HealthLeaders recently held its virtual RevTech NOW Summit, bringing leaders from different organizations together to discuss the latest topics around revenue cycle technology.
Revenue and finance executives from CommonSpirit Health, Baptist Health, Frederick Health, Northwell Health, and University Health KC served as panelists through the day’s sessions.
Staff and RCM Solutions
During the first session, panelists discussed how they were able to get staff on board with the implementation of a revenue cycle management solution, emphasizing the importance of transparent and open communication.
“We really want to be able to thoroughly talk through the decision making, why we’re moving to [the] solution that we’ve selected,” Anissa Fabrizio, assistant vice president of HIM Coding and CDI for CommonSpirit Health, shared. “And we’re generally doing that once we’ve made the decision that we are truly moving forward.”
A common misconception when an organization tells staff its looking to bring a tech solution into revenue cycle operations is that staff are being replaced, which Fabrizio denied, explaining the technology is meant to help them be more efficient.
Preventing Disruption
As we’ve seen in recent months, every revenue cycle needs a back up or continuity plan in the event of operations being disrupted. During the second session, panelists shared some of their strategies to prevent disruption and ensure seamless workflows.
Vendor relationships play a crucial role here, as Sean McCardell noted, sharing that though Frederick Health was affected by the Change Healthcare ransomware attack, it was able to brings its claims platform back up within 72 hours.
“I understand that having a lot of vendors can be helpful when you run into issues like these,” he said.
“However, I think if you find the right vendors, you can work to overcome many of the obstacles, and as a smaller [health system], it’s a lot easier for us to manage a handful of vendors versus 15.”
Revenue Cycle Resilience
The last panel of the day focused on financial stability and how to develop a resilient revenue cycle through technology. Leaders must be more strategic as they navigate a new healthcare economy where patients are paying more of their healthcare costs and payers grow more stubborn with denials.
Andy Talford, senior director of back-end revenue cycle at Moffitt Cancer Center, explained the organization’s approach to combating denials.
“We’ve always taken the approach of ‘we don’t take a denial sitting down,’ so we pretty much try to find everything we can ourselves,” he said. “We don’t outsource all of our denials, but we do bring in third parties on certain types that they can do either because of volume or complexity.”
The AMA's CPT Editorial Board has hit a stalemate over proposed changes that would boost reimbursement for RPM, so what does it mean for its future?
A push to improve reimbursement for Remote Patient Monitoring (RPM) programs has stalled, and that could prompt health systems and hospitals to think twice about launching or expanding their platforms.
According to social media and news reports, the roadblock is coming from the American Medical Association’s 21-member CPT Editorial Panel, which hasn’t been able to agree on amendments to the CPT codes covering RPM services. The panel indefinitely suspended the proposed changes at its May meeting.
RPM was initially recognized in 2019 by the Centers for Medicare and Medicaid Services (CMS) through a small set of codes for remote physiologic monitoring services, enabling clinicians to seek reimbursement for gathering data from patients through certain medical devices outside the hospital setting. CMS has slowly amended and expanded those codes since then, adding codes for remote therapeutic monitoring.
Advocates have long argued that the codes are too restrictive on everything from what devices can be used to what conditions are covered to what data can be gathered. In all, providers can only expect to receive about $170 in Medicare reimbursements per patient per month.
At issue is the requirement that a healthcare provider collect at least 16 days of RPM data from a patient over a 30-day period to bill for Medicare reimbursement through CMS Providers and RPM advocates have long argued that the threshold is too high, that some programs don’t need 16 days of data, and that the reimbursement doesn’t cover the time and effort put into collecting the data. But a proposal before the CPT committee to create new “supply of device” codes that would have allowed providers to be reimbursed for less than 16 days of data over a 30-day period didn’t get the support to move forward.
“Since separate payments for [RPM] services were established, industry stakeholders have advocated against this 16-day requirement arguing that it is clinically arbitrary and ignores conditions where a reduced number of days would be more clinically appropriate,” Thomas Ferrante and Rachel Goodman, partners in Foley & Lardner’s Telemedicine & Digital Health Industry Team, said in a 2023 blog.
