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Health Care Reform: The Impact on A/R Performance. August 29, 2012. Healthcare Reform: Summary of Changes . 1. 3. 4. Measuring Outcomes. 5. Crossroad – Buy or Build?. Does it Matter to You … In-house vs. Partnering?. Agenda. 6. 7. How Does it Work?. Things to Look For. 2.

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Presentation Transcript
slide1
Health Care Reform:

The Impact on A/R Performance

August 29, 2012

slide2
Healthcare Reform: Summary of Changes

1

3

4

Measuring Outcomes

5

Crossroad – Buy or Build?

Does it Matter to You … In-house vs. Partnering?

Agenda

6

7

How Does it Work?

Things to Look For

2

Typical Challenges

www.hbcs.org

slide3
Summary of Changes

Largest overhaul since ‘Care and ‘Caid in 1965

Law calls for:

  • Insurance Industry reform
  • Mandates coverage for most Americans
  • Creates more insurance options
  • Expands Medicaid

Health Care Reform

Source: “The Essentials of Healthcare Reform, Sarah Densmoore,

www.hbcs.org

slide4
What does this mean to you?

Industry:

  • Stress from the unknown
  • Increased burden on patient
  • Higher deductibles / co-pays

Financial:

  • Increasing cost to collect
  • Cost shift to front-end focus
  • Costly technology

Business Office:

  • Need to do more with less
  • Increased Turnover
  • Costly training & re-training
  • Reporting, Processes

Technology:

  • Multiple systems / platforms
  • System conversions
  • Data collection / consolidation

Typical Challenges…

www.hbcs.org

slide5
The patient is experiencing…

Shift to high-deductible consumer directed health plan

Increased out-of-pocket maximums

Increased share of premium costs

Cutting back / delaying medical care

Despite Health Care Reform

www.hbcs.org

slide6

Cumulative Increases in Health Insurance Premiums, Workers’ Contributions to Premiums, Inflation, and Workers’ Earnings, 2000-2010

  • Every year since 2000:
  • Premiums increased between 3 - 13%
  • Earnings increased within 2 - 4% range

Notes: Health insurance premiums and worker contributions are for family premiums based on a family of four.

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2011. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2011. Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2011 (April to April).

www.hbcs.org

slide7

Cumulative Percent Change in National Health Expenditures, by Selected Sources of Funds, 2000-2010

  • Rise in out-of-pocket changing A/R:
  • Increased self-pay
  • Increased balance after insurance

Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ .

Notes: This figure omits national health spending that belongs in the categories of Other Public Insurance Programs, Other Third Party Payers and Programs, Public Health Activity, and Investment, which together represent about 20% of total national health spending in 2010. Medicare and Medicaid were enacted in 1965; by January 1970, all states but two were participating in Medicaid.

www.hbcs.org

slide8
Are you measuring outcomes?

www.hbcs.org

www.hbcs.org

8

slide9
Most are at a Crossroad: Buy or Build?

Cost to Collect

Opportunity costs: what is going untouched?

Staffing, Training, Turnover, Re-training

Tools: Charity Care / FAP / Scoring / Segmenting

Workflow technology to increase efficiencies

Reporting requirements

Factors to Consider…

www.hbcs.org

slide10
Taking the Right Approach in Outsourcing

August 2012 – hfm Magazine

Most are at a Crossroad: Buy or Build?

Strategies behind outsourcing:

  • Seizing improvement opportunities
  • Remedying staffing inefficiencies
  • Servicing noncore areas of hospital operations
  • Accessing the latest clinical & business technologies
  • Taking advantage of the benefits of outsourcing specialization
  • Seizing investment opportunities
  • Finding the right partner:
    • Seamless integration
    • Deep & current experience
    • Broad capacity
    • Patient-centered orientation
    • Cost considerations
    • The right monitoring tools
    • Running a pilot
    • Systematic monitoring

www.hbcs.org

slide11
Collaborate together on Health Care Reform challenges
  • Share the risk – must be a balanced equation

Acquire technology “off balance sheet”

  • IVR, Web Portal, Scoring, Workflow Tools

Extend your current business office resources:

  • Manage the staffing flux – allow partner to become overflow for aged accounts

Work together to:

  • Improve cash collections
  • Improve reporting
  • Manage costs

To “Buy” is not for all, but for some…

www.hbcs.org

slide12
Does it matter to you? If in-house…

Revenue Cycle Management:Do you have core competency?… Self pay billing and follow-up; insurance billing and follow-up

Industry Experience:Is in-house better for you vs a partner exclusively in healthcare?

