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Increasing Revenue Through Clinical Connectivity

As most of you know, I’ve been working hard to create more content related to revenue in healthcare. My interest in this has grown even more since I had the chance to attend the ANI 2012 conference in Las Vegas where I got the chance to talk to people like Rishi Saurabh from GE Healthcare. It’s amazing how many people (myself included) don’t think that revenue cycle management is sexy since there are so many opportunities in healthcare.

One example of missed healthcare revenue management opportunities has to do with connecting clinical content with the financial data. From my experience, it’s quite rare to see a healthcare institution that does a great job of connecting these two pieces of data. The clinical data is in a silo of its own and it’s only looked at by the clinical people. The financial data is in its own financial data silo and only ever looked at by the financial people.

These silos are a problem and present a really big opportunity for healthcare organizations to increase the revenue of their organization. Although, doing so in an organization is not always easy. It takes great leadership to bridge the two content silos. Plus, you need someone who’s effective at understanding both the clinical and financial point of view. So, it’s not hard to understand why this doesn’t happen more often.

I think the most basic example of what I’m talking about can be seen in the annual checkup. I was talking with a colleague the other day when I told him that I couldn’t remember the last time that I’d been to my doctor. In fact, I honestly don’t even know my doctor’s name (which might beg the question of whether he’s really MY doctor). Why hasn’t my doctor sent me a reminder about the need to do an annual physical exam? Why don’t I have a regular connection with my doctor that helps me to take better care of my health?

I think at least part of the answer to this is that the clinical is not tied to the financial. If the clinical were tied to the financial, then the doctor could provide a care plan for me and my specific health needs. Then, the financial could ensure that I’m following that care plan. Imagine the revenue implications of me visiting the doctor regularly as part of a well defined care plan.

I’m sure that many of you out there are likely skeptical about whether patient reminders will actually change behavior. Certainly in many cases, these reminders will be discarded or ignored. However, a certain percentage of those reminders will be followed. This will mean your patients get better care and your clinic increases their revenue. Plus, maybe we need to take a deeper look at the care plans that we offer patients. If large percentages are ignoring the suggestions, then maybe we need to rethink the plan or how we’re communicating that plan to the patient.

There are certainly plenty of other medical examples where a follow up doctor visit would make sense and improve the health of your patients. In fact, you could get really sophisticated with how you reach out to your patient population.

I believe the key to success of this type of program is to integrate the clinical data with the financial data. It creates tremendous power and amazing opportunities.

August 27, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Revenue Cycle Management Interview with Rishi Saurabh – GE Healthcare

As most of you know, I had the chance to attend the ANI 2012 conference in Las Vegas that’s put on by HFMA. This conference is a hospital CFO’s home since all of the major players in the healthcare financial management space were in attendance. Around every corner was another Hospital CFO it seemed.

While at the conference, I was able to corner the Global Product Marketing Manager at GE Healthcare, Rishi Saurabh, for a short video interview about revenue cycle management. In the video Rishi provides his insights into the biggest challenges facing hospitals today and also provides some insight into how GE plans to approach these challenges. I hope you enjoy the video:

July 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Is Revenue Cycle Management Getting Transgressed with Meaningful Use Stealing the Focus?

This is the next in a series of posts I’ve been doing focused on Revenue Cycle Management (RCM). It’s been a fun series to do as I’ve explored more of the details of RCM and learned a lot along the way. Although, as is usually the case, the more that I learn the more I realize I still need to learn. I will be attending ANI in Las Vegas later this month, so I’m sure I’ll have plenty more RCM related topics to write about after that event.

This post was inspired by a comment Madelyn made on my Is Revenue Cycle Management Sexy? post:

You’re making a really important point with this story and it’s a topic we’ve discussed at length in my company. The availability of incentive funds is causing so much thought and energy to be focused on EHRs, but if a practice or hospital’s RCM is a mess, they’re losing far more money than the Meaningful Use dollars could ever reimburse them for.

What an extremely important question! I’m afraid far too many clinics are falling into this trap.

Each day I’m amazed a little bit more on the far reaching impacts of meaningful use on healthcare and EHR. There’s been amazing array of unintended consequences that are associated with meaningful use and the EHR incentive money and most of them aren’t good consequences. Sure, there are also some really great benefits to the government EHR stimulus money, but my fear is that they benefits won’t outweigh the negative consequences and the taxpayers will be out a cool $36+ billion.

Why do so many practices and physicians become so irrational when they hear about “free” government money for EHR? This I don’t have an answer to, but I hope by pointing it out more doctors will take a step back and do what’s right for their clinic. I’d expect in most cases this will involve EHR and technology, but Madelyn makes a really important point:

If your RCM is a mess, you could lose far more money than you gain from meaningful use.

