Healthcare Leaders Must Make Herculean Efforts to Collect Revenue in Today’s Changing Landscape
Ms. Minich-Pourshadi interviewed several hospitals CFO’s to get their perspective about the challenges they will face in the coming year. In my opinion, the thoughts shared by Mark Bogen, the Senior Vice President and CFO for the 435 bed South Nassau Communities Hospital in Oceanside, N.Y., were spot on. I’ll expand on a few of his thoughts below.
We all understand that due to the reconstructive actions, our government has taken to “fix” our healthcare system, this coming year will be especially challenging. Healthcare financial leaders feel as though they are under attack and possibly “at war” with federal and state governments and commercial payers.
The commercial payer requirements, have always been overbearing; however, over the past few years, they have morphed into a complex process even Albert Einstein would struggle with. In many cases, it’s become a game of cat and mouse. The result is a bevy of insurance denials that have always been a healthcare financial leader’s Waterloo.
We are just beginning our reinvention of our healthcare system, and the federal government has added their share of complexity to the reimbursement process as well. With the advent of ACOs, now there are new quality requirements to meet in order to gain reimbursement. We have complex waterfall payment processes, which ensure one arm of our government payer system gets paid first before the other, and it almost takes a forensic data scientist to maximize a hospital’s Bad Debt and DSH reimbursements.
The pressure placed on healthcare organizations to justify each case, large or small, is moving into a new stratosphere. Revenue cycle leaders are battening down the hatches, attempting to get more done with less people. Many revenue cycle departments are poorly staffed because they must comply with the expense reduction mandates placed upon them in order for their organizations to continue operations.
Securing every available reimbursement dollar has become a Herculean effort. Hospitals need new tools and technologies to ensure they are properly reimbursed. Without these tools, accurately forecasting cash flow will become almost impossible. Now add in the new deadlines healthcare reform initiatives are mandating, and it’s almost an in-executable situation.
The current healthcare transformation places incredible pressure on healthcare leaders to select and purchase the right technology for their operations. The top of the list of key technology purchases in 2013 will be EMR, ICD-10 and other technologies that support business operations and improve financial health.
In addition to systemic or foundation type technologies, there are many niche technology solutions that offer attractive ROI’s that cannot be overlooked. Since time is of the essence, decisions that can positively affect revenue must be evaluated and decided upon rapidly to ensure a quicker financial return. Since many of the niche plug-and-play technologies are SaaS based, they often can be paid from operational budgets, creating an easier process for approval.
We are at the beginning of a radical shift in the way healthcare services are delivered and how they are paid. Healthcare leaders should take note of the lessons from history. Other industries have gone through transformational reconstructions similar to the healthcare industry. It took forward thinking individuals like W. Edwards Deming who introduced the “Plan-Do-Check-Act” cycle to Japanese and American auto makers, radically changing the status quo for design, testing, service and sales and Jack Welch, of General Electric who brought six-sigma to the forefront which improved the way business is operated today and has helped numerous industries make the substantive re engineering changes needed to survive and flourish.
Healthcare leaders must seize every opportunity to improve their business operations while they are operating in this year’s minefield of change. As leaders walk through a maze of mines, they need to be open to change. The old sayings “what’s not broke doesn’t need fixing” and “we have always done it this way” doesn’t cut the mustard anymore. Those who have chosen healthcare as a career must learn to cope with change and there is no better time for change than right now.
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