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● Think Tank


performance, process and volume remains critical. IT should be able to respond to the needs of the organization while responding quickly and with reasonable requirements for updates or enhance- ments, whether mandated or requested by the team.


Jeffery Rose, M.D., CMIO, TriZetto Corp.


Rose: T e RCM process for providers should give them access to real-time information about the cost of medications, interventions or tests. T is should


happen regardless of reimbursements so providers can pick the most cost-eff ective and appropriate action. T e IT department should share information from the revenue cycle to the EMR to the claims process in real time so all the players have information about precisely what is being done, how much it costs and how much will be reimbursed.


Campbell: T e ACA’s fi rst impact to the revenue cycle will be increases in volume for a host of primary care and sub-acute environments. T e secondary impact will be the continued tightening of reimburse- ments and general risk shifting to providers via ACOs and other population-based models. In this context, it’s critical for HIT to provide tools that help the operational team track and accrue all appropriate revenue. It’s also important to provide deep analytical capabilities to give management actionable procedure - and payer-specifi c intelligence. And fi nally, being able to reconcile not just with opportunities but with other charge data is critical. Payers are looking for billing discontinuities and providers should too.


Schwartz: It is urgent that healthcare organizations develop revenue cycle management practices that proactively address rising payer scru- tiny (Medicare/Medicaid and commercial) and the related compliance concerns that have a direct impact on revenue. Strong revenue cycle management practices are the key to maintaining the organization’s overall fi nancial health. By leveraging defi ned policies and procedures to govern the revenue cycle process, staff is better aware of what the expectations are, which allows them to better meet rising demands in this regard. Technologies that help to document and validate data accuracy are essential. Having a strong revenue cycle also infl uences the outcome of


various patient accounts. Making sure medical records are correctly capturing and collecting the proper information that will later be translated into a code can lead to the supporting documentation needed to validate the accuracy of related charges. Strong revenue cycle management practices improve patient engagement by allowing them to be involved earlier. T is ultimately allows the patient to be active in determining how they will meet their fi nancial obligations, and what resources may be available to assist them. When the process is managed eff ectively, then bad debts are lower, fi nancial assistance is correctly given and cash fl ow meets expectations in a timely way. It’s important to keep the patient’s per- spective, along with the future of healthcare, in mind. When there are a lot of billing issues and unexpected bills for the patient, there can be a high level of frustration. T ere are going to be reductions in payment structures, starting with Medicare reductions. To be able to get some of those dollars back, hospitals must perform well on quality indicators. Revenue cycle management IT needs to adjust course accordingly.


Supply chain will need to move from a pure cost-management focus toward a thoughtful and deliberate revenue integrity strategy. Suc- cessful organizations will engage patients, their clinicians, revenue integrity and supply chain pros together with innovative executives to share in delivering cost-eff ective quality care. Clinicians must retain


10 June 2014


the feeling of empowerment yet have fi rm direction on delivering custom quality care. Too often, the data that drives these strategies is unilaterally interfaced - meaning that information fl ows out of the hospital through complicated one-way interfaces but is not looped back into the system for integrative analysis and data integrity to support organizational strategies.


Lang: T e focus of revenue cycle management will extend beyond aff ecting overall productivity to determine reimbursement parameters that include cost, quality and outcomes data captured in the provider electronic health record and regional health information exchanges. T ese data will be used in the risk-based payments of Medicare and commercial insurers that now withhold reimbursement without proof of quality. T ese data will also be used for accountable care organizations to collect fi nancial and quality data that can populate the necessary reports or predictive analytics that will scorecard the ACO’s ability to provide superior care at lower costs. Having just a revenue cycle management program is not enough.


Providers are fi nding they need to connect data sets across numer- ous systems to yield clean, comprehensive results that can support comparative eff ectiveness and predictive analytics. T e industry uses the term “Big Data.” UPMC created a data governance program in October 2012 because data is one of the most valuable assets UPMC has. T e initial focus of the program was to populate our enterprise analytics with high-quality, well-defi ned data. T is was a massive undertaking as our executive leadership had the vision of establishing a “shared” stewardship of our data assets and data management decisions across the business and IT. T ey wanted key business leaders to become the information owners to elevate the “data analytics” abilities of UPMC staff beyond IT. T rough the eff ort to name and empower decision makers assigned with specifi c rights and accountabilities, we will be able to capture data defi nitions, business rules and metadata in tools to enable broad self-service access to information and transparency.


DeAngelo: • Streamlining processes from initial point of service to fi nal bill.


• Focus on tools to help provide up-front visibility to patient collectability and transparency to costs as patients play a stronger role in their healthcare decisions.


Patrick DeAngelo, Vice President, Technology and Process, McKesson Business Performance Services


• System focuses on automation and data validation up front – emphasis on mistake- proofi ng data transactions; human focus on exceptions only.


• Stronger standards will need to be developed among the industry in regard to data transfers – exceptions need to be removed.


Robert Magnuson, Principal Advisor, Impact Advisors LLC.


Magnuson: T e ACA will reduce the number of self-pay patients and emergency room visits. Self-pay patients are extremely costly to an or- ganization as they require a great deal of work to confi rm their status as well as producing a collection rate typically under 10 percent across the fi nancial class. Emergency room visits are the most expensive place to receive care. By increasing the number of insured patients, patients will be more inclined to seek treat- ment before their situation is emergent.


HEALTH MANAGEMENT TECHNOLOGY www.healthmgttech.com


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