June 7, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Increase in Patient Self Pay Increases Collection Risks

There is a major trend that is happening in healthcare that is going to impact the economics of healthcare in a major way. This trend is the increase in Patient Self pay. There are a number of factors which are causing more patients to pay for their medical expense including lost jobs and employers dropping health insurance coverage. I’ve heard a number of people predicting the move to a patient focused payment model with high-deductible insurance plans. In fact, this New York Times article says “The share of employees enrolled in high-deductible plans surged to 13 percent in 2011 from 3 percent in 2006, according to Mercer Consulting.”

Personally I think this is a great thing for healthcare since I’ve long been a proponent that any healthcare reform needs to put the consumer (patient if you prefer), not the insurer or the government at the center of the healthcare financial system. However, this change also poses a risk for practices and hospitals since the risk inherent in collecting self-pay balances rises in parallel with this increase in patient self pay.

How then are EHR vendors and revenue cycle management companies dealing with this shift to patient self pay?

This certainly won’t be a comprehensive list of ways that revenue cycle management can help with patient collections, but it will show a few ways technology can help now and in the future.

EHR software can integrate a Patient Pay Estimator to provide patients a close approximation of their final bill which helps a practice collect payment before they leave. The software physicians use to estimate the patient total for an office visit are going to have to get better and more accurate. I don’t have the numbers in front of me now, but I’ve seen multiple studies that illustrate well how the key to good patient collections is to get the money while they’re present. Once the patient leaves your office your ability to collect from that patient drops dramatically.

I know I’ve been to a lot of doctors where I get to the front desk and they don’t know what to charge me. Far too often they just say, don’t worry about it, we’ll send you a bill in the mail. If they just had the right information available to them, they could collect the money on the spot and not have to worry about collecting it from me later. An EHR can really facilitate this process if it has a good patient liability estimator built into the EHR.

In the cash or check world, it was much harder to set up budget plans or recurring payment. Now there are more and more systems out there where you can store a person’s payment information and set up the recurring payment to happen automatically. This will likely be a key trend going forward.

I’ve even seen some of the larger EHR vendors who have programs that offer financial assistance. In fact, the really large EHR vendors have whole financing divisions that can assist patients who have financial issues related to their healthcare. I wonder how deeply these financing options can be integrated into EHR software, but I could see it as a big advantage to have it as an integrated part of the payment workflow. I’m always amazed at how quickly you can be approved for a credit card or financing a car. I expect this type of financing will be pushed down throughout the various layers of healthcare. Will it become a differentiating factor in a large EHR vendor versus a small EHR vendor?

Another interesting idea to stem the patient payment problem is to accept prepayments. Meaningful Use is bringing the patient portal and PHR software back to the forefront of many EHR implementations. If you have patients filling out the paperwork for their office visit, why not collect the co-pay at the same time? Pre-payment could become a really great way to avoid revenue cycle management issues on the back end.

I’d love to hear other people’s thoughts related to patient payment and revenue cycle management trends. What can be done to help avoid the patient self pay collections issues?

May 4, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Revenue Cycle Management is So Popular Because Most Physicians Aren’t Business People

In a previous post, I asked the really important question: Is Revenue Cycle Management Sexy? I was amazed and impressed by the discussion that spurred out of that post. People were talking revenue cycle management details in the comments, on Twitter and even on their own blogs about how revenue cycle management is indeed sexy.

Turns out that a number of doctors wouldn’t be practicing medicine today if it weren’t for revenue cycle management companies that support these doctors. Keeping doctors in business is sexy to me. I know that the media often spins revenue cycle management as the rich (doctors) getting richer. They also love to talk about revenue cycle management companies taking such a huge chunk of a physician’s reimbursement. Let’s look at these two factors.

Are Doctors Rich?
First, it’s a little bit of a misnomer that doctors are all rich. Doctors don’t do anything to help this image since so many of them drive around in their high priced Mercedes and BMWs. There are many doctors (specialists top this list) that do make a very large amount of money. Many primary care doctors and certain specialties make much less. Don’t get me wrong. Every doctor I know is making plenty of money to live and live well. In fact, they’re making more than the average American. Although, when you look at their overhead, medical school expenses, etc you wouldn’t classify most doctors as rich.

Plus, let’s be honest for a minute. Many doctors are great at caring for patients and terrible at running their practice. Most physicians aren’t business people. There’s nothing wrong with this. In fact, some of the very best doctors are terrible business people. In these cases, many doctors turn to revenue cycle management to help them improve the business side of things. In some examples, no revenue cycle management assistance for a practice means the practice goes out of business. Hard to classify a practice that can’t collect money and goes out of business as someone that’s rich.

