A new study has found that emergency room visits and inpatient admissions decrease after ransomware attack.
With the uptick in cyberattacks, the importance of cybersecurity is being reemphasized. However, there’s also the impact to operations—having to divert patients to other facilities for their care until the impacted facility recovers, which can take weeks.
A new JAMA study found that emergency room visits and inpatient admissions decrease after ransomware attack. Considering emergency department and patient discharge data from the state of California between 2014 and 2020 and identifying eight ransomware attacks that disrupted the operations of 15 hospitals, researchers gathered the following:
Beginning with a mean of 740.9 emergency department visits and 182.25 inpatient admissions the week before the attack, there was a decrease of 8.10% and 8.16%, respectively, the following week.
In the second week after the attack, emergency department visits and inpatient admissions increased by 16.21% and 16.62%, respectively.
Decreases returned to preattack levels within eight weeks after the attack.
Nearby facilities unaffected by the attack saw an increase in emergency department visits and inpatient admissions for up to four weeks. The study did not note any significant changes to inpatient admissions at unaffected hospitals during this time.
The scope of the impact of the Change Healthcare ransomware attack has effectively left its mark on the healthcare sector, with some providers still struggling to recover financially.
As leaders look to revenue cycle management solutions to increase efficiency and productivity, cybersecurity needs to be considered in the vetting process for vendors and solutions. Information technology and cybersecurity team members should also have a stake in the decision making process.
“There is a newer wave of IT leaders that grew up from the operational side of business and weren’t just tech people,” Bill Arneson, director of business operational transformation at Moffitt Cancer Center, previously told HealthLeaders.
“I think those are the people that you need, someone that can speak business and IT to bridge those gaps.”
New data is showing an increase in provider compensation for the fourth year in a row.
A new report by the Medical Group Management Association (MGMA) found that the median compensation for primary care physicians, nonsurgical specialists, and surgical specialists increased by 4.44%, 1.81%, and 4.42%, respectively.
Advanced practice providers (APPs) saw a 6.47% increase.
Although providers were able to balance operating costs against inflation, the report noted that these increases are 21% below the Consumer Price Index, which saw a 3.4% increase in 2023.
There were also increases in provider productivity across all specialties and care settings, with an increase in median work relative value units (wRVUs) for APPs, primary care, and surgical specialty physicians at hospital-owned practices.
Independent practices saw higher increases in productivity than hospital owned practices for collections, total encounters, and wRVUs.
Providers throughout the sector are working against inflation and low reimbursement rates to maintain financial stability.
A recent operating margin index report by Kaufman Hall found that despite favorable financial performance in the first quarter of 2024, there was 0.2% drop between February and March. In April, CMS announced its proposed rule for a 2.6% rate increase to Medicare Advantage payments, with providers calling it “inadequate.”
Some providers have found success in supplementing their staff’s efforts with automated solutions to assist with cost containment.
At Grady Health, the system’s billing subsidiary, One Grady, leans heavily into automation to take some of the administrative burden off of staff and increase efficiency throughout its revenue cycle.
“Beyond that, we’re having to be very intentional and strategic about the way in which we handle denials,” Monica Richey, vice president of physician revenue cycle for One Grady, previously told HealthLeaders. “And really dig into how we operationalize our workforce to be able to manage those denials.”
Similarly, OSF Healthcare leans on the automated functions within its EHR platform to streamline processes and enable staff to complete more complex tasks. Prior authorizations were a consistent issue within the system’s revenue cycle, but they’ve seen some improvement having payers utilize their EHR’s payer payment platform to automate the process on their end.
“I’m always promoting that [option] with the payers because it promotes automation and the more we automate with the payers, the less they bother us,” Cathy Beebe, director of ministry managed care, previously told HealthLeaders.
Recent articles highlighting executive’s approach to different revenue cycle challenges.
Ideally, revenue cycle processes should flow seamlessly from one into the other. Realistically, challenges can crop up anywhere from front to back end, so leaders must be vigilant and strategic in their efforts.
