Navigating Uncompensated Care
By Jay Mason
Despite decades of efforts around improved revenue cycle management, hospitals across the US are still struggling with levels of uncompensated care that threaten their viability and vitality. Much of that low-hanging fruit has been harvested. Hospital executives looking to further reduce uncompensated care will have to look toward solutions that enable innovation and leverage technology.
The chorus in the healthcare industry has been to treat patients with the right care, in the right setting, at the right time. If we’re serious about that mantra, there needs to be renewed focus upon the most basic yet overlooked part of the patient experience: scheduling. More specifically, that focus needs to be on scheduling connectivity, or getting patients through to the next step in the continuum of care.
Having an effective strategy around scheduling connectivity — both inside and outside of the hospital — is essential to capturing revenue and reducing the costs of uncompensated care. Simple referrals, most would agree, are not enough. Appointments can and should be made instead. It’s possible to achieve this goal realistically, through a combination of better communication, greater awareness of available physicians, and adjustments to staff workflows.
Hospitals are still relying on patients to schedule important follow-up appointments on their own. Sometimes patients will, but often they won’t. Hospitals that are looking to keep patients within their system need to confirm follow-up appointments with their physicians before patients leave their walls, or they may not get a second chance.
From a cost perspective, uncompensated care is driven largely by uninsured patients who continue to use the emergency department for walk-in care because they are not effectively connected to community-based providers, such as FQHCs (Federally Qualified Health Centers). As for inpatient care, hospitals are facing new pressures to ensure patients are getting the right follow-up care, as penalties for hospitals readmissions will become the norm.
To address these issues, hospitals need to embrace the goal of scheduling connectivity. Effective scheduling connectivity starts with ensuring that physician offices are willing to allow trusted partners to access their available appointment slots. This must be done with great sensitivity to the needs and preferences of those providers. Physician offices won’t open up their schedules for others to access if they feel as though they are losing control of their calendars. Rather, scheduling connectivity should strive to ensure that physician offices are given the tools to better manage their calendar.
Effective scheduling connectivity also means that patients obtain a confirmed appointment before they leave the hospital. In other words, submitting a request for an appointment or making a referral isn’t enough. The loop must be closed, or the risk is great the referral will never result in an actual appointment.
What do hospitals need to do in order to achieve the goal of scheduling connectivity? The solutions involve creating effective electronic links between provider schedule solutions. But technology alone is not enough. Hospitals will also need consultation to understand the unique and dynamic nuances that match needs and preferences of both the physicians and patients.
Jay Mason is CEO of MyHealthDIRECT of Brookfield, WI.
By Jack James Dio
Redbox recently e-mailed me to tell me about a hot new release called Drive Angry on DVD and Blu-Ray. It’s a Nicolas Cage movie I somehow missed, but check out this summary:
An undead felon breaks out of hell to avenge his murdered daughter and rescue her kidnapped baby from a band of cult-worshipping savages. Joined by tough-as-nails Piper, the two set off on a rampage of redemption, all while being pursued by an enigmatic killer who has been sent by the Devil to retrieve Milton and deliver him back to hell.
This is one of the most ludicrous premises I’ve ever read. Naturally, I can’t wait to see this movie. I know going in it’s going to be horrible, but I can rent it for a dollar. The dollar is the deciding factor.
But I love the fact that someone funded this idea. It pleases me that capitalism is at work.
Someone went into what I imagine are highly fancy offices of movie makers and said something to the effect of, “Hey, this one’s got Nicolas Cage as an undead felon who breaks out of hell. Of course, he’ll be pursued by an enigmatic undead killer.” And in response, a guy smoking a cigar and wearing a pinky ring and shiny black shoes yanked out his checkbook and replied, “Let’s get started! I’ve always wanted to make a flick about a rampage of redemption.”
If someone’s going to hand over money to people with ideas — good or bad — then the people with ideas will take it. People take the money and they always will.
This is where we are now in healthcare technology. If you’re in the mood to read a 32-page document on that, see PwC’s recent paper called The New Gold Rush.
Everybody wants in. This by definition means there will be a higher percentage of bad ideas making the rounds. More bad ideas are here, and there are more coming. Very few will pass the elusive acid test of being able to answer a simple question: do I really need this?
How long, for example, until there’s an iPhone application to let you take a picture of a funny-looking mole on your arm and tell you if it needs to be seen by a specialist? Will the fear in your heart from an erroneous “uh oh” message back from that iPhone app be worth it when you could’ve already been to the dermatologist? Or to your patient medical home, which I like to call an internist? (Incidentally, if there’s already an application for this, please don’t hold it against an undead felon like me.)
I’m not prophetic, but a lot of bad ideas are coming soon to a facility near you.
The current healthcare IT landscape reminds me of LinkedIn and its ever-present recommendations. Everything is recommended and spoken highly of. There’s little objectivity, and few are willing to say, “Wait a minute — this product stinks.” Or, “Sorry, but this cat cannot do that job!”
Where’s the balance? Where’s someone to say plainly, “We don’t need that?”
Probably 12 years ago as part of a VC gathering, I heard the Gomez in Gomez Advisors present the company’s rankings of Internet stockbrokers, banks, mortgage lenders, and credit card issuers. I don’t remember the criteria, only that it seemed oddly biased.
After some audience questions, it turned out that Gomez also consulted with more than a few of the companies he was ranking, which smelled funny to a room full of CTOs and CIOs.
When he finally sat down, he looked over at a table near where I was sitting, loosened his tie, and said, “Man, tough crowd.” He didn’t like the hot seat he found himself on, but he also didn’t change anything in his approach because it made money. (Full disclosure – Gomez Advisors was bought by Compuware in 2009 and it has an array of products for Web and mobile application management, including an EHR tool.)
Who’s going to help make this tidal wave of interesting but unnecessary HIT products and services manageable? Who has time? And does anybody really care?
After all, some things simply don’t change, like the inescapable fact that Nicolas Cage makes plenty of awful movies and will continue to do so. The difference, it seems, is in the price of admission.