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The Revenue Cycle and COVID-19: 3 Issues, 3 Responses

By Alexandra Wilson Pecci  
   March 26, 2020

"Now is not a time to say no to creative ideas," says Ric Sinclair, chief strategy and product officer at Waystar.

No two revenue cycles are the same and no two will react to the COVID-19 crisis in exactly the same way. But at this point, the right way forward is still unknown.

"Anybody that says they have the perfect answer to this isn't really embracing being an honest human," says Ric Sinclair, chief strategy and product officer at Waystar.

But there are some commonalities and strategies that revenue cycles can learn from each other as they navigate this unprecedented event.

"I fundamentally believe in a time like this, the willingness to ideate, test, and fail rapidly on any idea is far more important than the tendency to try and shut down ideas that seem like they're not going to work," Sinclair says. "Now is not a time to say no to creative ideas."

Waystar represents more than 450,000 healthcare providers and 750 hospitals and health systems, and in speaking with those clients as they work through their COVID-19 strategies, three main revenue issues have emerged.

"Over the last few weeks we've both doing a lot of proactive reach-out and also receiving a lot of client inbound [calls]," Sinclair says. "We've heard these things firsthand and directly."

Issue 1: Canceled elective procedures and visits

Hospitals are seeing mass cancelations of elective surgeries and even basic wellness checks in order to deal with the more immediate need of treating COVID patients.

"Elective surgeries are often more profitable cases for hospitals and health systems," Sinclair says. "This will impact their bottom line."

He notes that these mass cancelations come on the heels of another recent financial blow: "A CMS reimbursement change to allow things like high-cost cardiac procedures to be performed in ambulatory surgery centers; those had previously been an in-patient only procedure, which further can exacerbate those bottom-line challenges," he said.

The response: Deal with the crisis at hand and be ready to accommodate elective patients when it's over

While every revenue cycle leader wants to mitigate the financial impact of cancellations Sinclair believes there's no cure-all right now. Instead, leaders must focus on "managing the COVID crisis at the expense of daily business norms."

For instance, he's seen a a couple of larger facilities looking to defer or delay patient financial interactions until after the COVID-19 crisis.

"If a patient has a balance, they may hold off on sending a statement or sending a collection letter, where their normal processes would have sent that out," he says.

In addition, some facilities are moving more and more toward electronic interactions in order to save paper.

"We see those trends taking place on our network," Sinclair says, noting that Waystar processes billions of dollars in electronic HSA and credit card payments.

"We're able to see the trends of how that's coming in, and it's continuing to trend more and more towards payment and communication from iPhones, versus paper bills," he says.

Finally, he's also seeing some of the larger systems conducting real estate analyses in areas more affected by the pandemic to determine whether their outpatient facilities be repurposed to accommodate COVID-19 patients.

For now, facilities need to make sure COVID-19 patients receive care and be ready to swell up resources for elective procedures when the crisis is over.

"I don’t think there's a necessarily priority to think about how those elective patients get back," Sinclair says. "It's to make sure you have the people processes and technology in place so when they are back, you're operating more effectively than ever."

Issue 2: A newly remote workforce

"By and large now, most revenue cycle operations have moved to a shelter-in-place, remote workforce," says Sinclair.

That in and of itself is hard, with hundreds of employees logging onto systems from home for the first time all at once. Leaders must manage this while attempting to track productivity, ensuring team members have what they need to be successful, and keeping payments flowing.

The response: Shore up technology.

"Those that are doing well are healthcare providers that were more on more of the front of the technology adoption curve," Sinclair says.

Healthcare providers that have primarily operated their tools and software from an internet and software as a service-based subscription model—which can be accessed anywhere in the world from an internet browser—are faring better than those revenue cycles whose processes are more client server based, or more dependent on being localized to a network.

Those in the latter camp are having significant challenges with a range of revenue cycle processes, "up to and including just getting invoices out the door," Sinclair says.

Software providers can also work with revenue cycles to make sure their systems are faster, more stable, and more secure than ever before, now and in the future.

Issue 3: More uncompensated care

"There's an influx in the number of uninsured patients requesting or requiring treatment," Sinclair says. There's mounting pressure to provide uncompensated care, and Medicaid programs are already stretched thin.

"This makes it difficult to financially clear patients," he says.

In addition, a new research brief from the nonprofit FAIR Health reported that the total costs for all hospitalized COVID-19 patients may range from a low of $362 billion in charges and $139 billion in estimated in-network amounts to a high of $1.449 trillion in charges and $558 billion in estimated in-network amounts, depending on the incidence rate and severity of the infection in the US population.

The response: Use technology and help patients

"We're seeing a lot of activity around using AI and technology to help patients with their financial clearance to more rapidly let patients figure out if they are eligible for insurance, if they're eligible for charity programs, if they're eligible for Medicaid," Sinclair says.

In addition, providers are increasingly working with the patients themselves to help in this area.

"A lot of our more progressive providers are starting to help patients navigate this process in order to get higher reimbursement of a managed Medicare plan, as opposed to trying to collect from the patient," he says.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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