During the COVID-19 Public Health Emergency, CMS relaxed the rules, dropping the RPM threshold to two days instead of 16. But when the PHE officially ended on May 11, 2023, the 16-day threshold was returned. A bill initially introduced in 2021 and resubmitted each year by U.S. Reps. Katie Porter of California and Troy Balderson of Ohio has sought to extend that relaxed threshold for two years and prompt the U.S. Health and Human Services Department to study a long-term solution, but the bill hasn’t made it out of committee.
The issue has hampered the development of new RPM programs, as health systems and hospitals often rely on Medicare reimbursement to sustain those programs. Without that financial support, some organizations may decide against launching or expanding their platforms.
The AMA’s CPT Editorial Panel next meets on September 19-21. Whether any changes to RPM codes are on that agenda remains to be seen.
Mentorship between new and tenured nurses is mutually beneficial, this nurse leader says.
On this week’s episode of HL Shorts, we hear from Dr. Jennifer Mensik Kennedy, president of the American Nurses Association, about how CNOs can create mentorship opportunities to help retain nurses. Tune in to hear her insights.
Amy Perry shares with HealthLeaders her plan to guide the health system into the future.
As Banner Health enters a new era under new leadership, incoming CEO Amy Perry is shifting the focus onto technology to drive the health system forward.
The Phoenix-based nonprofit operator is saying goodbye to longtime CEO Peter Fine, who is retiring after 24 years at the helm, and welcoming current president Perry into the role beginning June 30.
The changing of the guard represents Banner charting its course for the foreseeable future, with an emphasis on modern, innovative solutions that have become almost a necessity for health systems in a post-COVID world.
“When Peter came to Banner, he established a 20-year strategic plan and that got us all the way up to the precipice of COVID and then we've been calling the last three-ish years ‘survive it’ because it's been such a difficult time,” Perry told HealthLeaders. “But now coming out of that and seeing the momentum that Banner has is really the start of our new 10-year plan, 10-year vision for the future.”
At the heart of that vision is investment in technology to make care easier to access for patients and easier to deliver for physician and nurses. Perry highlighted that last fall, Banner put together a “very aggressive” five-year plan to make a billion-dollar commitment to technology to build its automation and data for accelerating usage of AI and large language models. Further investment will also go towards the digital consumer experience.
“That technology, changing our reimbursement, even leaning further into our payvider status, being able to ensure more members, and just serve our community in a new and innovative way is really where we're going in the future,” Perry said.
Specifically, Banner is prioritizing data. The soon-to-be CEO noted that before you can use data in different ways, it must be curated in a manner that can be utilized in the most streamlined and accurate fashion. Without clean, highly reliable data, you’re susceptible to human error in its collection and management.
“That is the fundamental, important stuff of putting together any technology plan,” Perry said. “It allows us to create more customization in our digital consumer experience. It allows us to do more predictive analytics.”
Ultimately though, Banner wants to use technology to make delivering care easier, which is why it is rolling out an AI tool to all 33 of its hospitals that is designed to take some of the burden off clinicians.
The technology, developed by Regard, will summarize clinical notes, allowing doctors to spend more time with their patients and less time completing administrative tasks.
Banner recognizes the importance of using technology to supplement the workforce and drive labor costs down. In 2023, the system experienced an 8% increase in expenses, including salaries, benefits, and contract labor rising 6% year-over-year to $6 billion.
“It's critical that we change our processes and we add the technology that can facilitate a different kind of work stream,” Perry said. “We talk a lot at Banner about the fact that we just can't ask people to do more with the same number of people without changing the process. It's absolutely impossible. It's not sustainable. So the only sustainable change is to look at each one of our work streams and say how do we blow this up? How do we start over? How do we do it differently?”
These are questions health systems across the country are asking themselves, but the ones attempting to answer them won’t be caught flat-footed during healthcare’s digital transformation.
UnityPoint's CNO discusses the future of the health system's virtual nursing program.
The potential of virtual nursing seems promising as many health systems begin to brainstorm and implement programs of their own.
Sarah Brown, CNO at UnityPoint Health, laid out how the Iowa-based health system has set up their virtual nursing program and what their four goals are for the future.
Brown is a part of the HealthLeaders Virtual Nursing Mastermind panel, where several health systems will discuss the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.
Starting goals
Many health systems are using virtual nursing to offload work and give time back to nurses to be at the bedside. And at UnityPoint it's no different.
