Four financial themes were prominent in the year’s first half:
Chasing elusive profitability
The median hospital operating margin turned positive in May, and labor costs appear to be headed in the right direction, though they still exceed pre-pandemic levels.[1Increased patient lengths of stay represent profit headwinds. Regaining profitability requires “unrelenting cost discipline” and concentration on producing “recurring savings.”[2]
Staying on revenue growth track
Pursuing top line growth remains a high 2023 priority alongside cost control. Commitment to telehealth remains steadfast. Half of CFOs expect to increase investment throughout the year. .[3]
The current emphasis is on making telehealth more convenient through:
Attractive hybrid virtual/on-site combinations of care
Throughout the first half of 2023, payers were aggressively pursuing prior authorization of procedures, and 95% of hospitals say that this process is consuming considerable staff time.[5] Initial prior authorization/precertification denial rates for commercial inpatient claims rose to 2.8% in 2022 and reached over 3% in 2023’s first quarter.[6] The cash flow impact is not trivial. As one measure, 50% of hospitals indicated that they are carrying over $100 million in receivables for claims older than six months.[7]
Addressing ongoing workforce challenges
This year has seen some easing from pandemic crisis levels, but staffing is a substantial challenge across clinical and administrative functions. Nursing remains a flashpoint. Over 142,000 RNs returned to work in 2022, a 4% uptick, and turnover declined nearly 5% to a still-high 22.5%.[8] However, prognoses augur a meaningful nurse exodus. In late 2022, nearly one-third anticipated leaving direct care within a year. [9] On the administrative side, 63% of organizations say they are experiencing staff shortages in revenue cycle management. [10]
These workforce disruptions are producing:
Increased cost. Median staff costs increased 10% from 2022 to 2023.[11]
Knowledge loss. Early retirements of seasoned executives create an “experience brain drain.”[12]
Stepped-up retention efforts. Organizations are working to retain employees through pay increases, hybrid work extension and benefits such as on-demand Earned Wage Access.
Patient Financial Experience
Even with financial constraints, providers realize that substantial improvements in patient experience are vital and cannot be deferred. The impetus emanates from two leading directions — patient demand and competitive pressure.
Patient demand
The patient struggle to meet cost obligations is ongoing. In a Harris poll, 61% of Americans cited affordability as their highest barrier to care access, while 26% said healthcare costs strain their finances and 23% stated insurance fails to cover care.[13]
The need is fueling expansion of patient financing programs. Low- and no-interest credit lines covering significant dollar amounts and extended durations remain the industry gold standard for generating patient-friendly experiences. Over 60% of hospitals and medical groups anticipate greater reliance on third parties to offer patient financing over the next two years. [14]
Competitive pressure
Early 2023 witnessed little diminution in activity by payers, “retail health” providers, and other competitors to expand further into ambulatory care services. Bain & Company projects non-traditional players will own 30% of the primary care market by 2030. [15]
Beyond taking market share, these competitors are leveraging technology to offer highly convenient care and financial experiences, pressing traditional providers to “up their game.” Several strategies are urged by industry leaders, from partnering with the national firms to adopting retail practices to expanding outpatient facilities aggressively - either organically or through acquisition.[16],[17]
Digital Transformation
Digital transformation has been a significant goal in healthcare for several years. A mid-year status check reveals several points of technology emphasis.
Technology as enabler
Facing heavy financial challenges, providers are focusing pragmatically on digital enablement of key near-term goals and are rigorously screening technology projects for rapid ROI. Current priorities support two goals:
Growth. Funds are flowing to technologies that foster diversification of revenue streams. Telehealth, remote patient monitoring and other tools are critical to fast-growing ambulatory services and Hospital-at-Home programs. Home services are projected to grow 20% over the next decade. [18]
Cost reduction/process improvement. The first half of the year saw an expansion of financial process automation to cut costs, manage remittances effectively and address continuing supply chain management/payables changes.
Requirements for value realization
Unlocking transformative value from technology deployment is increasingly understood as carrying several critical success factors:
Wide deployment and use throughout the organization. Application Programming Interfaces (API) to facilitate integration of various information systems are important for broad adoption.
Interdisciplinary teams to drive projects. The goal is faster product development that more closely maps to desired business outcomes.
Building Trust
The Trends Report noted the challenges and benefits of building trusted relationships with patients, employees and other vital constituencies. Trust yields practical returns.
Consumers “crave a trusted partnership” with healthcare providers.[19] Analysts believe that their reservoir of community trust enhances most providers’ partnership attractiveness to retail health corporations.
