Executive Summary

The Revenue Cycle Management Task Force of the Heathcare Information and Management Systems Society is addressing the next generation of revenue cycle management processes and tools. Payers, providers, vendors, and consultants are involved.

• Front-end processes such as patient access, business analytics, and point-of-service collections are a key focus.

• Patient access will need new technology or updated legacy systems.

• Patients will be able to manage their care with a single portal.

 

When payers, providers, revenue cycle vendors, consultants, and financial institutions met to discuss the next generation of revenue cycle management processes and tools, there was a surprising amount of agreement.

“It was very encouraging to see how quickly the participants coalesced around what the future of revenue cycle management should look like,” reports Pam Jodock, senior director of health business solutions for the Heathcare Information and Management Systems Society (HIMSS). The HIMSS’ Revenue Cycle Management Task Force is a multi-year project that’s addressing coming changes in the revenue cycle.

“We are looking at what we believe the patient financial experience of the future should be,” says Jodock. “The center of that vision is what we are referring to as a healthcare information hub, for lack of a better term at the moment.”

This vision assumes that electronic health information will be freely exchanged between all parties. Individuals would be able to research their benefits, determine the eligible providers, schedule appointments, and address all their financial concerns upfront.

“At the end of their first visit, they would have the opportunity to sit with someone to determine the next step of their care, schedule it, and also make payment arrangements,” says Jodock.

Front-end processes — patient access, business analytics, and point-of-service collections — are a key focus for the task force. Zubair Ansari, MHA, director of patient financial services at Johns Hopkins Medicine International in Baltimore, MD, says, “With an increasing shift from a traditional managed care population to newer economies of scale where consumers are more price-sensitive and utilizing real-time tools and technology, it is imperative we engage patient access leaders throughout the country.”

Here are three key issues identified by the group:

• Updated technology is needed.

Jodock says, “It may be a matter of introducing new technology, or improving on legacy systems if that’s cost-prohibitive.”

• Data security is a major challenge.

Today, information is not shared openly between payers, financial institutions, and providers. “Building those systems in a way that allows timely exchange of data, while at the same time protecting an individual’s personal health information, is going to take time and a lot of cooperation,” says Jodock.

• There is a paradigm shift in healthcare toward a more “consumer-centric” focus.

“It’s not just about the business needs of a particular stakeholder group,” says Jodock. “At the end of the day, we all have the same customers, and we are all interested in patient satisfaction.”

One-stop shopping

John Showalter, MD, chief health information officer at The University of Mississippi Medical Center in Jackson, says the patient-centric vision developed by the task force will “empower patients to make better and more informed healthcare decisions, while increasing convenience and streamlining payment for healthcare services.”

The goal is for individuals to access all of their financial and health information on one site, without having to toggle between insurance carrier, provider, and financial institution websites as they do currently. Jodock says, “This information hub would facilitate the communication between the various parties and give the patient a one-stop shopping experience.”

Patients search multiple portals to get information in bits and pieces. In some cases, information isn’t available at all to the patient. “The intent is to develop a revenue cycle management process that supports all players equally,” says Jodock. “It must focus on cost containment, quality improvement, and be consumer-centric.”

It is much harder for patients to access information than it is for providers or payers. The task force wants to change that level of difficulty.

“It shouldn’t be harder for me, as a patient, to access information and participate in the revenue cycle,” says Jodock.

Fee-for-service payment methodology is one reason it’s so complicated to tell patients what their care will cost. Because providers are paid on a piecemeal basis, it’s impossible for the payer to predict what the total episode of care is going to cost.

“But if reimbursement is more focused on quality of care and outcomes — with medical homes and bundled payments, for example — it changes the way the insurer pays for care,” says Jodock. “It makes it easier to anticipate the patient’s responsibility.”

 

SOURCES

Zubair Ansari, MHA, Director of Patient Financial Services, Johns Hopkins Medicine International, Baltimore, MD. Phone: (410) 464-6455. Email: zansari1@jhmi.edu.

Pam Jodock, Senior Director, Health Business Solutions, Heathcare Information and Management Systems Society, Chicago. Email: pjodock@himss.org.

John Showalter, MD, Chief Health Information Officer, The University of Mississippi Medical Center, Jackson. Email: JShowalter@umc.edu.