It has become one of healthcare’s truisms — the industry has lagged the consumer economy in terms of adopting new technologies and processes to deliver a more convenient and transparent customer experience. However, as patients have taken on more financial responsibility for their medical bills, they’ve brought their expectations of convenience and transparency with them. It boils down to a straightforward challenge for hospitals: become more consumer-centric or get left behind.
The world of healthcare operations — medical coding specifically — has become so complex that leveraging emerging technologies to automate and streamline processes is now essential.
In recent years, hospitals and health systems have worked to make the patient experience more convenient, offering tools that allow patients to register for appointments online or engage with their clinicians remotely. However, even providers deeply committed to improving patient satisfaction have struggled to include one crucial component of a more consumer friendly experience — price transparency.
In a survey of more than 425 representatives from 200 hospitals and health systems conducted by Kaufman Hall in 2018, just 17 percent of those surveyed said their organizations “provide clinicians and staff with tools to answer patient questions about price.”
The key to delivering true price transparency lies in the mid-revenue cycle, which is comprised of clinical documentation, case management, charge processing and coding. By streamlining and improving the accuracy of the data captured in and disseminated from the mid-revenue cycle, finance teams can deliver more accurate estimates regarding the cost of care to patients.
Knowing the industry’s past shortcomings, forward-thinking hospitals and health system leaders looking to meet patients’ expectations are increasingly investing in mid-revenue cycle management. In 2018, the mid-revenue cycle management and clinical documentation improvement market was worth about $3.1 billion and by 2023, the market is expected to reach $4.5 billion, according to a 2019 report from Research and Markets.
Becker’s recently spoke with Conifer Health Solutions’ Scott Rowe, vice president and CIO, and Debby Cornett, vice president of clinical revenue integrity, about why optimizing mid-revenue cycle management should be a point of emphasis for providers working to thrive in a more consumer-centric market.
Consumerism, the patient experience and the mid-revenue cycle
The patient experience begins upon the first interaction between an individual seeking care and a hospital staff member, whether that is over the phone, via text or in person. While it’s important to ensure staff are personable and effective communicators, these initial interactions are largely only as good as the data that informs them.
“Oftentimes the quality of the message that’s being delivered, or the root cause for an error that occurs down the line, can be because the information captured in the mid-revenue cycle wasn’t accurate,” Mr. Rowe said. “If you don’t have good charge information in in the mid-cycle, your estimates will be bad upfront.”
According to Ms. Cornett, the mid-revenue cycle directly impacts the experience patients have on both the front-end and back-end of their interactions with providers and staff.
It’s not uncommon for leaders at organizations with limited resources to overlook the mid-revenue cycle when, in reality, it is an area of operations where technological upgrades and refined processes can yield substantial benefits.
“High quality patient service starts in the midpoint of the revenue cycle with an accurate charge description master,” Ms. Cornett said. “The next critical component lies with timely and complete documentation, in order to accurately reflect the services rendered and the care given with the coding.”
An optimized mid-revenue cycle is built to precisely extract data that can be swiftly audited as needed. These processes need to be supported by technology that allows staff to quickly examine data to confirm both revenue integrity on the back-end of the revenue cycle and price transparency on the front-end.
“If we haven’t made sure there’s real-time updates from the charge description master going to the front-end of the revenue cycle, then the price estimates for patients will not be consistent,” Ms. Cornett said. If the data is not accurate and delivered in real-time to back-end staff, patients can receive multiple bills because additions or revisions must be made to charges or coding on the claim.
Patients are now empowered with more information about clinical care quality and cost than ever before. In an environment where reimbursements are declining and patient payments make up a larger share of hospital revenue, providers in competitive markets can’t afford to botch the billing experience.
Invest and optimize
One of the biggest barriers to a high-performing mid-revenue cycle is underinvestment in technology. Leaders of hospitals and health systems are increasingly asked to do more with less. It’s not uncommon for leaders at organizations with limited resources to overlook the mid-revenue cycle when, in reality, it is an area of operations where technological upgrades and refined processes can yield substantial benefits. The fiscal challenges facing hospitals and health systems are varied and complex — executives need to equip their teams with technology that can simplify and streamline wherever possible.
It boils down to a straightforward challenge for hospitals: become more consumer-centric or get left behind.
However, equipping teams with the right technology is not enough; staff must be empowered to use the technology at the highest level. The failure to optimize technology can be another barrier to creating more accurate and efficient mid-revenue cycle. Ms. Cornett said she often encounters organizations that have powerful tools in place, but the tools haven’t been properly calibrated for optimal performance.
“Health systems have to start assessing the utilization of their current technology,” Ms. Cornett said. “Organizations may have access to other components that can help streamline mid-revenue cycle, but they are not using them.”
In Mr. Rowe’s view, the world of healthcare operations — medical coding specifically — has become so complex that leveraging emerging technologies to automate and streamline processes is now essential.
“The new game in healthcare is consumerism and improving quality,” Mr. Rowe said. “And you really can’t play the new game without leveraging technology.”