Jan. 17, 2016 — Traditionally, most health systems have viewed the revenue cycle as a cost center, evaluating success based on the ability to minimize costs. That approach may limit technology investments and staff that can make a financial impact on revenue cycle functions.
“Healthcare executives, especially finance executives, really need to start thinking about the revenue cycle as a strategic business unit, much in the same way as we think of a facility or a service line as a business unit,” said Jeff Hurst, SVP of Finance, Florida Hospital. “If you begin to view your revenue cycle as an asset versus overhead, you begin to make strategic investments in that asset and you begin to develop and grow that asset.”
Hurst cites two reasons for this new approach:
• Revenue collection is more complex because patients’ out-of-pocket responsibilities have increased.
• Per-episode payments are expected to decrease with the move to value-based payments.
That means that health systems can no longer tolerate inappropriate insurance denials, high levels of bad debt, and failure to find a payer source for uninsured patients who qualify for Medicaid or other coverage.
“You have to fundamentally look at the areas where you are rightfully entitled to payments and identify where there is leakage,” Hurst says. “Then you have to think through where you need to make investments to put mechanisms and processes in place to capture that leakage.”
Shifting toward consumer-centric care
Collecting money from patients requires “customer-centric” front-line employees who can engage consumers effectively.
“If you don’t understand something, you don’t engage with it,” Hurst says. “We must create that level of trust that breaks down barriers so patients can really understand the complexities and the nuances of healthcare bills. That takes a particular type of individual.”
Admissions staff members at Florida Hospital engage patients during pre-service to review all aspects of their financial obligation, including what they will owe as balance-after insurance, or patient pay.
“Healthcare financial literacy continues to be an issue,” says Hurst. “Many patients don’t understand the terminology and often are surprised to learn they must pay for a portion of their care. The ClearBalance® program is a great incentive to help patients pay their bill vs. allowing their financial responsibility to flow to bad debt. No one wins in that scenario. Neither our patients nor our organization are well-served.”
Florida Hospital also is proactive in the community, connecting with business leaders, employers and payers to ensure they understand the health system’s value proposition, clinically and financially. The goal is to remain the preferred destination for healthcare services throughout Orlando and Central Florida, Hurst explains, adding that the ClearBalance program is integral to demonstrating consumer value.