Hospital and health system revenue cycle leaders discussed how their teams can help the revenue cycle prove its value in 2021 and beyond.
The year 2020 has proven that it pays to innovate and plan. Revenue cycles that have been consistently at the forefront of technology adoption and managing a remote workforce have had a clear advantage over those that were forced to play catch-up during the global pandemic, all while attempting to keep their organizations financially afloat.
Now, revenue cycles that have been ahead of the curve cannot lose the momentum for change as they settle into this virtually enabled "new normal." Instead, they must continue to prove their value and forge ahead with initiatives that strive to make the revenue cycle sleeker, smarter, streamlined, and ultimately, seamless.
At the HealthLeaders Revenue Cycle Exchange in mid-September, executives discussed three ways the revenue cycle can continue to prove its value in 2021 and beyond.
- Improve the patient experience
Even before the COVID-19 pandemic, the world was mostly virtual for many industries. The pandemic has accelerated that shift even more, including one of the worst laggards: healthcare. Now it's time for the revenue cycle to fully catch up, especially in the wake of virtual visits becoming the norm practically overnight. That means pushing tools like self-arrival technology and other forms of electronically enabled patient self-service.
"I think it's our job to match revenue cycle to where the rest of the business is. We need to match what the culture is doing," said Karen Shaffer-Platt, vice president of revenue cycle at UPMC in Pittsburgh, Pennsylvania. "Do we really want to sit patients across from a registrar and do a face-to-face interview asking them name, social security, and phone number anymore?"
Similarly, Joann Ferguson, vice president of revenue cycle for Henry Ford Health System in Detroit, notes that pre-pandemic the system was still using a lot of paper for consents, but COVID-19 quickly pushed the organization to verbal and electronic signatures, saving countless hours of manually scanning thousands of pieces of paper.
In addition to using technology to streamline typical front-end revenue cycle functions, Pattie Froehling-Gilliam, vice president of revenue cycle for Optum360/Excela Health in Greensburg, Pennsylvania, advocates "pulling it forward."
"We have to pull everything that we used to do on the backend forward, from a digital front door, to educating our patients, to making sure that they understand the type of coverage they have, and giving them avenues in which to pay, right down to working to mitigate denials on the backend," she said.
Karen Kennedy, regional director of revenue cycle for Cleveland Clinic in Florida, echoed that sentiment, noting that the "pulling it forward concept" not only makes the patient experience better but also cleans up the rest of the revenue cycle.
"The cleaner you can make everything upfront, the easier it is down the road," she said. "You shouldn't even have to touch anything after it's billed. It goes out electronically, it gets paid electronically, the patient responsibility drops correctly, a statement goes out. It should never have to be touched. So, whatever we can do to get there is definitely where we need to go."
Even with technological advancements, the pandemic has also shown more than ever how much the patient experience benefits from personal outreach, compassion, and flexibility. Many revenue cycle leaders paused collections during the height of the pandemic, and have expanded their payment plan offerings, sometimes even doing outreach to let the patient know about their choices.
"I think it made it easier when we proactively reached out to let them know what those options were instead of just waiting and having them move those bills into a drawer and think about it after the fact," said Lynn Ansley, senior director of revenue cycle management at Moffitt Cancer Center in Tampa, Florida.
- Fully optimize technology
Even amidst the pandemic, revenue cycles have chugged along with projects such as EHR conversions, improving denials management, and preparing for the January 1 price transparency mandate. Through it all, optimizing technology has proved invaluable.
For instance, many revenue cycles are building bot technology to reduce keystrokes and automate rote tasks like cash posting and claim edits, as well as accelerate working denials and handling accounts that can be coded without human intervention. Ferguson noted that in the wake of the system's rapid expansion of virtual care that it has automated the process to meet payer modifier and code set requirements.
"We have an internal team with automation that's constantly looking at different ways for us to cut down on that human intervention, especially when it's a redundant process," agreed Froehling-Gilliam.
Whereas bots mimic keystrokes, AI uses analytic and predictive technology, and leaders are using it to negotiate with payers, such as using EMR documentation to defend inpatient status and negotiating a blended rate between observation and DRG.
Optimizing technology for the revenue cycle also extends to the patient clinical experience. Although many patients and clinicians have been excited about telehealth services, Ansley notes that platforms like Zoom don't have a built-in feature that allows for patient and visit data to be automatically integrated with the revenue cycle. Although she understands that slowing down might cause telehealth efforts to lose momentum, she'd like to strike the right balance between maintaining continuity of care and slowing things down so revenue cycle can get it right for the long term.
"In revenue cycle, we hate reacting to things," she said. "We like to have our plan in place before we go live. We like to have the automation solutions that bucket into this seamless experience, so there are [fewer] manual touches. Virtual visits [were] not that for us and still isn't."
- Manage an effective workforce
Leaders described the effort to quickly shift to a remote revenue cycle workforce in mid-March as a "mad scramble." Seven months later, though, most revenue cycles are still either fully or partially remote—and many have no plans to go back to the office in the traditional sense—and with this shift, new challenges and opportunities have emerged.
Among the challenges are managing revenue cycle roles that may be better suited for the office. For instance, parents of young children may find themselves trying to manage remote schooling alongside their own work requirements. While some revenue cycle tasks, such as coding, are more flexible and can be done anytime, denials management tasks often require employees to be on the phone during the payer's operating hours. Others, like CDI, benefit from face-to-face interactions with clinicians.
The solution for many leaders has been a hybrid solution of rotating staff. For instance, Ferguson says that Henry Ford Health System's long-term plan is to have rotating days where employees come on-site in teams to work together in a more collaborative space but continue to work mostly remotely otherwise.
Another challenge has been maintaining the social aspect of work and ensuring that employees feel connected to the organization.
"You can work from home and be a part of any company, but we want to make sure the culture here at Baptist is here with them," said Ron Wachsman, vice president and chief revenue cycle officer for Baptist Memorial Health Care in Memphis Tennessee. In that sense, employing a rotating hybrid model of mostly remote work with some in-office days also provides a solution.
A mostly remote workforce has opened up several opportunities, too. In addition to staff satisfaction, Vicki Kaplan, vice president of coding and HIM at Ochsner Health System in New Orleans, notes that remote work has helped them to retain employees who might have left for jobs that did allow them to work at home.
"If the whole industry goes that way, you've got to do it," she said.
Remote work has also resulted in lots of empty real estate, potentially saving organizations money in expensive rental and lease agreements.
"If we can lighten the weight and lighten the expense of the revenue cycle, we should," said Shaffer-Platt.
Finally, leaders like the prospect of expanding their prospective employee pool beyond their local geographic areas.
"We're no longer limited to just recruiting in Memphis; we can recruit nationwide and really get the best team possible," said Wachsman. "We're really excited about being able to expand our catchment area to get the best people in revenue cycle to be part of our team."
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Alexandra Wilson Pecci is an editor for HealthLeaders.
