The recent cyberattack on Change Healthcare has brought the conversation around cybersecurity concerns to its zenith.
The ransonware attack on Change Healthcare has affected pharmacies across the country, with the industry estimated to be losing over $100 million a day. While ransomware attacks seem popular for health systems, cyberattacks are getting more sophisticated.
As always, HealthLeaders is keeping up with the latest cybersecurity and IT developments and insights. Here’s a round-up of recent articles in case you need to get caught up:
The Health and Human Services Department raised the alarm for the healthcare sector to make cybersecurity a priority at the end of 2023. The agency presented a four-step plan to improve the sector’s defenses, which include establishing voluntary cybersecurity performance goals for the sector and providing resources to incentivize and implement cybersecurity practices.
In January, the American Hospital Association released a statement alerting members of a new threat, where hackers pose as IT help desk staff to steal information from revenue cycle or financial workers, with the goal of accessing their accounts to change payment instructions to fraudulent U.S bank accounts.
When systems implement new technology, the vendor it’s working with may not have the same security standards. The race for digital expansion shows no signs of slowing down, and vendors are making their own efforts to ensure the security of their solutions, but the rate at which they evolve makes it difficult for systems security standards to keep up.
New York City’s Montefiore Medical Center must pay $4.75 million dollars to the Health and Human Services Department’s Office of Civil Rights for failing to secure patient data. Investigators found that the system failed to properly monitor its electronic health records, which left it unable to stop or detect a 2013 data breach until years later.
The IT business unit of UnitedHealth was hit with a ransomware attack in late February and has affected thousands of pharmacies, resulting in a substantial loss of revenue. With the network being offline, providers have had to use alternative clearing houses to submit claims. The American Hospital Association has urged the HHS to take action and make funds and resources available to affected providers.
The system's operating margin fell to -3% during the 2022 fiscal year, but has since stablized.
A recent study by healthcare advisory firm Chartis found that more than 50% of rural hospitals are currently operating at a loss, with 167 rural hospitals having closed or stopped inpatient services since 2010 and 418 currently in danger of closing.
Kirsten Largent, senior vice president of financial operations for OSF HealthCare, which serves rural patients in Illinois and Michigan, says the system's operating margin pre-COVID was 3%. During the 2022 fiscal year, the margin fell to -3%, which she attributed to significant workforce disruption.
Largent says the system's finances have stabilized since then.
"The trend of operating results improved quarter over quarter during fiscal year 2023, ending the year with breakeven operating performance," she says. "This was an improvement of over $117 million."
Largent credits the turnaround to a rebound in patient volumes, reducing agency costs, renegotiating managed care contracts, and strong performance on value-based contracts.
Adapting to the financial strain throughout healthcare, Rene Woerner-Utley, vice president of patient accounts at OSF, says the system focused on the patient's revenue cycle experience. As well as offering self-service payment plans for up to 36 months, the system implements text and email reminders and a billing chat bot on its website.
In addition to the billing chat bot being able to answer patient's questions about their statements, it can also triage and advise them about the right point of care for their health concerns.
"We use many vendors as extensions of revenue cycle to assist with some of the niche billing requirements," Woerner-Utley says. "These include, but are not limited to, vendors for workers [compensation] and third-party liability billing, second level clinical denials, low dollar account collection, and coordination of benefits collection, to name a few."
"We want to meet the patient where they are and give them access to these services 24 hours a day, seven days a week," she says.
When it comes to the patient financial experience, communication and transparency are key.
HealthLeaders recently held its virtual Patient Financial Experience NOW Summit, bringing together organizations to discuss the revenue cycle process from the patient’s perspective.
Revenue and finance executives from Avera Health, Community Medical Center, Ochsner Health, Vanderbilt University Medical Center, and VHC Health served as panelists throughout the day’s sessions.
With the event’s focus on the patient financial experience, panel topics ranged from patients’ preferred methods of communication, seeing patients as consumers, and simplifying the billing process.
Patient communication
During the first session, panelists discussed how their organizations have changed their approach to patient communication in the aftermath of the COVID-19 pandemic. John Zabrowski, SVP, chief financial officer, and chief strategy officer for VHC Health, explained how the system worked to expand its virtual presence as telehealth options became a necessity.
“Interestingly enough, we’d been working on it, it was on our road map,” he said. “But we are a smaller, independent healthcare system growing, so for us to have fully invested in it and get it up and running, we were pretty proud of that.”
Ochsner Health refined their text messaging campaign, sending reminders for important appointments or test results. According to Eduardo Benitez, director of physician billing, credentialing, TPL, and customer service, those efforts helped soothe the anxieties and stress that patients can feel when they try to contact their provider. Additionally, the system expanded their payment method offerings to include Apple Pay and the option to pay by phone.
Not overlooking patients in rural areas, Sarah Hartwig, patient access officer for Avera Health, expressed the importance of maintaining multiple channels of communication for patients and being mindful of those who may not be tech savvy or even dealing with a language barrier.