"Our goals with it initially, and I would say they have morphed a bit over time," Brown said, "[were] really to redesign the work so that we could remove some work from our nurses that were at the bedside to try to make their experience while they were at work better."
Brown said UnityPoint wanted to set up the program in a way that did not sacrifice quality or patient experience. The main focus was on improving the bedside nurse experience, and that remains a priority, along with efficiency and quality goals.
"I think the efficiency piece comes when we’re getting high, 90%, maybe even 100% of our admissions on our med surg inpatient united completed within the first four hours," Brown said. "That's not something we could have said before."
Brown attributed that success to how they resourced differently. There is now more focus and consistency with the people doing the admission and discharge processes, and so they are able to do more of them. Brown said they are heading toward a retention goal with the program as well.
"With that experience, they catch more things," Brown said. "I think where we want to go is then more focused on our new-to-practice nurses that really need more of a mentor [or] coach sort of role."
What's next
Brown sees UnityPoint going through four evolutionary phases with the virtual nursing program.
Phase one includes the admission and discharge processes and other documentation needs, along with some care planning and patient education.
Phase two will focus on operations and implementing in-room technology. This would enable the virtual nurse to help check medications, blood draws and other processes with the bedside nurse in the room. They could also help assist with documentation during a rapid response situation, and help with virtual rounding.
"I think we are a bit hampered with moving forward in the other phases without the in-room technology," Brown said, "so that piece will be really important to us."
The third phase is expanding the program to allow for monitoring on a broader scale. Virtual nurses could then act as eyes in the sky, to look for deterioration, sepsis, or other patient conditions.
At that point, the health system could move to the fourth phase and use virtual nursing for mentorship of new-to- practice nurses.
Brown said that three years into the program they have really matured the first phase, but they still have a long way to go to get to the long-term goals.
Additionally, Brown is hopeful that UnityPoint can implement virtual care in the EICU.
"Like many organizations, we are at max capacity in many of our hospitals on a daily basis," Brown said. "I have this idea that there has to be a way we can incorporate virtual waiting room monitoring or virtual nursing in our emergency departments as well."
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A strong start is expected to give way to more modest returns the rest of the year.
Kaiser Permanente started the year on a positive note by riding “favorable financial market conditions” to a healthy bottom line in the first quarter.
However, the nonprofit health system cautioned that historically, the first quarter is buoyed by the open enrollment cycle while the operating margin in the remaining quarters is usually deflated by steady revenue and incurred expenses.
For the first three months of the year, Kaiser reported a $7.4 billion net gain, $935 million of operating income, and a 3.4% operating margin. All those figures easily surpassed Kaiser’s performance over the same period in 2023, when it reported $1.2 billion in net income, $233 million in operating income, and a 0.9% operating margin.
Here are three takeaways from Kaiser’s first quarter financial activity:
Lifted by Geisinger deal
Kaiser’s $7.4 billion in net income was largely the result of its subsidiary, Risant Health, completing its deal for Geisinger Health.
The acquisition is part of Risant’s vision to form a value-based network, with four to five other systems expected to be added in the next five years.
By bringing in Geisinger, Kaiser received a one-time net asset gain of $4.6 billion. Excluding the deal, Kaiser’s net income for the first quarter was $2.7 billion.
The transaction considerably strengthened the system’s bottom line in the quarter, but will require investment going forward, with Kaiser having designated up to $5 billion to support Risant.
Rising expenses
Though Kaiser’s operating income of $935 million marked an increase of more than 300% over the first quarter in 2023, the system noted that it was still “below historical first-quarter trends leading up to the pandemic.”
The reason? Cost pressures stemming from high utilization, care acuity, and higher prices for goods and services. That led to Kaiser reporting operating expenses of $26.5 billion, representing a nearly 6% increase from the same period last year.
With labor costs weighing heavily on hospital operators, many are turning to trimming the workforce. Kaiser has now laid off around 350 workers in mostly IT and administrative roles since last fall, with 76 more reductions coming by June 21, according to regulatory documents.
Shifting out of private equity
Amidst all the chatter about private equity’s impact on healthcare, Kaiser is planning to sell up to $3.5 billion of its private investment holdings, according to The Wall Street Journal.
