
  • Forty-two percent said that offering customers payment plans would be valuable.

Of course, you won’t be doing this in a vacuum, and some of the trends affecting patient financial responsibility are beyond your control. For example, unless something changes dramatically, many patients will continue to struggle with high-deductible health coverage. Nobody – except the health insurers – likes this state of affairs, but it’s a fact of life.

Also, it’s worth noting that boosting patient engagement can be complicated and labor-intensive. To connect with patients effectively, hospitals will need to fight a war on many fronts. That means not only speaking to patients in ways they understand, but also offering well-thought-out hospital-branded mobile apps, an effective online presence and more. You’ll want to do whatever it takes to foster patient loyalty and trust. Though this may sound intimidating, you’ll like the results you get.

However, there are a few strategies that hospitals can implement relatively quickly. In fact, the Becker’s survey results suggest that hospitals already know what they need to do — but haven’t gotten around to it.

For example, 87% of hospital respondents said they had a problem with collecting co-pays before appointments, 85% said knowing how much patients can pay was important, and 76% of respondents said that simplifying bills was a problem for them. While it may be harder than it looks to execute on these strategies, it certainly isn’t impossible.

When Hospitals Leak Money

Posted on October 20, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A couple of weeks ago I was skimming healthcare business headlines and stumbled across this guaranteed showstopper: You’re probably leaving $22 million on the table. That headline is from a column by Jim Lazarus, who works in the Advisory Board’s Revenue Cycle Solutions division. In his column, he named four ways in which hospitals could recapture some of this lost revenue.

In the article, Lazarus notes that hospitals aren’t following best practices in four key areas, namely denial write-offs, bad debt, cost to collect and contract yield.  Unsurprisingly, Advisory Board benchmarks also demonstrate that median performing organizations are having trouble reducing net days in accounts receivable. The Advisory Board has also found that the overall average cost to collect has worsened by 70 points of net patient revenue from 2011 to 2015.

To turn the stats around, he suggests, hospitals should focus on four critical issues in revenue cycle management. They include:

  • Preventing denials rather than responding to them. “Hospitals are losing, on average, five percentage points of their margin to underpayments, denials and suboptimal contract negotiations,” Lazarus writes.
  • Collecting more from patients by improving their financial experience. According to Lazarus, between 2008 and 2015 the portion of patient obligations being written off as bad debt has climbed from 0.9% to 4.4%. To boost patient collections, hospitals must offer price estimates, convenient payment methods and a positive care encounter, he says.
  • Being sure not to take a hit on MACRA compliance. See that doctors, including those coming on board as employed physicians, get up to speed on documentation performance standards as quickly as possible.
  • Building the value of merged RCM departments. If multiple RCM organizations are being integrated as part of consolidation, look at ways to improve the value they deliver collectively. One approach is to create a shared services organization providing a common business intelligence platform across entities and service lines systemwide.

If you’re an IT leader reading this, it’s probably pretty clear that you have a substantial role in meeting these goals.

For example, if your hospital wants to lower its rate of claims denials, having the right applications in place to assist is critical. Do your coding and billing managers have the visibility they need into these processes? Does senior management?

Also, if the hospital wants to improve patient payment experiences, it takes far more than offering a credit card processing interface to make things work. You’ll want to create a payment system which includes multiple consumer touch points and financing options, which is integrated with other data to offer sophisticated analyses of patient payment patterns.

Of course, the ideas shared by Lazarus are just the beginning. While all organizations leave some money on the table, they have their own quirks as to why this happens. The important thing is to identify them. Regardless, whether you are in RCM, operations or IT, it never hurts to assume you’re losing money and work backward from there.