COVER STORY · REVENUE CYCLE MANAGEMENT
advancing such work by exception, which is still early on in its development. And the staffing shortages continue to
be very real, says Sue McBride, principal in the Advisory Services division at the Charlotte, N.C.-based Premier Inc., and the association’s revenue cycle practice lead. “COVID really set off alarms around staff- ing shortages,” the Pittsburgh-based McBride affirms. “It allowed people to work remotely; and that bigger pool of people affected recruitment. So, for the first time in revenue cycle, we’ve had clients tell us
Sue McBride
that they’re having a difficult time attracting people; they’re competing against retail or fast food; that was surprising. So it became more of a focus to get automation in there.” There is a nuance in all this, McBride
notes: while on one hand, salaries are ris- ing for all sorts of positions, including cod- ers, utilization management nurses, and call center workers, she says, “It’s good and bad, because while there’s competition to attract those people, but it does also open up the talent pool.” In any case, Craig McKasson, Premier’s
senior vice president and chief financial officer, notes that “What’s interesting is that the pendulum swinging a little. That nationaliza- tion is happening in healthcare and also in other indus- tries. But health system leaders are starting to want to bring people back on-site. So it will be interesting to see
Craig McKasson
what happens. Tech companies used to say, everyone will work virtually; now, they’re creating hybrid systems.” Those working in the trenches are expe-
riencing the challenges first-hand, among them Amy Trogdon, revenue cycle director at Integris Health, an eight-hospital inte- grated health system based in Oklahoma City. Trogdon reports, “We have not had an issue with staffing of our remote work- force; we’ve actually seen a decrease in our turnover rate; we have very little turnover among our remote workers. With our on- site staff, we are seeing staffing challenges. First, just finding people who want to work in healthcare is an issue. We have competi- tors outside of the healthcare industry that
can afford to pay more, with benefits. So trying to retain high-quality, knowledge- able individuals is difficult. We’ve put together a good retention plan. And we’ve cut turnover in our remote work- force by 50 percent.” Paul Shorrosh,
Amy Trogdon
CEO of AccuReg, a Mobile, Ala.-based solutions provider
in the revenue cycle area, says, that, “Nationwide, I think the field is still in crisis. There’s so much competition for these employees, and health systems are not doing well financially; profit margins are low. So it’s hard to attract and retain good-quality employees. It’s true across health systems; it’s definitely a crisis, we hear it everywhere we go. And the answer to that is technology: automate everything you can; and we’re so data-intensive in healthcare that there’s a lot of opportunity there. And second is digital; allow your employees to focus on high-value work.”
How to match people and processes? Richard L. Gundling, senior vice president in the professional practice at the Downers Grove, Ill.-based HFMA (Healthcare Financial Management Association), says that, in his view, the great opportunity/chal- lenge of the moment is around “broader thinking about how to use the human staff, and matching it up with AI and robotic pro- cesses, so that purely transactional processes like payment processes can be automated. Meanwhile, patients are responsible for more of their healthcare costs, so there needs to be more advisement, as well as time and energy devoted to collections.” In that regard, what are the smart
CFOs and senior revenue cycle manage- ment leaders doing right now? “Among other things, they’re looking at regula- tory finance and audits, looking at the No Surprises Act, and updating compliance processes, and training their staffs on these regulatory complexities,” Gundling says. “And they’re looking at the different payer rules, and at where they’re experiencing high claims denials rates.” Leaders need to be leveraging technology to get into the weeds, he says, and analyze such areas as “payer-provider coding disagreements and medical necessity judgments, and even prompting the clinician at the bedside—is there a comorbidity that needs to be docu- mented? Or an alert telling the physician a
claim will be denied unless something isn’t done?” Or they might need to be prompted to document the fact that they’ve done a psychosocial assessment on a patient. The key point with regard to all the
process improvement work that can be technology-facilitated, Gundling says, is that “Those changes require a lot of training; so you have to make sure you’re dedicating enough resources to staff compliance. You have to avoid penalties, that would be a cost; avoid public condemnation. And make sure you’re documenting comprehensively, so you get paid. That requires staff. You can have staff working on that instead of purely mechanical processes.” Asked the same question, McBride says,
“How are successful organizations leverag- ing automation? They’re leveraging certain types of solutions in the revenue integrity/ coding space, for example: AI solutions that can look at massive numbers of accounts and immediately spit out the variance. Some solutions can machine-learn so you don’t keep making the same mistakes over and over. Meanwhile, in the billing, collec- tions, and patient services area, automating cash posting, and pinging Medicare for claims status, we see automation increas- ing there; and recently, more places have moved towards digital self-scheduling and bill pay. With self-scheduling, fewer calls go to the call center, and so there’s greater adherence to appointments. In that context, digitizing the patient experience helps.” The key, she emphasizes, lies in examin- ing processes that could be dramatically optimized through automation. Indeed, she notes, technology can be
used to enhance processes that might not be directly related to revenue cycle management, but which can impact finance: for example, the implementa- tion of systems of automated reminders through text messages, emails, and phone calls, to ensure that patients show up for their medical appointments, thus ensuring that there are not major gaps that lead to sub-optimal billing because of unfulfilled appointments. Developing systems that encompass a broad range of processes across health systems will be important in that regard as well, she emphasizes. Asked how RCM leaders should move
forward process-wise to leverage technol- ogy to optimize staffing, HFMA’s Gundling advises, “Do an assessment to find out where the opportunities are. Different communities might have different needs. If you’re in a socioeconomically disadvan- taged area, you might need more staff to help patients access Medicaid, or help them
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