Hospitals work to weigh value over cost

Dec 15, 2015 | Healthcare Accounts Receivable

At the recent Revenue Cycle Solutions Summit in Atlanta, pricier health care providers discussed why value means more to them than cost.

Benjie Johnson, the chief officer of Integrated Revenue Cycle for the University of Michigan Health Center, explained that the university health system has fixed costs associated with the hospital's mission, but that these costs are consistently being challenged and questioned. The theme emphasized by the panel was representing the value of an organization.

Jeffrey Hurst, senior vice president of Finance for Florida Hospital, said it's short-term thinking that causes hospitals to weigh cost so heavily. The real challenge, he explained, is focusing on population health and fostering relationships between patients and hospitals.

"The challenge right now is that's an academic conversation," he said. "I think the challenge we have in health care is most people tend to be short-term oriented."

That challenge is evident in how differently hospitals and patients view "value." While many hospitals see value in how they will get paid, population health would disagree. Adam Gobin, the director of Revenue Cycle Management for Emory Healthcare, pointed out that if a patient were to come in for one ailment and also get diagnosed for another, that type of visit would constitute value in population health.

While many providers facilitate closer financial relationships between physicians and hospitals in order to better analyze the quality of care, a study published in the Journal of the American Medical Association found that this type of integration has actually driven health care prices up for outpatient care. JAMA attributed this increase in price, as well as the potential for higher spending in commercial health care, to the effect of greater bargaining power.

Emory is working to meet these standards and save money by using predictive analytics to avoid denials. Prior to this system, Emory had looked at claims to see where it got denials, but now it looks at what's getting paid. Gobin explained that Emory's previous methods caused them to miss out on information that would be vital to creating more efficient finances.

Florida Hospital has a similar policy. Hurst explained that a little over a year ago, the hospital began a program in which staff would work with physicians on clinical documentation in order to "get away from denial management and get to denial avoidance."

More health care providers are choosing to outsource receivables management to improve their own financial efficiency in the interest of population health. Contact Professional Medical Services today to learn more about our revenue cycle solutions.