Audits can identify security risks and vulnerabilities.
While some organizations are still recovering from the effects of the Change Healthcare cyberattack, others are working to develop a robust cybersecurity infrastructure.
As these attacks become more sophisticated and the extent of their damage grows, organizations must be vigilant when it comes to patient data and information.
When conducting cybersecurity audits, the HHS Office of Inspector General (OIG) uses their findings to provide recommendations to help strengthen the subject’s security. For example, in a recent audit of the office’s Administration for Children and Families division, OIG found that data hosted in certain systems were at a high risk of compromise due to the following:
Cloud computing assets weren’t identified and inventoried accurately.
While there were some security controls in place, several others weren’t implemented in accordance with federal requirements/guidelines.
ACF didn’t perform adequate cloud and web application technical testing techniques against its systems.
In addition to reviewing ACF’s cloud computing assets, OIG looked at the configuration of the division’s scanners, performed internal, external, and web application penetration tests, and even conducted two simulated phishing campaigns.
“We made a series of recommendations to ACF to improve its security controls over cloud information systems, including that it update and maintains a complete and accurate inventory,” OIG said in a statement on the audit.
Other recommendations included getting security controls up to federal standards and using cloud security assessment tools to identify misconfigurations and weak cybersecurity controls in its cloud infrastructure.
Some organizations use multiple vendors for things like electronic health records, remote patient monitoring, and even to complete revenue cycle processes. Cloud computing assets can store vendor software and data but, as the OIG’s audit showed, lax security controls can increase their risk of being compromised.
Adam Zoller, chief information officer at Providence Health, previously explained the challenge of aligning healthcare’s cybersecurity standards with vendors.
“As a large hospital system, we are relying on hundreds of third parties,” he said. “And when some of those devices are 100% vendor-managed, they often won’t modify anything.”
As leaders adapt their strategies to fit the changing healthcare economy, certain pain points are prioritized over others. Surveying 115 executives within revenue cycle, finance, IT, and operations, a recent Sage Growth Partners report found that executives are prioritizing the following for their organizations:
RCM solutions can help staff work smarter—more efficiently—and not harder.
A common misconception around RCM solutions is they're going to replace staff, when in reality, they're meant to make their jobs easier. Philip Boyce (senior vice president and chief revenue officer, Baptist Health System) explains the importance of transparency and listening staff concerns.
70% of surveyed leaders and executives cited strong leadership as an important contribution to revenue cycle success.
In a market report by Sage Growth Partners, 115 executives within revenue cycle, finance, IT, and operations were surveyed on important factors that contribute to the success of an organization's revenue cycle. The respondents' answers reflected the following, in order of importance:
Transparent communication about the implementation of an RCM solution can prevent challenges down the road.
Anissa Fabrizio (Assistant Vice President of HIM CDI Encoding, Common Spirit Health) explains her system's approach to informing revenue cycle staff about plans to implement RCM solutions, while being mindful of their questions and concerns.
Refining operational processes was one way organizations saw improvements in their revenue cycle.
Financial stability is front of mind for most of the healthcare sector, with revenue cycle management noted as a priority by 59% of leaders, according to a recent report by Sage Growth Partners.
The firm surveyed 115 C-suite executives, revenue cycle executives, and executives from other finance, IT, and operations roles. Of these respondents, 43% said their organization’s revenue cycle has improved since 2019, citing the following for their success: operational process improvements, technology advancement, and investing in workforce.
Here are three HealthLeaders stories featuring organizations that have utilized these strategies and also seen results.
Operational process improvements
When Ravi Patel, former vice president of digital health for Ann & Robert H. Lurie Children’s Hospital, first joined the hospital staff, only 27% of patients were utilizing the patient portal. Seeing the potential to improve patient engagement and satisfaction, he launched the Every Patient, Every Time initiative, where staff offer patient portal access and assistance during each interaction.
“What we found was just purely telling them about it…was enough to get them activated,” Patel previously told HealthLeaders. “So we started to see a steep increase with performance management.”
In addition to boosting patient portal utilization up to 83%, the hospital also saw shorter waiting and call handling times.
Technology advancement
At Nicklaus Children’s Hospital, vice president and CFO Ariana Urquia saw that efficiencies in prior authorization, claims, and coding processes were costing the hospital money. To streamline workflows, the hospital partnered with a revenue cycle management company to implement solutions in its billing and collection processes.
“We use tools to help prioritize which patient accounts we should be looking at,” Urquia previously told HealthLeaders. “Based on the documentation that exists in the medical record at a point in time and other parameters to say, ‘Hey, you may want to take a look at this account.’”
Investing in workforce
Revenue cycle executives’ interest in AI and automated solutions hasn’t slowed down, with many organizations pacing their digital growth and looking to their staff for suggestions and insight.
During HealthLeaders’ Revenue Cycle Exchange in February, Cassi Birnbaum, administrative director of hospital and professional coding for Stanford Health Care, highlighted the efforts of revenue cycle team members during the system’s recent technological expansion.
Despite the misconception that RCM solutions will replace staff, staff are positioned to gain the most from digital expansion. For example, by implementing solutions to complete more redundant administrative tasks, staff are able to complete more complex tasks.
The system began managing the hospital's daily operations in February 2023.
El Centro Regional Medical Center, an affiliate of UC San Diego Health, began efforts to stabilize its finances in February 2023. As part of the stabilization, UC San Diego began overseeing the hospital’s daily operations, as well as clinical and financial management.
A little over a year later, the facility is seeing results. The third quarter saw net operating income increase to $7.2 million, as well as a year-over-year gain of $16.9 million.
These gains can be attributed to improvements in the hospital’s contract management process, which have enabled it to negotiate favorable contract terms and efforts to ensure timely reimbursements for care.