“We have immigrant populations, we have refugee populations. Language needs to be considered,” she said.
Patients as consumers
According to Melissa Woods, the financial journey begins with the patient, making sure that they’re educated and that they understand upfront what their costs are going to be. One way the system does this is through its financial resource center on its website, the associate vice president of revenue cycle at Ochsner Health said
Similarly, at Vanderbilt Health, Heather Dunn expressed that in addition to financial resources being available online, the system is also making efforts to expand its bundles program. The system goes to employers directly with their offerings so patients don’t have to pay out-of-pocket costs, which she says has been very successful.
The system also has a price estimate tool on the system’s website.
“We truly believe that patients should know their financial responsibility,” Dunn explained.
“Whether they choose to schedule with Vanderbilt or not, they should have a tool that helps them through their benefits, understand what their financial responsibility is going to be.”
Stress-free statements
The last panel of the summit dug deeper into billing practices, specifically how organizations can simplify their process and actual statements so patients understand what they’re paying for.
Ochsner Health’s Savanah Arceneaux, director of pre-service and financial clearance, discussed the system’s payment plan structure and the patient account customer service team that can set up plans on the back end after a patient receives a bill, as well as answer their billing questions.
“We also have financial counselors that can help set up payment plans at the time of service when patients check in and we’re not able to get that within our pre-service collections,” she said.
With patient's shouldering more of their healthcare costs, health systems are trying to meet them halfway.
Savanah Arceneaux (Director of Pre-Service and Financial Clearance, Ochsner Health) walked us through the system’s different payment plans, including future ideas to expand their payment plan offerings.
The pandemic brought an emphasis on patient preference when it comes to how they communicate with systems.
During the HealthLeader's Patient Financial Experience NOW Summit this week, one panel took a closer look at how the COVID-19 pandemic forced health systems to change their patient communication strategy, leaning more towards patient preference.
Check out the following following clip from the event.
Rather than a rev tech overhaul, use solutions to supplement your staff's efforts.
When implementing technology into your revenue cycle, staff support is vital to ensure a successful rollout.
When Boulder Centre for Orthopedics began using a revenue cycle acceleration platform for pre-collect payments, Director of Revenue Cycle Sherri Lewis’ main consideration was how it could make her staff’s jobs easier.
“I think every practice has their own culture and our culture here in Boulder is very much a “buy in” culture,” she told HealthLeaders.
There’s a misconception about rev tech solutions replacing staff, which Lewis acknowledged. However, she sees rev tech as an opportunity for staff to expand their own knowledge and help them work smarter, not harder.
“It’s [important] to show them the value [of the technology], get their buy in, and have them realize how it affects the whole practice,” she said.
Lewis gave the example of one revenue cycle employee who managed pre-collects and how the solution streamlined the manual tasks, enabling the practice to collect over $1 million in pre-collects.
“I don’t want my staff to think they’re going to be replaced, because we still need hands on the problem,” she explained.
There are still some tasks, like filing claims and denials management, that are still done manually; but with insurers implementing more tech solutions on their end, tasks like these are becoming more difficult and time consuming to accomplish.
“We do so many manual appeals, and I’d say maybe 25% of our appeals actually get paid,” Lewis said. “The office visits aren’t getting appealed unless we can do it in a batch type format.”
Some revenue cycle processes, like coding, require more expertise than others, but Lewis is in no rush to have AI or automated solutions handle them. While she may be excited about AI and evolving rev tech solutions, her goal is to have her staff be able to keep pace with them.
“If I had an AI company [do our] coding, would they pull the right strings? Would they not transpose numbers?” she asked. “Would they do it so great that we would all lose the ability to code after a while and just trust that they’re doing the right thing?”
Building a positive patient financial experience is the cornerstone to any successful revenue cycle.
Revenue cycle leaders must pay attention to each aspect of an organization's revenue cycle to have a prospering organization. Although there is an individual argument for streamlining each segment of the cycle, when it comes to improving the patient experience, it's imperative to put the microscope on the patient’s financial experience.
Now more than ever before, patients are responsible for more of their healthcare costs, causing stress not only on the patient, but an organization’s bottom line when pre or post service collections fall flat.
Luckily, there are three areas that revenue cycle leaders can place the focus on to improve these processes that will be featured during today’s Patient Financial Experience NOW Summit.
Let’s take a look at what revenue cycle executives from Avera Health, Community Health Systems, Ochsner Health, Vanderbilt University Medical Center, and VHC Health will be chatting about.
Patient Communication
Communicating with patients through their preferred method can benefit revenue cycle operations, and options like text and email front desk staff are able to focus on nurturing relationships with patients during face to face interactions. Panelists will discuss their organization’s approach to patient communication and how they leverage their staff in their patient experience.
Patients As Consumers
How can organizations tailor their revenue cycle operations to be more consumer friendly for higher patient satisfaction? By making the billing and payment process as easy as possible. Panelists will discuss price transparency efforts, billing statement clarity, and how payment methods like cash sharing apps can enable bills to be paid faster.