Here are some recent articles highlighting an executive’s approach to different revenue cycle challenges.
To remedy the challenges of working with limited staff and resources, Selma Family Medicine Center decided to implement a new practice management system. Seeing how much time and effort it took staff to manage tasks like claims and denials, administrative director Jeff Denney, appreciates the vendor support that manages reporting for coding, billing, and collections.
Since implementing the new system, Selma Family Medicine has seen a reduction in overall denials and days in accounts receivable, along with a 39% increase to their gross collection rate.
Recruiting and retaining staff continues to be a challenge, but Moffitt Cancer Center has found success in actively showing employees just how far they can go in the organization.
“What I encourage our team members to do a lot is not just focus on the next six months, but look out a little bit further,” Lynn Ansley, vice president of revenue cycle management, told HealthLeaders.
Succession planning is ingrained in the company’s culture, with training and growth opportunities extended to employees and regular conversations with leaders to check on progress.
The pandemic made having a robust digital presence a priority for health systems. Ochsner Health rose to the challenge by making their patient portal as user friendly and accessible as possible.
Patients can schedule appointments, communicate with their healthcare team, request prescription refills, and pay their bills through the MyOchsner portal.
With patients security in mind, the system also has controls in place to protect sensitive information, like two-factor authentication.
When it comes to working with payers, OSF Healthcare has seen results through leaning into the efficiencies of its EHR. The system has a number of automated solutions throughout its revenue cycle, they’re strategic in the way they work with payers.
Cathy Beebe, director of ministry managed care, previously told HealthLeaders how the system’s data analytics team will perform queries to learn about the pattern of denials among various payers.
Strategizing for low patient volume and revenue is a must for revenue cycle leaders.
Financial stability is a priority for all health systems as they struggle with inflation and rising operating costs. However, despite an optimistic first quarter, hospitals aren’t completely out of the woods yet.
An operating margin index report by Kaufman Hall showed a 0.2% drop between February and March of this year, with the index dropping to 3.9% from 4.1%.
In addition to a decline in major KPIs in March, the report also found many hospitals experience reduced volume and revenue—which may foreshadow challenges to financial stability to come.
Outpatient services fell by 5% in April, as a result of continuously declining volume. There were also increases in bad debt, charity care, as well as the number of days in accounts receivable.
As patients become responsible for more of their care costs, systems must adapt their financial strategies to accommodate them. This can be done in a number of ways, like offering payment plans, accepting different payment methods, or simply making the payment process as quick and easy as possible.
At Ochsner Health, patients are able to set up payment plans and make payments online through the system’s patient portal. For patients who may not be as tech savvy, or prefer to speak to someone, they’re also able to make payments over the phone.
Leaders are also looking at ways to cut or contain costs to ensure a positive operating margin. Kristin Largent, senior vice president of financial operations for OSF HealthCare, previously told HealthLeaders how the system was able to rebound after struggling with declining operating margins.
Increasing patient volumes towards the decline of the COVID-19 pandemic, reducing agency costs, and renegotiating managed care contracts were all attributed to the system’s success.
Revenue cycle executives are having to revamp their payer strategies.
Claim denials are an evergreen issue within revenue cycle operations and new data shows that working with payers will get harder before it gets easier.
A benchmark report by Kodiak found that the final denial rate on inpatient claims increased by 51% between 2021 and 2023. The report used data from patient financial transactions from over 1,850 hospitals and 250,000 physicians nationwide.
An increase in initial denials for prior authorization and precertification errors was also noted.
“The increase in final inpatient claim denials drained $1.2 billion in revenue that hospitals and health systems rely on to provide care to their communities,” Colleen Hall, senior vice president and revenue cycle leader at Kodiak Solutions said in a statement.
“On top of that, more initial claims denials mean hospitals are spending more money and other resources to appeal these denials, adding to the financial impact of the revenue loss from the final denials.”
In addition to being expensive, the process of appealing denials is also time consuming. Revenue cycle leaders have to be more strategic in how they work with payers, as well as ensuring seamless revenue cycle operations overall.