“I am extremely proud of the results we have achieved and amazing progress we have made in a short period of time,” David Momberg, the hospital’s CFO, said in a statement. “Including turning around our net operating loss into profitability in a single year, achieving our first profitable quarter in over three years in Q3, as well as numerous gains on the operational front.”
Similarly, Selma Family Medicine Center in Alabama struggled to maintain financial stability when issues with staffing and limited resources began to negatively affect the facility. Looking to the revenue cycle, the facility’s administrative director, Jeff Denney, decided to invest in a new practice management system to increase efficiency with their billing processes.
By outsourcing, Selma Family Medicine saw a reduction in overall denials and days in accounts receivable, as well as a 39% increase in gross collections.
OSF Health also leaned into technology to strengthen the system’s revenue cycle—specifically the automated features of its EHR. Getting payers to utilize the EHR’s payer payment platform and automate prior authorizations enables staff to focus on more complex tasks.
“We have weekly underpayment reports and if we suspect that a payer has their rates loaded wrong, we’ll reach out to them,” Cathy Beebe, OSF director of ministry managed care, previously told HealthLeaders.
Whenever there are changes to Medicaid reimbursement rates, the system works with each payer’s Medicaid configuration teams to ensure make sure that rates loaded correctly.
Philip Boyce explains how his system implements financially oriented revenue cycle management solutions into its operations.
Health systems look to revenue cycle management solutions to help streamline processes and increase efficiency. During the recent virtual RevTech NOW Summit, Philip Boyce, senior vice president and chief revenue officer for Baptist Health System, offered his own insights, discussing his own efforts.
Left unchecked, these challenges may continue to negatively impact finances and quality of care.
The changing healthcare economy has hospitals and systems struggling to maintain financial stability with narrow profit margins.
A new report from AHA details the shaky state of the sector’s finances, attributing it to different factors including low reimbursement, inflation, and labor costs.
Reimbursements and investments
Payer reimbursements not covering the cost of care have been a longstanding issue and a growing aging population is putting pressure on Medicare and Medicaid. According to the report, Medicare and Medicaid underpayments for inpatient services totaled over $130 billion in 2022, with Medicare paying 82 cents per dollar that hospitals paid.
Hospital finances also take a hit from administrative expenses, mainly, as the report notes, due to practices by commercial health payers, as well as Medicare. The time staff spend appealing claims and sorting through prior authorization requirements takes away from more important tasks.
Additionally, there have also been substantial investments, with many systems prioritizing digital expansion, strengthening digital infrastructure, and cybersecurity.
Drug shortage and supplies inflation
The ongoing drug shortage, along with increasing costs, has added 20% to hospitals budgets. Per the report, 2023 had the most drug shortages in over a decade, with an average of 301 drugs in shortage each quarter.
Expenses for hospital supplies strained budgets further—about 10.5% of a hospital’s budget—with many supplies being difficult to secure due to supply chain issues.
Labor
Labor costs account for over 60% of an average hospital’s expenses, with costs increasing from $42.5 billion to $839 billion between 2021 and 2023. The report does note, however, that labor costs fluctuate based on the demand for care services and supply of talent.
The report attributes high turnover rates, along with the number of healthcare professionals leaving the field altogether, to burnout among clinicians. This may cause labor costs to continue to rise, if left unaddressed.
OSF Health saw its share of workforce disruption in 2022, with the system's operating margin falling to -3% the same year. To supplement the work of their staff, the system leaned on revenue cycle technology.
"We use many vendors as extensions of revenue cycle to assist with some of the niche billing requirements," Rene Woerner-Utley, vice president of patient accounts, previously told HealthLeaders.
"These include, but are not limited to, vendors for workers [compensation] and third-party liability billing, second level clinical denials, low dollar account collection, and coordinattion of benefits collection, to name a few."
The partnership, announced in April, hopes to improve the accuracy of medical coding for cancer care.
Healthcare continues to embrace technology in different areas and artificial intelligence is finding its second wind in cancer care.
In April, Moffitt Cancer Center announced its partnership with NVIDIA, Oracle, and Deloitte to use AI and machine learning technology to address operational challenges—particularly regarding medical coding for cancer and comorbidity.
The goal of the initiative is to improve the accuracy of clinical documentation for conditions besides cancer that could affect the care a patient receives. Findings will be used to improve clinical quality and help automate medical coding for cancer care.
“This collaboration represents a significant step forward in our mission to provide our patients with the highest quality cancer care,” Dana Rollison, vice president, chief data officer, and associate center director of data at Moffitt, said in a statement.
“By leveraging artificial intelligence and machine learning technologies, we can unlock new insights, streamline workflows, and ultimately improve patient outcomes.”
Previously, HealthLeaders examined the results of a study from the Icahn School of Medicine at Mount Sinai on the accuracy of large language models when used for medical coding. Each of the three models evaluated for the study showed limited accuracy in reproducing the initial medical codes.
“Our findings underscore the critical need for rigorous evaluation and refinement before deploying AI technologies in sensitive operational areas like medical coding,” Ali Soroush, MD, MS, assistant professor of data-driven and digital medicine at Ichan Mount Sinai, said in a statement.
The findings from Moffitt’s initiative will also be implemented in the organization’s overall AI/machine learning strategy, with emphasis on improving clinical documentation and coding accuracy, using data quality analysis to enhance governance, and optimizing the revenue cycle by reducing claim denials.
Moffitt Cancer Center will be participating in our upcoming Mastermind program centered around revenue cycle and finance AI. The HealthLeaders Mastermind program acts as an advisory board, bringing together the best and most successful health systems in revenue cycle/finance AI. For questions about joining, contact Content Director Amanda Norris at anorris@healthleadersmedia.com.
