Live from #HIMSS17: The patient-centered revenue cycle

Nurse with tablet

Among the pre-conference sessions offered at #HIMSS17, the Revenue Cycle Solutions Summit challenged its attendees to #rethinkRCM. Truth be told, rethinking revenue cycle management isn’t so much a challenge as it is a necessity.

As one of the speakers noted, unless your healthcare organization wants to go the way of Blackberry or Blockbuster, it simply must address revenue cycle management innovation to evolve.

Chase the cheese

Spencer Johnson’s book, Who moved my cheese? features two mice, Sniff and Scurry, and two mouse-sized people, Hem and Haw, who – spoiler alert for those who haven’t read the 1998 change management fable – serve as a lesson for what happens to those who resist change.

Resisting change isn’t an option for those tasked with healthcare revenue cycle management. The financial complexity of managing an organization’s revenue cycle is significant. Navigating that complexity to ensure fair, efficient reimbursement is critical to keeping ones doors open, but it’s no easy task.

Payers continue to innovate. First, indemnities. Then, PPOs, HMOs and now HDHPs. In order to secure reimbursement ASAP (see what I did there?), healthcare organizations have to be agile and responsive – like Sniff and Scurry.

Spare the sticker shock

While payers have been busy moving your cheese, patient demand for more information about care and its corresponding cost has increased significantly over the past five years. Blame it on “consumerism” or those high-deductible health plans, but an increasing number of people want to know: what’s in-network, what’s out-of-network, what’s covered, what’s not covered and just exactly what they’ll owe before receiving care.

It makes sense, right?

But, this much estimating and this much explaining seems to be very new – at least to the extent that it’s happening now. Maybe the plans are more confusing. Maybe patients just stopped reading them.

Either way, it’s now on you to provide that information through a secure patient portal. But with so much variation in eligibility and coverage, even determining a co-pay amount isn’t easy. I mean, are we talking about seeing a primary care physician or a specialist? At the specialist, did the patient see a physician or a nurse practitioner?

All of those variables impact the answer.

There’s also a desire to anticipate costs across the continuum of care. For example, did you know before your heart surgery that it would be $1,000 to remote into that device every month and another $40 for your cardiologist to read the results? Sure, it’s not going to make you rethink having this life-saving procedure, but, it’s nice to know that kind of information going in.

For the patient who finds out afterwards, it’s too late – it’s already negatively impacted his or her patient experience. Moreover, it may have tripped that pacemaker.

Increase information access

There isn’t one solution that manages the revenue cycle – in fact, you likely have several systems in place just for the pre-encounter phase. There also isn’t just one department involved in preparing all of the information needed to not only generate a bill but collect on it.

Managing the revenue cycle is an enterprise challenge. It requires an enterprise solution.

By integrating your healthcare organization’s core systems with a single solution, you’re empowered with a centralized, secure, electronic repository for patient information for authorized staff at every single touch-point, ensuring that information is accurate and up-to-date. Now, make that solution one that also offers native business process management tools and you’ll be able to take advantage of workflow management and automated routing that will streamline processes and help reduce those information silos.

Your organization will have a more complete picture of a patient’s care and financial profile to deliver more consistent, standardized communication, resulting in better patient experiences. It’ll also make the cheese a bit easier to find.

Julie Fogel joined Hyland in 2011. A member of the content marketing team, this SCUBA-diving, rock-n-rolling, baseball-loving storyteller currently covers healthcare. She also frequently appears in or provides voice talent for Hyland-produced videos.
Julie Fogel

Julie Fogel

Julie Fogel joined Hyland in 2011. A member of the content marketing team, this SCUBA-diving, rock-n-rolling, baseball-loving storyteller currently covers healthcare. She also frequently appears in or provides voice talent... read more about: Julie Fogel