Technology's tangible impact on boosting a hospital's bottom line.
Hospitals are feeling financial strain from all directions, from staffing shortages and productivity concerns to value-based care and payer denials. Inflation, lingering issues from COVID-19, and pressures dealing with a hybrid workforce have exacerbated things all the more. Enter technology, the potential game-changer. Kelly Johnson, Managed Services Program Director, Revenue Cycle Center of Excellence, Altera Digital Health, shares how high-performing tech tools, from advanced EHR systems to automation, can and are making a real difference. Below, she dives into the top issues impacting hospital bottom lines and where technology is integral.
Q: What are the leading financial challenges that healthcare organizations face today?
Kelly Johnson: Hospitals and health systems have a lot going on post-COVID-19. A primary concern is the disparity between escalating costs and payer contract constraints that put a 5% cap on price increases. Hospitals are dealing with rising drug and supply costs that far surpass this threshold.
This economic pressure is evident, especially when observing community hospitals that struggle with the same issues despite having additional funds and grants from donors and community plans. A telling example is hospitals closing specific departments, like maternity units, due to competition and unsustainable overhead for minimal monthly cases.
Where we land is that hospitals require more advanced IT resources to navigate these cost issues, including detailed insight into overhead, revenue per procedure, and other crucial financial metrics. The rise of the self-pay patient demographic highlights this urgency, with the burden of high-deductible plans causing an uptick in bad debt. Modern systems that determine self-pay segmentation and employ algorithms to predict a patient's propensity to pay are essential. Further, hospitals are starting to see real value in robotic process automation (RPA) and bot technologies for things like analyzing claims to ensure key charges are properly documented.
Q: How can healthcare IT help address the challenges presented by value-based care?
Johnson: Denials are one of the biggest hurdles under value-based care—an issue accelerated by providers’ loss of COVID monies. Healthcare has not fully addressed the core pieces that drive value-based pricing. For example, providers get stuck identifying what to track and the appropriate order to track it so that it gets reimbursed appropriately. Additionally, healthcare organizations generate a lot of pharmacy waste, but many are not up to speed on reporting it correctly so that it gets on the claim and into the 837 form.
Advanced EHR technology can help. For example, with our Sunrise™ EHR, we ensure from a regulatory perspective that we are operationalizing key features like pharmacy waste so providers can properly document it. We are also helping prevent these problems upstream—around 85% of denials are initiated during registration and preauthorization. We look for denial patterns and then build rules during registration and preauthorization. For example, if a specific payer denies X-rays without a preauthorization, we create a rule requiring an authorization field to be populated before service. We also have an EHR feedback loop that identifies frequent flyers in the ED, automatically notifying their primary care physician through the patient portal for follow-up to improve care and reduce inappropriate readmissions.
Q: How can health IT technology help reduce the amount of duplicate medical records?
Johnson: Managing duplicate medical records is another costly headache in healthcare, requiring robust processes and tech solutions. Good visibility through dashboards and reports is vital to spot potential duplicates immediately and rectify inconsistencies. It's about the financial data and consolidating medical documents into the appropriate medical record, timely and efficiently. Most importantly, your EHR should be versatile and capable of handling various medical record merges, whether at the enterprise or facility level or within a single visit. The EHR should also provide a reliable audit trail, as auditors often inspect merged records to trace the lineage between the old and new data. The goal is to ensure the utmost accuracy and integrity of patient information, and the right technology can make all the difference.
Q: What kind of technology or services can help organizations become more efficient and address their staffing shortages?
Johnson: These are hot topics right now. Revenue cycle staffing shortages mirror those happening across healthcare. To help, hospitals are using productivity technology—often tied to an EHR tool—to monitor employee efficiency. They are particularly interested in employees working from home, as more tasks, such as pre-registration and preauthorization, are being done remotely.
Productivity software has advanced significantly, providing insights into whether an employee is more or less productive when working from home. It can track the number of accounts an employee works daily, how often they interact with an account, and even specific actions they take. These tools include dashboards, detailed reports, and work queues, clearly showing individual and team productivity.
Additionally, RPA and bots are becoming essential tools, handling repetitive tasks while freeing up staff to focus on more complex issues. Bots excel in areas like processing coordination of benefits denials or checking insurance eligibility. In the future, the ideal scenario will be a balanced combination where technology supports and enhances human expertise.