To help stabilize finances and improve facility workflow, Selma Family Medicine Center invested in a new practice management system. In addition to streamlining the facility’s billing processes, the system has a support team that manages the reporting for coding, billing, and collections.
To help with denials management, OSF HealthCare continuously encourages payers to utilize their EHR’s payer payment platform. In doing so, not only does communication with payers get easier, but the automation allows staff to focus on other tasks.
“Sometimes I have to threaten if they don’t get that module turned on, I will turn off the clinical data exchange because we could force them to have to request paper medical records through a vendor,” Cathy Beebe, director of ministry managed care at OSF, previously told HealthLeaders.
“I hate to be mean, but sometimes we have to do that.”
Hospitals are getting a much-needed hand to address cybersecurity concerns.
The Advanced Research Projects Agency for Health (ARPA-H) announced on Monday the launch of an initative to develop tools that IT teams can add to their cybersecurity efforts. As part of the Universal PatchinG and Remediation for Autonomous Defense (UPGRADE) program, the agency will be investing more than $50 million for the development of tools.
“It’s particularly challenging to model all the complexities of the software systems used in a given health care facility, and this limitation can leave hospitals and clinics uniquely open to ransomware attacks,” Andrew Carney, UPGRADE program manager, said in a statement.
“With UPGRADE, we want to reduce the effort it takes to secure hospital equipment and guarantee that devices are safe and functional so that health care providers can focus on patient care.”
The recent Change Healthcare ransomware attack and Ascension outage have highlighted the fact that the healthcare sector lags behind other sectors in cybersecurity. Such incidents have the capacity to halt the operation of an entire system, including claims submission, payment processing, and even clinical care, resulting in substantial losses for providers and health systems and potential harm to patients.
“A lot of companies may not have a plan, or an updated plan, or may not have communicated it and had it tested,” Joi Lee, manager of cyber governance, risk, and compliance for Moffitt Cancer Center previously told HealthLeaders.
“We’re in the business of treating patients, so a lot of the time, if you don’t have people that are focused on this type of stuff and know its importance, it gets thrown by the wayside. It’s not important until you need it.”
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.”
It will be some time before RCM solutions develop the capabilities to complete tasks like coding with accuracy.
As popular as revenue cycle technology solutions like bots and AI are, there are some tasks that require a certain level of expertise—a level that these solutions have yet to reach.
Denials and prior authorization are a consistent challenge for even the most efficient revenue cycles. With payers growing more and more stubborn with denial appeals, many organizations are looking for solutions capable of completing complex tasks involving coding and documentation.
HealthLeaders previously looked at the results of a study examining the accuracy of large language models (LLMs), state of the art artificial intelligence systems, when used for medical coding. The results showed that LLMs have not yet reached the point where organizations can utilize them for a task like coding. However, there are ways to leverage it alongside the efforts of revenue cycle staff.
Automated solutions are best utilized to complete repetitive, more administrative tasks, which enables staff to dedicate attention to more complex tasks. This can also present an opportunity to staff to upskill and expand their revenue cycle knowledge, such as becoming a certified medical coder.
Sherri Lewis, director of revenue cycle for Boulder Centre for Orthopedics, recently told HealthLeaders about how she’s able to get her staff on board with implementing rev tech into their processes.
“It’s [important] to show them the value [of the technology], get their buy in, and have them realize how it affects the whole practice,” she said.
Lewis is one executive looking forward to the ways AI and other rev tech solutions evolve over time, but believes that a human touch will always be needed.
“If I had an AI company [do our] coding, would they pull the right strings? Would they not transpose numbers?” she asked.
“Would they do it so great that we would all lose the ability to code after a while and just trust that they’re doing the right thing?”
As organizations add solutions to their processes, it's important that staff be onboard.
There are many things to consider when making the decision to invest in a revenue cycle management solution: the organization’s finances, what processes the solution will be applied to, and staff response. Getting revenue cycle staff to buy-in to the implementation of new technology can ensure a seamless rollout and increased productivity in the future.
Here are three tips to gain staff support for a rev tech rollout.