Billing Made Simple
This panel takes a more in-depth look at billing, particularly at how to simplify statements so patients know exactly what they’re paying for. Panelists will discuss ways they simplify their organization’s billing statements, as well as strategies to streamline data from process to process.
IT specialists are essential to seamless and successful revenue cycle operations.
To stay vigilant against the threat of data breaches and cyberattacks, health systems should look to their IT departments.
As technology advances and innovations like revenue cycle management solutions become more commonplace, IT specialists are becoming essential to streamlined and successful operations.
Bill Arneson, director of business operational transformation at Moffitt Cancer Center, has observed the growth of revenue cycle management technology and organizations’ increased interest.
“I think the biggest change is that now salespeople are getting executives excited about revenue cycle technology, which means [IT specialists] are meeting a lot more vendors,” he told HealthLeaders.
He adds that being able to filter through different vendors to sus out the ones that would best suit your organization makes the difference. For example, when talking to vendors, the goal is to see what their solution can and can’t do for the organization’s revenue cycle processes.
Questions IT specialists and leaders should be asking during vendors include:
What customers do you have that use our systems?
What struggles have you had with interfaces?
Will the vendor provide support for the solution or does the organization have to take over?
Regarding technological support, Arneson is in favor of having internal expertise so that the organization has ultimate control.
“If you have the knowledge internally, you can document it, you can share it amongst other people,” he explained. Doing so, he noted, also makes for a more secure and stable process.
Executives and C-suite leaders are taking notice of the critical importance of IT staff. Having spent the entirety of his career in IT, Arneson admitted that there are still those who believe it’s easier to say it’s too difficult to do something than look at creative solutions to grow the business.
“There is a newer wave of IT leaders that grew up from the operational side of business and weren’t just tech people,” he said. “I think those are the people that you need, someone that can speak business and IT to bridge those gaps. Those are the people getting stuff done.”
In his current role, he serves as an innovator and translator from the revenue cycle through business and technology. For roles like chief information officer or innovation officer, he said, they’re no longer just technical jobs; but rather business roles that leverage technology.
As the utilization of revenue cycle management solutions increases, other executives can benefit from furthering their understanding of technology and how it can be leveraged.
“You can do some cool things and I think healthcare people inherently understand that because they have all these medical devices that do wonderful things,” Arneson said. “They’re already fully bought into technology. You just have to show, as a technical leader, how this technology can help instead of being a debt you have to pay."
Over 288,000 disputes were submitted through the portal during the first six months of 2023.
Organizations have been struggling to abide by the No Surprises Act since it went into effect in 2022. Now, two years later, the number of surprise billing disputes is climbing higher and higher each quarter, according to data from the Centers for Medicare & Medicaid Services.
From January to June 2023, over 288,000 disputes were submitted through the federal independent dispute resolution, IDR, portal. The IDR has struggled to keep up with the substantial number of submissions since the portal was opened in 2022.
According to CMS, the majority of these disputes were initiated by a small number of providers, who have been vocal in their belief of insurers taking advantage of the law.
A previous HealthLeaders story examined the results of a survey of over 48,000 physicians, investigating how insurers use the law. Regarding payments for independent dispute resolutions in favor of providers, 52% of respondents said payments were never made, 49% said payments weren’t made within the 30-day period, and 33% said were paid an incorrect amount.
Staying on top of price transparency efforts and compliance is one-way providers and health systems to get ahead of payers and potential disputes.
“Reach out to peers to brainstorm on ways they have accomplished compliance, so you don’t need to reinvent the wheel,” Tina Barsallo, vice president of revenue cycle operations at Lifepoint Health, previously told HealthLeaders.
Revenue cycle executives are struggling to get staff and patients to get on board with emerging technologies.
An organization’s lack of communication and transparency to staff can pose a significant obstacle for a successful rev tech rollout. With the increase in cyber and ransomware attacks, patients are beginning to feel equally uneasy.
Findings from a recent Deloitte report surveying 60 healthcare executives show that consumer concerns about AI are a low priority for executives. 45% of respondents said they’re less concerned about educating patients about AI and its risks, and 50% not focusing on building consumer trust in the solutions.
A lack of transparency or change management strategy can negatively affect an organization’s staff. One common misconception when an organization begins to consider implementing a rev tech solution or platform into its processes is that they’re intended to replace staff.
While the report’s findings don’t confirm these ideas, it doesn’t deny them either. Upskilling workers, open communication, and transparency, and change management strategies were ranked considered some of the lowest considerations, respectively.
In a previous HealthLeaders article, Sherri Lewis, director of revenue cycle for BoulderCentre for Orthopedics & Spine expressed her enthusiasm for AI solutions but acknowledged staff’s concern about their job security.
“I don’t want to take people’s jobs away, but there is so much they could do on the other side of it, like collecting our outstanding accounts receivable,” she said.
In the future, Lewis hopes that tech implementation will be seen as an opportunity for employees to upskill and expand their knowledge, to be able to address tasks they previously didn’t have time for.
