Healthcare finance faces plenty of uncertainty, but revenue cycle and clinical quality are areas that offer opportunities to limit losses.
With all the rapid changes taking place due to healthcare reform and the economy, many healthcare finance leaders are grasping for any way to minimize their financial exposure—and that means assessing risks that are more likely to generate financial losses. As the payment environment changes in the coming years, healthcare facilities must become extremely adept at identifying, measuring, monitoring, and ideally eliminating their risks, or they may lose greatly needed revenue.
Most industry leaders foresee several payment and quality initiatives taking an even stronger hold in the coming years, including price transparency, consumer-directed health plans, bundled payments, pay-for-performance programs, health savings accounts, and the payment incentives of the Centers for Medicare & Medicaid Services. Regardless of which of these ideas wins out, a greater emphasis will be placed on the quality and value of healthcare services with the demand for transparency of service price. So where should finance leaders look for risks, and how should they approach them? Two good places to start: revenue cycle and quality and safety programs.
St. Vincent Health in Indianapolis, part of Ascension Health, oversees the revenue services for 19 hospitals in the system—an area that is generally rife with risk of financial loss. With $2 billion in total net revenue, Gregory Snow, vice president of revenue cycle for the system, and his team need to be vigilant about managing negative influences on the payment environment. Traditional prescreening is part of the approach; however, to offset the risk of losing revenue, they are using technology.
“The first access to St. Vincent’s enterprise is patient scheduling, followed by a series of preservice clearance functions, which include verification of coverage, insurance benefit levels, out-of-pocket estimates, need for financial assistance, and confirmation of the patient’s appointment,” says Snow.