Revenue Cycle Management Company Fees
I’m sure if we looked across the spectrum of revenue cycle management companies, we could likely find some bad actors that are really gouging doctors more than they should because the doctor is in a vulnerable position. However, I think this is more the exception than the rule from what I’ve seen. In most cases where I see revenue cycle management in play, it’s because the practice for one reason or another couldn’t keep up with the demands required to do good revenue processing or didn’t have the expertise to do it well.

The problem is those doctors who are great business men don’t understand why their colleagues would allow a company to take a percentage of their reimbursement. What these great businessmen/doctors seem to miss is the choice that most doctors are really making when they choose to get assistance with their revenue cycle from another company.

The real choice for many doctors is whether they’re ok paying 7% of their reimbursement in return for a huge increase in how much reimbursement they actually receive. It’s just basic math really. If I can increase a doctors reimbursement more than the percentage I take, then it’s a good choice for many (definitely not all) doctors.

Could the doctor just increase the reimbursement themselves without having to pay a fee to someone else? Sure they could. In fact, many try this approach over an extended period. Then, many realize that they’re not very good at that part of the business. They realize that an outside revenue cycle management company can help them find missed claims that will now get paid. They realize that revenue cycle management companies can help those providers get paid faster.

Revenue Cycle Management and EHR
Some of the most popular EHR companies are built around this fact and offer the EHR for free or nearly free as a compliment to the core revenue cycle management. Plus, more and more EHR companies are building in some sort of revenue cycle management component. In many cases this is a good way for an EHR company to generate revenue, but for many practices it’s also a great service for them.

Of course, I’ve also heard from the many EHR vendors who don’t provide these revenue cycle management services to their providers. They usually give me an exasperated “How can doctors pay of their reimbursement to these companies?” A part of me understands this exasperation completely since I’m an entrepreneur like these EHR executives. If I were in a physician’s shoes I’d figure out the business process myself instead of giving a big chunk of my reimbursement to another company. This just ignores that many doctors can’t (or in many cases don’t want to) figure out the business process. In these cases, a percentage of their reimbursement is a better business decision.

Conclusion
The biggest challenge to revenue cycle management is doctors don’t want to admit that they need a revenue cycle management company. By doing so, they’d be admitting their not business people and that’s a really hard thing to do. Although, in many cases it is the best business decision.

Next up in my series on revenue cycle management I’ll talk more about the relationship of EHR and RCM.

April 10, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Is Revenue Cycle Management Sexy?

A few months back I attended a user group meeting for a large EHR vendor. While waiting for the opening keynote speech I was talking with the EHR vendor’s PR person. During our conversation they made a really interesting comment that stuck with me. I can’t remember the exact context of the conversation, but they said something to the effect of, “We also do a lot of work in revenue cycle management (RCM) and Accountable Care Organizations (ACOs), but that’s not the sexy things that people like to write about even though that’s where a lot of the money is in our business.”

It begs the question, “Is Revenue Cycle Management (RCM) sexy?”

Her comment really has had me thinking about revenue cycle management and particularly her final point about that being where the money is in their business. I’ve always believed in business that it’s a smart thing to follow the money, whether its sexy or not. On that note, I plan to do a series of posts related to revenue cycle management here on EMR and EHR. As for ACOs, I already started a series of ACO posts on EMR and HIPAA starting with my post “ACO Model Risks and Rewards.”

While I might not try and achieve the lofty goal of making revenue cycle management sexy, I do hope to be able to dig into many of the dynamics around revenue cycle management. I hope to look at reasons why revenue cycle management is so popular and doing so well. Why do so many doctors and hospital CIO/CFOs turn to revenue cycle management for their practice and hospitals? Are all RCM options created equal? What separates the various RCM options? What will be the future of revenue cycle management going forward?

In the past week, a number of online discussions have kicked up around a post I did on EMR and HIPAA around Streamlining Revenue Cycle Automation. The discussion shows there’s a real interest in discussing this topic.

I’m also interested to hear your thoughts on revenue cycle management. Are there areas you’d like me to cover? Are there important trends in RCM that more people should know about? No, this isn’t an open invitation for revenue cycle management companies to pitch me. I’m interested in good information about what’s happening with revenue cycle management.

No doubt that managing the revenue of a hospital of physician practice is incredibly important. Hopefully we can add to that knowledge base. Plus, I think it’s likely worth exploring how adoption of EHR is impacting revenue cycle management as well. Will there be less of a need for revenue cycle management with more EHR software or more of a need for RCM?

Let’s hear your thoughts, suggestions and ideas about RCM in the comments. Hopefully I can build on them in future posts.

March 9, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.