One key component of organizational trust is cybersecurity. Cyberattacks have not diminished in 2023. A federal report noted that “ransomware attacks, data breaches — and often both together — continued to be prevalent in attacks against the health sector” in the first quarter of the year.[20] Investment in cyber-defense is growing at 15% annually, while rising insurance premiums are adding financial burden.[21]
Conclusion
The Trends Report themes are not only still in force at mid-year, but many are also intensifying. Multiple crosscurrents span financial management, patient financial experience, digital transformation, and trust-building. Staying the course on driving change is imperative to meet today’s demands and usher in new levels of success for healthcare. To read the full report from CommerceHealthcare®, please click here.
CommerceHealthcare® solutions are provided by Commerce Bank.
1. Kaufman Hall, National Hospital Flash Report, June 2023.
[2]. Advisory Board, “10 Takeaways from our Cost Management Intensive,” March 17, 2023.
[3]. BDO, Healthcare’s Challenging Road Ahead: 2023 BDO Healthcare CFO Outlook Survey, February 2023.
[4]. Penn State Health News, “Penn State Health Enhancing Access to Primary Care Through Subscription-based Virtual Service,” June 13, 2023.
[5]. American Hospital Association, “Infographic: Commercial Health Insurance Practices that Delay Care, Increase Costs,” November 2022.
[6]. Crowe, Time for a Commercial Break: Crowe RCA Benchmarking Analysis, May 2023.
[7]. American Hospital Association, “Infographic: Commercial Health Insurance Practices that Delay Care, Increase Costs,” November 2022.
[17]. Definitive Healthcare, Retailers in Healthcare: A Catalyst for Provider Evolution, May 2023.
[18]. Sg2, 2023 Impact of Change Forecast Highlights, June 21, 2023.
[19]. The Harris Poll and American Academy of Physician Associates, The Patient Experience: Perspectives on Today’s Healthcare, May 20, 2023.
[20]. U.S. Department of Health and Human Services Health Sector Cybersecurity Coordination Center, “HC3 Cybersecurity Bulletin,” 2023.
[21]. A. Condon, “Hospitals Must Boost Cybersecurity Investment Despite Other Costs Weighing on Margins,” Becker’s Hospital CFO Report, April 17, 2023.
Unfortunately, refund processes tend to be manual, complex and time-consuming for both providers and patients alike, with traditional paper-based methods no longer matching the needs of consumers.
As the number of patients paying out of pocket for healthcare services grows, refunds are taking on even greater importance. Patients often have multiple provider encounters that involve self-pay. Ensuring those dollars are posted accurately and appropriately is important in the provider's relationship with the patient and in the patient's overall journey and experience.
While many providers attempt to collect balances due upfront to relieve the difficulty and stress of collections post-service, the estimates that are available ahead of service or at the time of service aren't always accurate based on which provider is paid first in the line of claim submissions.
Sue Martin, senior vice president of healthcare specialty services for CommerceHealthcare®, spoke about the burdensome nature of patient refunds.
"People must advocate for themselves," Martin said. "That means keeping up with appropriate insurance payments, as well as tracking where their self-pay dollars are being applied and where they may be entitled to refunds."
The traditional paper-based refund process has significant drawbacks. For providers, paper-based processes are inefficient, take more time and require additional labor. These antiquated processes are even more problematic as providers struggle with labor shortages and narrow margins in today's worsening economic climate.
Paper-based processes also are not ideal for patients, especially in an environment where so many consumers engage in online banking due to the convenience. It can be time-consuming to receive refund checks via the mail, and the traditional bank deposit process takes extra time. In addition, paper checks are prone to getting lost.
"We hear about these challenges on a regular basis from clients," Martin said, however, she offers a silver lining through modern technology. It's now possible to offer greater transparency about refunds to providers, payers and patients. CommerceHealthcare® offers its PreferPay® solution, for example, which is a secure, end-to-end automated refund process that integrates with provider solutions.
PreferPay® supports a variety of payment options including direct debit cards, direct deposit to a bank account and traditional paper checks. Offering multiple refund options is a huge step forward that improves providers' patient satisfaction scores.
"Consumers are looking for the same experience in healthcare as they have with their banking and shopping partners," Martin said. "Today, patients often have to wait for a paper refund check to arrive in the mail from their providers. With PreferPay®, they can get the funds owed to them in as little as 30 minutes."
Manual, paper-based systems commonly require multiple solutions and multiple departments to complete the entire patient refund process. Another major concern is the effort associated with escheatment of unclaimed funds.
Transitioning away from paper processes makes sense, but it's important to work with a trusted partner. "You want all the departments involved in the refund process to experience seamless workflows," Martin said. "CommerceHealthcare® works with providers to implement best practices and ultimately migrate to fully digital patient refund functionality."
A current-state review is a good first step on the transition to electronic patient refunds. Martin recommends tracking the costs surrounding check stock, printing and postage, as well as team member time spent processing the checks and following up, which should shed light on potential for return on investment.
