In this episode, we’re joined by Christopher Baratta, Principal, of Grant Thornton’s Business Advisory Services Practice and the West Region Healthcare Advisory Services practice leader to discuss the transformation of the hospital revenue cycle.
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Highlights of this episode include:
- The top three challenges in revenue cycle right now
- Which stages of the revenue cycle are most vulnerable to errors causing decreased revenue
- Skills the revenue cycle teams will need over the next 5 to 10 years
- The biggest challenges for hospitals over the next 12 months
Mike Passanante: Hi, this is Mike Passanante, and welcome back to the award winning Hospital Finance Podcast. As the transformation of the hospital revenue cycle continues, we’re talking with thought leaders from a wide variety of vantage points to get their views on the critical issues driving these changes. On today’s show, I’m joined by Christopher Baratta, a principal of Grant Thornton’s Business Advisory Services Practice and the West Region Healthcare Advisory Services practice leader. Christopher, welcome to the show.
Christopher Baratta: Thanks, Mike. Appreciate it.
Mike: Chris, why don’t you start out by telling us a bit about what you do at Grant Thornton.
Chris: Not a problem. So basically I’m one of the leaders in our healthcare advisory practice and primarily work with providers on trying to help them really improve their revenue, reduce their costs, and improve their patient experience. So that runs the gamut of revenue cycle, but also those people, process, and technology items as well.
Mike: Perfect. And so you’re well positioned to engage in the discussion we’re about to have. And really what we’re going to do here is look at a myriad of issues that are impacting the revenue cycle. So the first question I’d like to ask you are, what do you think the top three challenges are in the revenue cycle right now?
Chris: Well, we continue to see decreased revenue and increased costs to make the revenue cycle whole. With the onset of COVID, telehealth kind of threw a curve ball a little bit, and trying to figure out how to get reimbursed for those services. And then in general, we have the complication of how do we keep our revenue cycle culture with our staff now working remote because a lot of times our revenue cycles were coexisting in centralized billing offices and centers of excellence. So I would say denials and things of that nature are never going away and continue to be challenges for the revenue cycle. But now it’s the revenue cycle trying to be more agile and making sure that we’re really using the new technologies that we have in the EMR, thinking about how we manage our workforce, and continuing to think about the patient and what it means for them and their liability.
Mike: And you hinted towards a couple of other areas we’re going to touch on here. But first, let me ask you, which stages of the revenue cycle do you feel hospitals are most vulnerable to errors causing lost or decreased revenue?
Chris: I would say there’s two primary stages. A lot of what goes on now is on what we call the front-end of the revenue cycle. But that whole kind of scheduling of registration, along with where we’re trying to get authorizations for services, there tends to be a lot of loss there, and also when we’re trying to figure out what patient liability is and educating the patient around those things. Self-pay is very hard to collect once the patient has received the service. And so there continues to be some losses around are we getting point of service collections? The other area which continues to always be a challenge is just in generalized charge capture, making sure that we’re capturing all the charges for all the services that we’re providing and coding them effectively and correctly so that we’re truly getting reimbursed for the services that providers are giving to our patients.
Mike: And in your opinion, are denials increasing or decreasing, and why? Either way, what have you seen?
Chris: I’ve seen it’s been kind of consistent. When in the revenue cycle we think we’ve kind of attacked one of the denial areas, another one will pop up. Our payers are smart, they’re figuring out new ways to deny for services. Again, telehealth was an area that was interesting. We were trying to figure out how to appropriately bill and code for those services. We’ve learned a lot over the last 12 months and so we’re seeing decreasing denials around that. But in general, I would say denials are continuing to remain consistent. They’re always going to be there and some of those things are just due to the fact of how we intersect with the payer. Some of them are on the provider side and mistakes being made, and some of them are sometimes just misinformation coming on the payer side. And we just have to resolve them.
Mike: And this next question could be for you or for your clients, Christopher. I’m interested in how your organization has adapted to remote work. And do you plan to maintain some level of it post pandemic?
Chris: So I will say that remote work and the whole COVID experience has taught us a lot. In an advisory service, we were used to being on site, being with our clients, especially in the provider world, five days a week side by side. Obviously we couldn’t do that. What we learned though, is we could be efficient and very effective in doing things via Teams and things of that nature. So I think in the future, at least from a services provider perspective, it’s going to be a hybrid. There are still certain things like having idea sessions, whiteboarding sessions, that we found are much more effective when you are in person, or if you’re going live on a certain technology or a build on. However, the generalized day-to-day operational things, we can do that from a remote perspective as well.
So I think for the future as an adviser, it’s going to be targeted on site, continuing though, to have both a mix of remote and a blending in of in-person kind of conversations and meetings. For our providers, I think they’re seeing the same thing. It was quickly trying to be agile and seeing what that remote workforce looked like and now I think we’re going to be in a hybrid stage. There are going to be certain areas where, hey, we might not need all of that office space for our larger revenue cycle, let’s say, back-end office, or we could have a rotation program of folks coming in, being on site to make sure they’re getting the appropriate training and feedback from their management team, but also having some flexibility. One of the things that is good for the revenue cycle workers truly is having that flexibility to deal with their family demands and things of that nature. Where we didn’t see much of a change, though, was especially with those areas of registration. Those are patient facing. We do need folks sometimes to be taking intake information as a patient comes in. And that’s just always going to be on site type of information. But in general, I’m seeing now the hybrid movement for those centers of excellence and those centralized billing offices.