Charges Processed:Is the amount of global $ handled by a partner an important metric or do you just care about your AR?

Performance-Based Pricing: Is the staff “just doing their job” good enough for you?

Tenured Staff:What is average tenure of your RCM employees? Are they skills-based?

Customer Service: What is incentive to collect (so as to enhance your hospital’s Community Benefit)? … quantity ($); quality (compassionate, sensitive/excellent record of patient satisfaction) or BOTH?

Technology: What does it look like? Is IT developed in-house and innovative? Is there full integration with HIS systems? Are you ready for a conversion? Updated propensity to pay and scoring tools?

Communications to Patients: What are strategies around unified, consistent patient outreach? … inbound and outbound calls, IVR, statements, web portal

www.hbcs.org

slide13
Does it matter to you? If a partner…

Revenue Cycle Management:Understand the core nature of the partner’s business…are they: Self pay billing and follow-up; insurance billing and follow-up; full business office outsourcing, transitional business office staffing, bad debt, etc.?

Industry Experience:Are they exclusively in healthcare?

Charges Processed:Ask how much $X billion handled annually.

Performance-Based Pricing: Will partner go at-risk and “put their money where their mouth is”?

Tenured Staff:Are they US based? What is average tenure of RCM employees? Are they skills-based?

Customer Service: What is incentive to collect (so as to enhance your hospital’s Community Benefit)? … quantity ($); quality (compassionate, sensitive/excellent record of patient satisfaction) or BOTH?

Technology: What does it look like? Is IT developed in-house and innovative? Is there full integration with HIS systems?

Communications to Patients: What are strategies around unified, consistent patient outreach? … inbound and outbound calls, IVR, statements, web portal

www.hbcs.org

slide14
How does it work? You with Partner

Charge Capture & Entry

Insurance Follow-up

Registration & Pos Cash Collections

Claim Editing Submission

Patient Billing & Collections

Hospital Responsibilities

Partner

Responsibilities

Create Blended Model

Financial Counseling

Claim Adjudication

Insurance Eligibility Verification

Denial & Appeals Management

Reporting & Analysis

Pre-reg & Pre-cert

Patient Contact Center

Scheduling

Contract Management

www.hbcs.org

slide15
Things to look for in Partner- Patient Contact Center
  • Hospital-specific toll-free number
  • 24 / 7 account access (web portal)
  • Automated call distribution system
  • Multi-Lingual patient service representatives
  • Blended predictive dialing/skills based routing
  • Recorded calls for training and quality assurance
  • Contact center reporting
  • Interactive Voice Response (IVR)
  • Real-time, on-line credit card processing
  • Scoring technology (P2P) & segmenting accounts results in increased call resolution and identifying Charity Care

Increased collections & Improved patient satisfaction!

MUST: Extended Hours Inbound and Outbound Patient Contact Center

www.hbcs.org

slide16
Things to look for in Partner - Insurance Follow-up

Account follow-up workflow engine

PROVIDER DATA

Workflow Engine (Companionate Accounts)

Real-time Monitoring

Automated Follow-up

Dashboard Reporting

www.hbcs.org

slide17
Target Goal

After thorough discovery and research, improve your bottom line by leveraging technical and human resources through internal or external services, resulting in increased business office stability and accelerated and increased revenues.

www.hbcs.org

slide18
Thank You!

Questions?

Jeff Porter

847-550-0480

porterj@hbcs.org