Another best practice is to look for a partner and a solution that will work easily with the organization's treasury and receivables teams. Refunds routinely require processing from both accounts receivable and accounts payable for authorization and issuance of payments. These departments also need a workflow for tracking unclaimed payments.
In addition to processing patient refunds, PreferPay® can also streamline process flows that are critical to a strong employee value proposition.
"We've instituted workflows learned from other industries to drive better employee recruitment, retention and overall employee satisfaction," Martin said.
Automated payments also can be useful in areas like clinical trials and contract workers. "Take the automation and think bigger with it," Martin said. "You'll find it to be a true success."
"Implementing technology and automating refund processes that align with consumer preferences is absolutely a win-win for healthcare providers," Martin said. "Find a financial partner that offers a full suite of end-user and consumer satisfaction choices. If you make patients and your employees happy, you will find good success in the marketplace."
Sue Martin, Senior Vice President of healthcare specialty services for CommerceHealthcare®
CommerceHealthcare® has released its fifth annual Healthcare Finance Trends for 2023 report.
The report includes an in-depth analysis of research combined with practice experience and identifies consideration for the industry given multiple intersecting challenges in the year ahead.
The report’s key insights range across regulatory, financial, technological and supply chain considerations.
The full article is accessible at CommerceHealthcare.com, but one trend that will continue to carry importance for healthcare leaders is the need for a digital transformation.
Digital transformation is fundamental to healthcare’s business and care delivery model changes. IBM’s website succinctly captures the goal, “Digital transformation means adopting digital-first customer, business-partner and employee experiences.” A leading forecaster believes 70% of healthcare organizations will rely on digital-first strategies by 2027.1
Transformation efforts need to accelerate. One study showed that “digital, technology and analytics strategies exist for nearly all organizations, yet only 30% have begun to execute on those plans.”2
One functional segment ramping up digital transformation is finance. According to a recent survey, 94% of CFOs and senior leaders stated that such efforts will be at the forefront of financial operations and strategy for 2023-2024, and 79% described it as an “absolute need” for “commercial stabilization and long-term survival of their healthcare organization.”3
Advanced technology is gaining traction. Many see optimization in combining robotic process automation (RPA), artificial intelligence and machine learning to create “intelligent automation.”4Together these technologies create algorithms to automate decisions that guide “robotic” software to perform financial actions and thereby reduce manual labor.
Getting to digital-first in finance and across the enterprise has several critical success factors. These include sustained commitment, a platform-centric mindset and effective governance.
Commitment
Some assert that few healthcare executives have “created digital strategies that look far enough into the future.”5 Speed of change is also important. Health systems, hospitals, and practices exhibit varying risk appetites and change rates. When asked to self-identify “transformation personas,” a little over half regarded themselves as on the innovative “early mover” end of the spectrum, while the remainder will adapt as technologies prove themselves. Slower organizations will likely need to increase the pace.
Platforms, not point solutions
Implementing enterprise platforms rather than proliferating “point solutions” is obligatory. Organizations must be “prepared to compete in the platform economy as platform-based business models have changed the way we live, work and receive care.”6
There are still too many tools and applications. A survey of top decision-makers at health systems found that 60% use over 50 software solutions just in operations (24% have over 150).6System integration is one answer. Use of application programming interfaces (API) helps this effort substantially. API-first is fast becoming the norm among solution providers, with global API investment expected to nearly triple by 2030.7
Governance
Effective governance is vital to constructing a platform-based transformative model and to ensuring wide user adoption. Healthcare has seen the rise of new senior roles such as Chief Digital Officer and Chief Transformation Officer, positions focusing on initiatives like ownership of technology success at the department level and devising user incentives.
To learn more, access the full 2023 Healthcare Finance Trends Report on CommerceHealthcare.com
CommerceHealthcare® solutions are provided by Commerce Bank.
1. IDC, Futurescape: Worldwide Healthcare Industry 2023.
2. Huron Consulting, Embracing Healthcare’s Digital Transformation.
3. Black Book Market Research, “Black Book Announces 2022 Top Client-Rated Financial Solutions Delivering Digital Transformation and Managing Liquidity,” June 4, 2022.
4. Editor’s Choice, “RPA and the Rise of Intelligent Automation in Healthcare,” Information Age, March 11, 2022.
5. KPMG, 2021 Healthcare CEO Pulse.
6. Accenture, The Health Experience Reimagined.
7. Symplr, From Disparate to Dynamic: Opportunities and Challenges in U.S. Healthcare Operations, November 16, 2022.
8. Vision Research Reports, Healthcare API Market Size, Growth, Trends Report 2022-2030, July 2022.
