Why revenue cycle needs to change for the new payer mix
Following a very difficult year in which economic instability resulted in job loss for countless Americans, providers are seeing more underinsured patients or more covered by public insurance.
How can the industry work to ensure financial viability as elective procedures, preventive screenings and other delayed services pick up speed?
Modern Healthcare convened a panel of experts to delve into the issue during a webinar moderated by Modern Healthcare finance reporter Tara Bannow on Sept. 7.
CMS reports Medicaid and Children’s Health Insurance Program enrollment grew by more than 11 million people between February 2020 and March 2021. How has this affected you? Bert Zimmerli, executive vice president and chief financial officer, Intermountain Healthcare. The system is headquartered in Utah with operations also in Idaho and Nevada.
Our uncompensated care has trended down for four or five years. It does help having a health plan because Select Health (Intermountain’s insurance division) has a substantial percentage share in Utah of the (Affordable Care Act) individual exchange, and while the payment rates on that are a little bit less, that had a pretty significant impact on what would have otherwise been no pay. Also, in the last year, 65% of patients asking for financial assistance or charity care actually had a highdeductible plan or some form of insurance.
We’ve been working for seven or eight years to get our costs in line, where we can break even at the Medicare rate. We’re not there yet but we know we have to get there.
Suzie Desai, senior director and sector lead, U.S. Not-for-Profit Healthcare Group, S&P Global. The firm covers about 450 hospitals and healthcare systems.
Some large urban markets like Texas with big county hospitals that take care of a larger portion of the safety-net and Medicaid population are seeing incremental increases over the last year and a half, but it’s no individual hospital taking it up.
The delays of cuts to some of the supplemental programs that assist with uncompensated care have helped. Some states have even pumped up rates, which has helped providers.
But in Medicaid, there could be future shifts because the question is, are those people going to get their jobs back (and) move back to commercial?”
Dr. Gerard Brogan, senior vice president and chief revenue officer, Northwell Health. The New York-based system operates 23 hospitals and roughly 810 medical practices.
(We) haven’t seen a big change yet but expect that we’re going to because we started a big push to identify folks who are eligible for government programs, mostly Medicaid programs, in an effort to gear up more for population health.
Can you talk about the challenge of boarding patients while waiting for post-acute prior authorization?
Brogan: During COVID, insurers were short-staffed. Or they had for folks working from home and their processes were less efficient. A lot of patients were more difficult to place because they had just come off ventilators and had chronic diseases. Vendors that manage these transfers like information in a certain format that might need converting, adding an extra 12 hours at least to the process.
When you pass a certain point in the day, you’re not going to get a patient out, because these are not 24/7-type of operations. You’ve got certain windows during the day for ambulance availability and receiving.
So I think this is a big challenge that COVID put a spotlight on.
Zimmerli: Having a health plan helped us. As did knowing it’s in our best interest to work with post-acute providers that met certain quality and cost criteria.