The report, which cites unnamed sources familiar with the situation, stated that the move is due to cash constraints as the system works with investment bank Jefferies Financial Group to liquidate assets. Kaiser is also expected to sell off similar sized holdings later this year.
The system and its subsidiaries held almost $100 billion of investments at the end of 2022, most of which were made through its pension system, the report said. Illiquid alternative assets, including private equity and real estate assets, made up nearly 57% of Kaiser’s investments at the time.
The sales point to Kaiser moving away from private equity and into other investment areas.
Here's why your workforce growth strategies aren't working, according to this nurse leader.
The greatest challenge facing nursing leaders today is workforce development. Health systems are in dire need of solutions that improve both recruitment and retention.
These challenges come at a time when workplace violence is as prevalent as ever, and burnout plays a huge role in nurse leader turnover. Virtual nursing and other new technologies like AI have also had an impact on the workforce and need to be considered when strategizing.
HealthLeaders spoke with Dr. Jennifer Mensik Kennedy, president of the American Nurses Association, to find out what workforce growth strategies need to be put to rest and explore four ways CNOs can move forward and build a strong, healthy, and happy workforce. Tune in to hear her insights.
Health systems in Minnesota and Nevada are getting more than $30 million in grants to support ECMO programs, which treat patients with severe heart and lung conditions
A global philanthropy is donating more than $31 million in grants to health systems in Minnesota and Nevada to expand access to innovative life support technology that could help save lives in rural areas.
“ECMO can be a game changer for patients with severe heart and lung conditions,” Walter Panzirer, a trustee with the New York-based organization, said in a press release. “Without ECMO, hospitals have to transfer patients to other facilities, and those who are too unstable for transport could die before receiving needed care.”
ECMO provides prolonged cardiac and respiratory support for people whose heart and/or lungs are unable to provide an adequate amount of oxygen, gas exchange, or blood supply to sustain life. The technology used is similar to a cardiopulmonary bypass machine, and the device used is a membrane oxygenator, also known as an artificial lung.
As profiled in a November 2023 story in Scientific American and a March 2024 story in The New York Times Magazine, ECMO technology could be used during CPR—in a process called ECPR, or extracorporeal cardiopulmonary resuscitation—to treat patients in cardiac arrest at accident and disaster scenes and rural locations. The procedure has been in use for more than a decade in France, is being trialed in the Netherlands and was first performed in the U.S. by emergency physicians in 2019 at the University of New Mexico.
The procedure has the support of the National Institutes of Health, which ended a 2020 clinical trial at the University of Minnesota early, saying it would be unethical to deprive eligible people of the treatment, after it was reported that ECPR resulted in a survival rate of 43%, compared to 7% in traditional care. Other studies haven’t been so positive, including one published in 2023 in the New England Journal of Medicine, which compared ECPR with standard care across 10 medical centers in the Netherlands and found little difference in survival rates.
In Minnesota, the Helmsley trust has given $19.7 million to the University of Minnesota to expand and sustain a mobile ECPR program launched in 2022 with a van specially fitted with ECMO technology.
In Nevada, the trust is granting more than $5.1 million to the St. Rose Dominican Health Foundation to launch an ECMO program at Dignity Health-St. Rose Siena Hospital in Henderson. The grant will be used to add four dedicated ICU rooms and an adjacent sleep room for patients suffering from acute respiratory distress, recovering from cardiac arrest, or awaiting a heart or lung transplant.
(The foundation is also getting a $1.7 million grant to help renovate the hospital’s four cardiac catheterization labs and upgrade vascular disease imaging services for patients with coronary artery and structural heart diseases.)
Another $3.5 million will go to the Renown Health Foundation to establish an ECMO program at Renown Regional Medical Center in Reno, the first such program in the northern part of the state.
A $1.2 million grant to University Medical Center of Southern Nevada, initially made in 2023, helped to create a program with four ECMO machines, and the health system plans to add another seven machines in the near future.
Healthcare insiders 'DSH' on IPPS, 340B eligibility, and the future of telehealth.
The fiscal year (FY) 2025 IPPS proposed rule, released April 10, bodes ever-tighter financial futures for hospitals: Next year's projected increase is 2.6%, down from this year's 3.1% bump.
