In this episode, Jonathan Besler, President & CEO of BESLER, joins the podcast to celebrate our 200th episode and discuss topics that continue to interest the healthcare community.
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Highlights of this episode include:
- A look at some topics discussed by our 150+ guests over the last 200 episodes.
- What does the future look like for reimbursement, particularly worksheet S-10?
- Why healthcare and healthcare policy will be important issues over the next presidential election cycle.
- Why challenges to the mid-revenue cycle persist and are expected to continue for providers.
- Some topics that the Hospital Finance Podcast will explore in 2020 and beyond.
Mike Passanante: Hi, this is Mike Passanante. And welcome to the 200th episode of the Hospital Finance Podcast.
Joining me on today’s special episode is Jon Besler, our president and CEO. Jon, welcome back to the show.
Jon Besler: Mike, thank you so much for having me. I really appreciate being here.
Mike: Jon, 200 episodes, it’s been a great ride. I’m really looking forward to our discussion today.
Jon: Absolutely! It really has been a great run for us. When we started this just a handful of years ago, who would have thought in late 2019, we would have a 200th episode, with your point, listenership that continues to grow, continues to participate in the community each and every week with us. You’d mentioned the number of guests, over 150 guests over the course of these 200 episodes. Some folks have come back to participate and share with the community everything that they know and they learned. And it’s really been a great run.
And so, I do want to reach out and say thank you, thank you very much, to all of our guests who have participated, whether it was a one-time or you continue to come back and again share that information with our community.
And thank you to the listenership as well. We’ve discussed how, each and every month, it continues to grow. And I think the folks that really tune in and participate get a lot out of it. And I think, with the growth of that listenership, it continues to be a very positive thing for our industry.
Mike: We couldn’t do it without them! Jon, over the years, we’ve talked about lots of different topics related to reimbursement, particularly worksheet S-10. What do you think’s going on there? And what’s going to be happening in the future?
Jon: Well, I think if you looked at and asked any one of our listeners, or anyone in the hospital community, where’s reimbursement heading in general, whether it’s commercial reimbursement or government reimbursement? I think the very quick answer would be is that it’s heading down. It’s heading south.
Part of some of the ACA goals were to look at quality and cost—how do we increase quality and reduce costs? And I think the Schedule S-10 is a prime example of that.
The government likes—well, I shouldn’t say they like to operate on a budget because sometimes we see that they don’t. But in general, they really like to look at things in a very fixed way. So if we allocate a certain pool of dollars, specifically in reimbursement, you start with wage index, there’s a certain pool of dollars for wage index. And when you look at DSH and the history of DSH, it’s really an unlimited pool. And I think from a governmental perspective, it’s sort of untenable when you look at it from a budgetary and a future-looking standpoint.
And so, with the Schedule S-10, I think they looked at that as an idea on how do we take that same concept of a fixed pool of dollars and figure out where to send that money across the country into the providers that need it.
But I think where we’re heading with it, I don’t think it’s going anywhere. I think, if anything, the government has really firmed up the opportunities to issue more guidance around it. I think we’ve learned a lot from the audits over the past couple years. But I think we’re going to see a lot more of it (and continue to see a lot more of it). And candidly, I think the government is going to look to that schedule for other funding pools as well potentially.
We talked a lot about IME and GME reimbursement. And that’s an area that continues to be a benefit to many institutions. But also, from a governmental perspective, it’s fairly untenable. I think that they need to know that providers continue to need these dollars to come into their institutions to be able to make some of these changes—whether it’s changing a schedule on the cost report (like adding the S-10 or starting to audit and really take that schedule seriously) all the way through the basic blocking and tackling of just getting your claims out the door in the right way, and then accounting for them on the backend.
Mike: That sounds about right, Jon. Let me shift gears a little bit. We’ve talked a lot about healthcare policy, both at the federal and state level on the show. And we are heading, of course, into another presidential election cycle. Healthcare is clearly on the minds of voters. What do you see coming next?
Jon: From a policy standpoint, I think the government is going to continue to look at cost and quality as key drivers. From a consumerism standpoint, from a patient experience standpoint, our population needs to know, our citizen needs to know whether or not they will be able to access the appropriate level of care. Frankly, some of their most trying times that they’ll ever have in their life, whether it’s the beginning of life and women & infant care all the way through death and hospice and everything else that goes along with our healthcare spectrum. And so, from a policy standpoint, the lawmakers really need to take a hard look at it and make sure that we get it right.
When we compare ourselves—and I know that there’s been a number of podcasts around policy and some of the history of how we got to where we are (which is I think a really interesting history lesson, some of these challenges that we’re facing). But we really need to be very future-thinking as well. It’s great that we can rely and look at history and say, “Okay, we got it right this time,” or “These are the things that we do and why we do it.” But I really think if we peel back the onion and say, “Okay, this is where we are, but this is really where we need to go. This is how we need to take care of our citizens in a very proactive way,” and so we’re not continually faced with this rising cost concept, and how do we solve for the rising costs, frankly, I think whether it’s a tax issue, or a revenue issue that we’re trying to solve for, I really do think that it comes down to the patient care, the patient experience, and how to continue to drive quality.
I mean what we don’t want to see I think as a society is to look at healthcare consumerism, right? It’s very easy for people nowadays to move across borders. And so, I know that we’ve talked about healthcare travel. We used to import a lot of that. I think it would be very interesting to take a look at the folks that are here in the States that are starting to look in other countries that might have lower costs and higher quality because of a cheap plane ticket to whether it’s Europe or Asia or even just crossing the border up to Canada.