Mike: Great, and what types of skills do you think revenue cycle teams will need over the next 5 to 10 years that maybe they don’t have right now?
Chris: So one of the areas– I think we’re seeing a lot of advancement in automation and RPA or robotic process automation and AI. I do think as the revenue cycle evolves over the next 5 to 10 years, some of these more mundane tasks that people have to do today are going to go away and be replaced by automation, which means that the staff that we are going to have on hand are going to have to deal with more complex things, dealing with payers that are more complex, having conversations, dealing with things that might be on the front-end side of things, complicated as it relates to the authorization or how much of it is dealing with a [inaudible] side of things versus a technical side of things. So I do think that the caliber of folks that we’re going to have in the revenue cycle is going to need to be much more advanced in dealing with complex problems. And we won’t need to have things around correspondence and things of that nature, which is getting more and more automated today.
With that, you’re going to have to have staff that understand what are those exception reports that come out of, let’s say, RPA processes or things of that nature? So I think understanding data, which has always probably been a strong point in the revenue cycle, but even more so, seeing what are the things in the data and the trends telling us so that we can be proactive and really not have to deal with after the fact components like denials, but proactively see those trends and make sure that we’re synergizing with the clinical staff to be there and understand how to reduce any type of revenue hidden activity and also reducing our costs. So I think the revenue cycle is advancing. It always does. We’re still going to have to have that same understanding of payer rules and what do we get reimbursed with and what do we not get reimbursed with? But it’s going to be, I think, at a much more complex, data-driven level, where folks are going to have to be able to manage technology, but also think about those cultural things I mentioned around how you manage a hybrid workforce, making sure that people are engaged and trained if they’re not going to be in an office setting five days a week. So that’s kind of where I see the revenue cycle evolving to.
The great thing about healthcare and especially the revenue cycle, every single month it seems, we’re given new rules, new regulations, new things that we have to adapt to. I think the revenue cycle folks, that work in the revenue cycle have always done a good job with that. They’re just going to have to be more capable to deal with it and use the new advanced technologies that are coming at hand in a much better way. Gone are the days where we’re keying things in and tabbing things in. I think there’s a lot of great technology that’s here, especially the new EMR systems, and also on the horizon, that the revenue cycle staff and leadership are going to have to be astute to and know how to utilize.
Mike: Christopher, what do you think will be the biggest challenges for hospitals over the next 12 months?
Chris: I would say coming back of, it seems that we’re getting back to somewhat of “normalcy” with staff coming in. And I think it’s really getting to the point of how are you going to deal with now you have folks off site that are coming back on site, and what are those challenges going to be as we move forward? So I think there’s a cultural dynamic to it, and also I think there’s going to be a lot of components around. As I mentioned, as technology is growing, we’re going to have to adapt and really welcome in some of these disruptors that might make it challenging. One of the things I’m seeing from a generalized, hospital perspective is more and more technology is coming in, right? On top of that, what we’ve seen as a trend over the last couple of years is a lot of consolidation. So we have, because of economic pressures and whatnot, hospital systems or single hospital areas coming together and joining. And what happens there is you have not only the cultural integration, right, of two different entities coming together, but also the process and technological integration as well and that always is a challenge, that standardization. If I acquire someone or if I’m being acquired, I have to move to a different platform, I have to deal with different payer mixes or environments, really understanding those core components.
And then the other thing I think is going to be a big challenge – and we’ve seen this now for a couple of years – is more and more our patients are becoming consumers. They have wearable technologies. They have smartwatches that are telling them different things. We have to integrate all of that information and data and make sure that we are truly thinking through what does this mean for our patients? There is a lot about pricing transparency, which is a whole other topic, Mike, to get into for a different day. But in general, there’s that component that’s out there. There’s a component of, “Hey, what do I want to do?” There’s high deductible plans still. But patients still have a concept of, “I have an insurance card, but that doesn’t mean everything is covered.” But how are we going to deal with the shopping of services and all of this data components along with the technology and the security?
I think we’ve all heard of some issues at one of the West Coast systems that got hacked and patients and clinical staff did not have medical records for about two weeks. Well, as we have more and more information that we want to be able to transmit from our devices to our clinicians and to generalized specialists, we also have to be thinking about those cybersecurity pieces as well. So there’s there’s a perfect storm, I think, coming as it relates to the intersection of this brand new technology, consumerism, and just generalized day-to-day regulations that as a provider network, we have to be thinking about and be planning for it because you don’t want to be at the tail end of it and reactive. You want to be leading edge and thinking about it future forward.
Mike: Thanks for those insights, Christopher. If someone wanted to find out more about you or your firm, where can they go?
Chris: So, I mean, we have a website, grantthornton.com. And at any given time, I always appreciate folks contacting me. I’m on LinkedIn or they can just pop me an email as well to my email address, which is: firstname.lastname@example.org
Mike: Christopher Baratta. Thank you so much for sharing your insights today on the Hospital Finance Podcast.
Chris: Thank you.