"That will truly be a challenge for us, and I'm sure all healthcare systems," says Denise Scoffic, CFO, east region, at Mercy, a St. Louis, Missouri–headquartered health system with more than 50 hospitals and 50,000 team members across four states. "It's disappointing to see the lack of recognition of the current state of inflation that we're in, both from a labor perspective and from a supply and drug perspective."
Disappointing—"woefully" so, perhaps—but not surprising.
"I'm in Washington, DC. No one's talking on Capitol Hill about, 'let's put more money in healthcare,'" says Richard L. Gundling, FHFMA, CMA, senior vice president of content and professional practice guidance at Healthcare Financial Management Association.
For health system CFOs, it means getting even comfier doing more with less—while keeping an eye toward the regulatory movement bubbling beneath the surface.
"If you're not paying attention […] that can come back and bite you on the back end," says Venson Wallin, CPA, CGMA, CFE, CHC, CHFP, FHFMA, HCISPP, managing director and national healthcare compliance and regulatory leader at BDO, a global financial advisory firm.
Ahead, how not to get bit by less-buzzy regs.
Setting the stage
Mercy's fiscal year ends June 30, so forecasting is top of mind. "We definitely need to be realistic about what's coming our way," says Scoffic. "We must build in these regulatory challenges, such as the IPPS rate increase," even as "we'll continue to advocate for more reimbursement."
It's a balancing act.
Given the slim increase proposed for 2026, Mercy is seeking ways to "think and act even more quickly," says Scoffic, in part by exploring automation and ensuring all caregivers are working to the top of their licenses. She's also tapping team members across the organization for insight.
Mercy Hospital St. Louis, which is part of the system's east region that Scoffic helms, has an innovation center in one of their inpatient nursing units "where we engage the frontline caregivers to collaborate and think with us" about how to maintain high care standards while improving efficiency, she explains. The collaboration has yielded "great progress in reducing our length of stay and improving our throughput."
Wallin also supports a long view. When it comes to regulations, finance leaders should think beyond basic compliance to areas of risk and reward. "Where is your biggest focal point, and what could either benefit the hospital the most, or what could create the largest negative impact by not addressing it immediately?" Wallin asks.
As an example, CMS introduced new cost reporting requirements in the 2024 IPPS final rule, which apply to Medicare bad debts, Medicaid eligible days for disproportionate share hospitals (DSH), charity care charges by patient, and total bad debt by patient.
"This is not something that has been traditionally done in the past," Wallin says. And failure to comply could bring increased audit risk or, in the worst-case scenario, a "pause" on certain federal payments that hampers cash flow and threatens 340B eligibility (more on that next).
DSHing on 340B eligibility
CMS projects Medicare uncompensated care payments to DSH providers will increase $560M in FY2025. Although that'd be a rebound from this year's "staggering" $957M cut for providers serving a significant number of low-income patients, it may not be enough of a boost.
That's because DSH rules impact hospitals' eligibility for the federal 340B Drug Pricing Program, which requires Medicaid-participating pharmaceutical manufacturers to sell outpatient drugs at a discount to providers that care for many uninsured and low-income patients.
"The 340B program is on the radar, and under a lot of pressure at national and state levels," Scoffic says. Mercy Hospital Saint Louis, like several sibling sites, qualifies for 340B based on their share of Medicaid patients. "It's very important that we continue to advocate with our governmental officials."
Adding to recent stress on the program, this year's final rule introduced tightened criteria for Medicaid Section 1115 days that can be included in the DSH payment calculation. And fewer days could mean less reimbursement for many.
It could also jeopardize providers' access to 340B dollars altogether.
"With DSH, if you reduce your percentage, it reduces your reimbursement; with 340B, if you fall below the threshold, you get nothing," Wallin explains. The potential loss is magnified for small- to mid-sized community hospitals that may rely on 340B to make payroll and keep the lights on, he adds.
If your status stands to shift, consider reassessing your intake process to ensure you're properly capturing Medicaid eligibility as soon as patients walk through the door, Wallin advises. And if losing eligibility is unavoidable, brace for that impact to your bottom line.
Despite the challenges, Scoffic is heartened by recent moves to enhance the 340B program oversight. She points to an April 19 final rule introducing a pathway for resolving pricing disputes with drug manufacturers.