I think we really, as a community, need to start looking at are we continuing to provide the best care and how do we care for those patients at the best quality and the best cost?
Mike: Jon, let’s talk about the revenue cycle. We conducted a study late last year that looked at the mid-revenue cycle. And it’s seems as though the revenue cycle professionals and HIM professionals that participated in that study felt as though there was still room for improvement.
So, my question is with all the processes and technology in place at hospitals, why do we still talk about things like DRG optimization?
Jon: Sure, I think that’s an excellent topic to discuss. I think just overall philosophically, one of the core values at BESLER is excellence. And so, excellence, it’s not a destination, it’s a journey. So, from a process improvement standpoint, we’re always looking at (and we always should be looking at), “It’s good now, but how do we make it great? And if it’s great now, how do we move it closer to excellence?”
And so, the mid-revenue cycle I think has its challenges historically—and will probably continue to have them. I mean I think we’ve experienced a lot of system conversion type issues and folks out there looking for the perfect system to help from an IT standpoint, all the way from patient registration to, on the backend, billing and denials and everything else. But really, there’s a lot of human element that goes into that as well. And so, a system is only as good as some of the folks that continue to use it and continue to also make it better. And I do think that there’s an opportunity to continue to look at it.
And it’s not to say that, from a human element standpoint, we all go in with the best of intentions with the ideas and everything that’s in our head. But there are interpretive areas that, again, people are making with the best of intentions, but at some point, you got to make judgment calls in some of these things.
So, I really like to think about it like this. I mean I think the mid-revenue cycle in healthcare is very challenging. There’s a lot of areas and a lot of hand-off’s that happen within that space. A friend of mine asked me: “Why is this so complicated? Why can’t I walk into a hospital or walk into a physician’s office or get my care wherever I’m going to get it and understand exactly what I’m going to get and what exactly I’m going to pay for it? Oftentimes, I’m paying a couple dollars up front with a co-pay or a deductible or whatever. And then, surprise! On the back end, I owe a couple more thousand dollars. What happened?”
So, for the average consumer, I think it’s very challenging to understand what happens in that middle area.
And so, so I gave him this analogy. Well, he’s not a coffee drinker, so maybe he didn’t appreciate it. But I said, “You know, if you walk into Starbucks, and you’re going to order your $4 latte, and you’re going to ask for a particular kind of skimmed milk or almond milk or whatever it is that you want to add to it, a particular kind of bean that you want to add to it and so on and so forth, you’re going to pay your $4 and you’re going to drink your coffee, and odds are it’s going to be very consistent with the coffee that you got at Starbucks last week. And no one’s coming along—you certainly aren’t. No one’s coming along and auditing that particular cup of coffee each and every time.”
“But I bet if you did, or I bet if someone did, they would come in and say, ‘Well, they didn’t add 0.5 oz. of almond milk in that particular cup. And the Arabica beans were not ground up a particular kind of way. So, the standardization that we get and the allowance for the differential that we might get in a cup of coffee is very different than what we allow for from a healthcare perspective because we’re not talking about a $4 cup of coffee, we’re talking about a $40,000 claim that we would have on an in-patient perspective.” And that that’s even on the low end of some of the things that happen within a hospital.
Mike: Well said, Jon.
My final question for you… what would you like to see us cover on the podcast going forward?
Jon: Well, I think there’s a lot of interesting topics that we certainly will cover in 2020 and beyond. And I hear a lot from our listenership as I’m out and I’m speaking with clients and going out to different industry events and things like that. Topics like price transparency continue to come up. It’s a hot topic. It’s been a hot topic for a little while. But now that the wheels are starting to move in that motion, I think we’re going to see a lot more within that space. And I’m looking forward to hearing from the listenership and guests to talk about that particular topic.
You mentioned policy. Policy is not one of those things that happens, and then it goes away, and then you never see it again—whether it’s a new administration that comes in, a new idea that comes in, a new research paper that’s produced. As we should, we should be talking about, again, how do we move from good to great and great to even greater and greater towards excellence.
So, from a policy standpoint, I think we’re going to see a lot of discussion and a lot of changes in that particular area.
Obviously, we’re going into an election here in 2020. And so, whether it’s the current administration that gets another four years, or a new administration that comes in, policy will continue to be a hot topic. When this administration came in, they talked about pulling the ACA completely out. It wasn’t necessarily something that this administration was able to accomplish as of yet. We’ll see what happens in the next four years if that’s the direction that we end up going.
And so, that kind of conversation will continue to evolve because even though the ACA isn’t here in the same way that it was before, there are some key tenets of it that are still here. And so, I think there’s going to be a lot of active dialogue around what we’re doing and what direction that we’re going from a country’s perspective.
There are some hot topics and buzzwords that we continue to hear like blockchain in healthcare. And so, there’s some of these sexy terms that are out there—consumerism, population health. I think that, again, as it relates to policy, these are all things that our society is going to continue to move towards. We’ve got nearly the world at our fingertips with a smartphone. And so, as healthcare continues to evolve, and patient access and patient engagement and things like that continue to move into this new (and maybe not-so-new) very digital world that we live in, some of those topics around, “Well, how do we care for our patients now because the brick-and-mortar isn’t the only way that we can engage with them anymore?”, and so the consumerism and population health I think is going to be very interesting as we move into 2020 and beyond.
Mike: Well, I’m taking notes, Jon. It’s going to be an exciting next 200 episodes. And I’m really looking forward to it.
Jon: Absolutely! Me too. And Mike, thank you very much for all the great work that you do to host the podcast on a weekly basis. It’s great! And I’ll say thank you on behalf of our listeners as well.
Mike: It’s been a pleasure. Thank you so much.