There have been many memorable “where were you?” events since the 21st century began. But few can match the COVID-19 pandemic, at least from a healthcare perspective.
The effect on healthcare (and healthcare executives) has been particularly profound since our industry is in the center of everything. From the search for personal protective equipment (PPE) to setting up secure wings and field hospitals to instantly redeploying nurses from other floors to the emergency department (ED), the changes have been profound.
Yet it’s not just the front-line care areas that have experienced these challenges. They’ve also extended to the core operational functions, such as revenue cycle management (RCM) and business intelligence.
If there is a silver lining to all the trauma it’s that the pandemic has turned up the volume on the need to remove administrative waste and long-held assumptions. Many in healthcare have been far too comfortable for far too long saying “healthcare is 10 years behind other industries” in terms of business and operational technology. The pandemic has shown us the folly of that sentiment.
We have the opportunity now to take what we have learned and are constantly discovering and apply it to make hospitals and health systems data-driven paragons of efficient operations. Here are five RCM challenges healthcare executives are currently facing and how the industry can improve on them moving forward.
1. Allowing some employees to work from home
Prior to the COVID-19 pandemic, work from home was mildly embraced by some and driven more by increasingly expensive and/or unavailable office space. Many hospital and health system executives believed that RCM personnel were best managed and supported when together in the same building or campus as their managers. As such, few had plans in place to enable a real work-from-home option.
Then came the pandemic, and the options became A) allow work from home or B) cease RCM activities until the clinical side sounded the “all clear.”
While there were certainly challenges on the mechanical side, many healthcare organizations quickly discovered that their RCM staff was capable of performing most of their duties effectively while at home.
As they consider continuing work-from-home options, at least for those who want them, healthcare executives will need to be able to measure the productivity and effectiveness of their RCM staffs. This means they will need to get very good at workforce performance analytics.
The best analytics will be about performance versus activity and will enable them to gain an auditable, objective measure of the value-based performance of each employee and the department as a whole. They will then be able to set incentives and take a more practical look at workloads and what people can do. For example, if someone is currently working 50 claim exceptions per day with two touches, what can be done to incent them to double that amount? If a biller/collector can do double their current volume and get better yield while working seven hours instead of eight, then they should be paid for performance versus activity.
Organizations may still need to offer a minimal office environment for those who prefer to work that way. But they will have options that enable them to increase throughput and yield while also increasing employee satisfaction with their jobs.
2. Getting good at vendor/partner analytics
Let’s hope that the days when vendors and partners could make up for any mediocrity in their performance by dropping off a bigger box of donuts are long gone. Today, thanks to advanced analytics and data mining, healthcare executives can easily monitor and manage vendor performance to determine who is performing best on which types of issues so they can drive the best outcomes in each area. The reality is that partners should be measured as much as possible in the same manner as staff members. In RCM, cash remains king so key measures tied to cash performance, liquidity ratios, yield improvement as well as cost and “quality of touch” are best to measure the quantitative performance of a vendor, partner, or supplier.
3. Replacing dashboards with real-time command centers
If healthcare executives hadn’t already stopped relying on basic dashboards and scorecards by now the pandemic should have demonstrated why they should. Hospitals and health systems have no room for mistakes at present; they must capture every penny they can to make up for the revenue shortfalls driven by the canceling of non-emergent yet essential procedures.
Add to that a landscape that seems to be changing daily, or even hourly at times, and static and stale, dated views of organizational performance are no longer sufficient. It’s like looking at today’s weather forecast in yesterday’s newspaper.
What they need instead is a robust command center that offers streaming, real-time views of their current performance levels with deep insights including leading indicators into prospective problems, patterns, or other anomalies. With an RCM based command center, RCM executives can see how the organization is performing in multiple ways including yield, cost, quality, and velocity of payment from third-party payers and patients as well as internal process efficiencies or operational leakage.
They can compare the effectiveness of staff working in the office versus working from home to determine whether work-from-home is delivering value. They can also slice and dice the data further to determine if individual employees are more productive in the office or at home so they can make even better, more granular decisions.
The data-driven command center also enables decision-makers to look at what is being written off, where the leakage is occurring, and other factors in real-time so they can preserve and capture as much revenue as possible. The more molecular and atomic they can get at the source data level, the more effective they will be in managing organizational performance when it counts – as it’s happening. A data-driven command center delivers that capability. A robust data-driven command center also tends to put the spotlight on process problems and where the potential for robotic based automation exists.
4. Getting smarter through AI, Machine Learning & Robotics
There is a huge need right now to remove costs while improving yield. Fortunately, that is what artificial intelligence (AI), machine learning (ML), and analytical process automation (APA) are specifically designed to do because they are rooted in data.
Much of this is understanding what goes wrong and why claims are stalled or denied. For example, if Payer A requires two touches to resolve a denial or downgrade and the same denials or downgrades require four touches for Payer B, providers should ask themselves “Why?”. It could be a training or systems issue, but it could also be something occurring on the payer side.
Hospitals and health systems need to understand the patterns so they can ensure they are implementing the proper corrections. They should also be using APA to determine where costly manual labor can be replaced with automated systems.
When they are looking to increase RCM efficiency via Robotic Process Automation, healthcare organizations often start with authorizations and eligibility. Those are always the obvious places to start but yield improvement and process and cost efficiencies live in many places throughout the revenue cycle.
Data-driven APA can help them intelligently determine where the greatest potential gains from automation can be realized so they can start there, then work their way down.
5. Improve compliance efforts
While there will always be some exceptions, most compliance issues are unintentional. Fortunately, the more organizations get molecular and atomic with their data and processes, the more they have controls they can test, giving them full audibility and traceability of potential risk areas. These capabilities will help avoid false claims act violations, improper coding, and other unintentional risk markers.
More change to come
Although the overall number of daily COVID-19 cases may be trending downward, we are not out of the woods yet. Infectious disease experts are recommending caution for reopening the country; some are even predicting another surge in the fall to coincide with the start of the flu season, which could make the challenges even greater.
If that scenario takes hold, hospitals and health systems will be further challenged to get patients with chronic conditions who are fearful of the virus to come to the office for regular screenings so they can avoid negative outcomes in these other areas. More data-driven innovation will be required. And as it occurs on the care side, it will need to be matched on the business side so hospitals and health systems can continue to deliver these services.
The key is understanding not just what is happening but why it is happening so healthcare executives can make intelligent data-driven decisions. Hospitals and health systems would be wise to implement the appropriate technologies now so they are prepared for whatever the next “where were you?” moment brings.
Murder hornets anyone?