Additionally, Scoffic believes in the power of storytelling to win hearts and minds. "It's important to […] put stories to those dollars that we hope and think will be helpful in advocating that that 340B program continues on."
As part of their advocacy efforts, Mercy Hospital St. Louis puts a percentage of 340B dollars each month into a dedicated patient assistance fund, which is governed by a committee composed of members from the community, the hospital's mission team, and clinical leadership. All told, they're able to provide over $2M in annual assistance to patients undergoing costly drug therapies.
The hospital has also used program benefits to stand up substance use recovery programs; hire additional social workers to serve areas with underinsured patients; and invest in new technologies, like modern imaging platforms, in those same areas, "which, honestly with the pressure on finances, we wouldn't otherwise be able to do," Scoffic notes.
It's a testament to the program's role in "really, truly allowing us to get healthcare access back to those challenged communities," she says, "not just dropping to the bottom line."
Transcending physical boundaries
Looking at reimbursement beyond the IPPS, healthcare insiders are bullish on virtual care. In a recent address to AHA members, Rep. Brett Guthrie, R-Ky, who chairs the House Energy and Commerce Subcommittee on Health, said "there will be an extension of telehealth" because it's "convenient" and "helpful."
The remarks came days after AHA submitted a statement to the subcommittee, voicing support for telehealth proposals that would extend flexibilities set to expire this year and expand patient access.
At Mercy, whose systemwide virtual care program serves 600,000 patients across seven states, there's excitement over "starting to see recognition from a reimbursement perspective," Scoffic says. "Virtual care is really important to bring care to the patient, regardless [of] if they're in a rural area or elsewhere, with a goal of making the access [...] even easier."
The Arizona-based health system is rolling out to all 33 hospitals across 6 states a new tool designed to help clinicians ease their documentation burden
One of the nation’s largest health systems is scaling an AI tool across the enterprise in hopes of giving doctors more time in front of their patients.
Arizona-based Banner Health is giving clinicians in all 33 of its hospitals across six states access to a tool within the EHR that summarizes clinical notes. The technology, developed by Regard, is designed to reduce the clinician’s time spent in front of a computer and facilitate easier access to decision support for care management.
The project is indicative of a trend in healthcare, with health systems and hospitals across the country putting AI to work handling back-end and administrative tasks that otherwise would be done by doctors or nurses. Industry leaders see these projects as “low-hanging fruit” that prove AI’s value and offer immediate ROI.
“We are looking for multiple ways to take tasks away from clinicians and replace that with time they have in front of the bedside,” says Susan Lee, DO, MBA, CP, the health system’s Physician Executive for Hospital Based Medicine. “We want to be AI-enabled.”
“The more that we can envision these tools as enhancers and not replacers, I think organizations will successfully adopt them,” she adds.
Lee says the health system, which tested the tool at Banner Thunderbird Medical Center in 2022, took the unusual step of asking that each clinician be trained one-on-one, rather than via video or in a classroom. The idea is to personalize the clinician’s use of AI and make it more meaningful.
“I think for this tool, the ability to impact such a broad swath of clinical care in a meaningful way made us want to pursue the more personal route,” she says.
This also helps with buy-in, as clinicians come to understand that AI can augment their workflows rather than replacing them. Lee points out that clinicians need to select the tool in the EHR, review the summary, and act on it.
“There’s also a human at the end of the AI loop,” she says. “The physician is still making all the clinical decisions. This tool is helping the physician sort through information in a more rapid way and is also sorting through a very large portfolio of information that the physician could manually sort though, [but] it just does it a lot faster.”
Whether the tool actually improves documentation or care management remains to be seen. Lee says the health system will at first keep tabs on how many clinicians are using it and how often. They’ll also look at whether the tool captures all the information a doctor needs and whether that summary is accurate.
It’s also important to see how this tool evolves. As with any AI technology, the platform becomes more sophisticated as more data is introduced. Lee says Banner Health’s clinicians have been and will continue to offer feedback on the tool, giving Regard more insight into what works for clinicians and what doesn’t. That feedback should help in how the technology evolves, while also giving clinicians the confidence to use a tool they they had a hand in developing.
“Banner is looking to be a front-runner in many of these scenarios,” Lee says of the opportunity to influence a tool’s development. “We do want to be influencers. I think everybody should try playing with it.”
