Healthcare Matters

Whether providers are investing in services for collecting bad debt or solutions that promise them a way to get paid faster and at less cost, the business of revenue cycle management is booming. With average transaction costs across the industry at a whopping 15% –and that’s when providers are actually getting paid– the opportunities for “big savings wins” are very real (not unlike the kinds of wins that SCM solution providers deliver when they encounter categories of spend that haven’t yet been competitively sourced).

But here’s a warning: Despite the fact that revenue cycle management, procurement and supply chain management are very discrete tasks, the defining disciplines, whether delivered by outsourced consultancies or internal practitioners are often and carelessly grouped together. Let me put it this way: If you don’t have a deep understanding and working experience handling claims, contracts, coding, registrations, etc., and/or you’re talking to experts in materials management who can’t wait to tell you about how they’re going to tackle your revenue cycle –take a deep breath and go find someone who does.

Revenue cycle management is a potential mine field –just ask Accretive Health and their customers. But it is an extraordinarily vulnerable and worthwhile area for attack. Today’s tech-enabled solution providers shouldn’t just deliver the following services (listed below), but they should be able to do it in the context of reform, meaning, they warrant to ensure that your transaction flows will be modeled with accountable care frameworks and bundled payment plans fully accommodated.

Situation Assessment

Objective operations analysis designed to serve as the basis for planning and decision-making.

Operational Plan

A detailed plan of attack that drives your organization through a structured process aimed at establishing the targeted change, standardizing on the required technologies.

Turnkey Implementation and Integration Services

Don’t rely on an entity that just talks a good game. Focus on partners who have plenty of referenceable implementations.

Train the Trainer

Insist on being left with the capacity to drive the new solution with in-house resources. That means all new policies and procedures should be documented, all reporting formats/requirements designed and initiated, any/all external conversions operational and each critical element of compliance fully auditable.

• All of the forgoing should be accomplished without any disruption to cash flow during the process(s).

GPOs that offer services in this space do so with mixed reviews. In fairness, reform-era politics continue to move the goal posts. At least, that’s what we keep hearing.  So it is noteworthy that MedAssets aggressively promotes its expertise in this area –and that we haven’t heard or read anything “Accretive-like” in all the coverage it continues to receive in this critical area of its business.

ATLANTA–(BUSINESS WIRE)– MedAssets (NASDAQ: MDAS) today announced that Hartford Healthcare Corporation (HHC) has realized $15.3 million in financial improvement in one year as result of a comprehensive re-engineering initiative supported by the company’s end-to-end Revenue Cycle Management solutions.

“Our No. 1 goal is to better serve the patients in our community,” said Tom Marchozzi, chief financial officer, Hartford Healthcare. “This initiative has a direct impact on our patient’s experience from the first encounter at the registration desk to post-service billing. Beyond that, this effort has made a positive, lasting impact on our ongoing operational efficiency and financial viability to be able to continue to serve our community going forward.”

Similar to most integrated delivery networks today, HHC’s disparate information technology (IT) system environment was prohibitive to achieving aggregated reporting and best practice workflows and processes. According to Marchozzi, HHC looked at several options available to consolidate and improve performance.

The regional health network selected a combination of MedAssets Access Integrity, Charge Integrity and Reimbursement Integrity web-based applications to augment its existing IT infrastructure—50 different revenue cycle applications in all, including five patient accounting systems, three contract management solutions and six scheduling platforms. HHC also selected MedAssets Collections Management solution to reduce the cost to collect. The next-generation solution features advanced workflow and decision support capabilities to capture and prioritize all necessary collections data from hospital, physician groups and third-party management systems into one application to give HHC staff members an intelligent and unified work list.

The regional health network was able to centralize and standardize scheduling, contract management, business office, patient financial clearance and point of service cash collections functions across the five-hospital health system—all while preparing for bundled payments, and without disruption to cash flow. With the addition of this revenue cycle technology, HHC is now generating sustainable financial improvement, increasing patient satisfaction and developing best practice protocols for quality-based reimbursement models.

Preparing for a New Payment Environment

Another investment Hartford has made to sustain financial performance and develop accountable care best practices is the MedAssets solution for bundled payments. Among its many features, the web-based technology supplements current claim system and processes and performs severity-adjusted clinical analysis to deliver a comprehensive view of expected reimbursements under a fee for value reimbursement payment system. HHC will gain the ability to adjudicate in a bundled model, as well as track data at the patient, physician and/or facility level to support more informed contracting and budgeting based upon calculated opportunity for shared savings or potential penalties.

“Reduced provider reimbursement levels are imminent, and broadscale new thinking of current technologies and resource utilization will be critical to business success and survival for most healthcare organizations,” said Greg Strobel, president, Revenue Cycle Management, MedAssets. “Our end-to-end revenue cycle portfolio and expert services help healthcare providers like HHC to overcome the challenges presented by legacy monolithic systems in a way that is non-disruptive, low-risk and demonstrates real value. We look forward to continuing to support them in achieving best practices throughout the revenue cycle management continuum and preparation for accountable care.”

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—Tom Finn