Cost and Transparency Top Issues Facing Revenue Cycle
Cost and transparency are the leading challenges in healthcare today, according to a recent survey conducted by the HealthCare Executive Group (HCEG).
More than 100 C-suite and director-level executives ranked their biggest challenges. (http://bit.ly/2JIexhv) “We’ve talked about costs for decades, and it just keeps growing. But today we can really address costs,” says Ferris W. Taylor, executive director of HCEG.
The switch from fee-for-service to value-based reimbursement is underway. But like many changes in healthcare, it is happening slowly. “We need to do more,” Taylor says. “And if we don’t, then outside forces are going to be imposed on the stakeholders in healthcare.”
Surprise billing is one obvious example. It is a hot topic, both in the political world and in the regulatory environment. “Do we want the government to dictate what we do? Or, should we come together as an industry to figure out what we should be doing?” Taylor asks.
The question is really whether healthcare is able to change itself quickly enough. “Or, will the system be replaced in a way that may not be advantageous to consumers, providers, or insurers?” Taylor asks.
Registration, scheduling, and billing processes are not always patient-friendly. Revenue cycle professionals sometimes forget they are also healthcare consumers. Waiting 45 minutes for a three-minute doctor’s appointment is just one example, Taylor offers. “It doesn’t fit into the consumer’s life flow at all,” he adds.
The United States spends more than any other country on healthcare. “Yet the results we have are really not enviable,” Taylor observes. “How much of that is because we haven’t put on the consumer’s hat?”
Outdated data and analytics are another obstacle. Many hospitals still use legacy systems that are not fully integrated. “We do not have common agreement around what data elements actually mean,” Taylor notes.
Not too long ago, all the information that allowed providers to personalize healthcare was contained in a wall of paper folders. “We couldn’t even consider how to change healthcare when everything was in those folders,” Taylor recalls.
The fact that all this information is now available electronically makes big improvements possible for the revenue cycle — if the data are analyzed correctly. Recently, HCEG executives noticed something was amiss with data on healthcare plans. “It did not logically make sense,” Taylor says. The problem involved a field labelled “member enrollment,” which referred to the date the member first enrolled in the health plan.
It turned out that every time a member changed from one benefit design to another, the enrollment date changed. This made it look like members had enrolled in the health plan more recently than they actually had. “We lost the data we wanted to use because it had been overridden by something new,” Taylor explains.
This kind of frustrating situation carries big implications for the revenue cycle. “If we don’t agree on mutually beneficial outcome measures, we are not going to improve the healthcare system,” Taylor warns.
Will healthcare be able to change itself quickly enough, or will outside forces change the system in a way that may not be advantageous to consumers, providers, or insurers?
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