HFMA 2017: Experian’s Nicole Rogas says systems risk ‘financial distress’ if married to old RCM ways

An ever-changing world of reimbursement can be frustrating for those involved in revenue cycle management (RCM). Being too set in your ways to change, however, is one of the most common strategic mistakes seen by Nicole Rogas, MBA, senior vice president of sales at Experian Health.

Rogas spoke with HealthExec at the Healthcare Financial Management Association’s (HFMA) conference in Orlando on some of the challenges facing CFOs and other finance leaders in healthcare, how they can manage the gradual transition to value-based care and how worried they should be over the healthcare policy debate in Washington, D.C.

HealthExec: What's the most common complaint you hear from hospitals and health systems about their revenue cycle management?

Nicole Rogas, MBA: Doing more with less under new forms of reimbursement. Many clients are in acquisition mode, [taking on] additional facilities, outpatient care centers like ambulatory or post-acute care or new lines of business like standalone emergency departments. Rarely does patient access or the business office get additional lift to manage the additional volumes coming their way.

That is where innovative technology becomes key for RCM teams to create more efficient processes where touchless workflow is paramount. This facilitates the best utilization of staff where they are focused on working the most important issues. Improving productivity and managing margins can only come from a streamlined RCM process. For example, the average number of duplicate records on file at any given hospital is between eight and 12 percent. However, if an organization is making additional acquisitions, that percentage could be even higher, as there could be two to three health information management (HIM) systems that need to merge together. Many hospitals have dedicated HIM teams for managing those duplicates and reviewing those files manually, but that’s a pretty resource-intensive and expensive way of managing duplicate records. This process needs to be automated with the ability to precisely match data.

With today’s changing healthcare environment, the cost to collect is rising. Moving the patient collection process to the front of the revenue cycle is becoming increasingly important, so providers need immediate insight into a patient’s coverage. Tools that can provide insight into a patient’s financial situation, as well as their propensity to pay, will allow providers to optimize their collection strategies from patients.

Lastly, providers should make sure their RCM partners provide ROI metrics to prove their returns and get additional funding to purchase additional tools they need to achieve their goals.

What common mistakes in strategy and planning for revenue cycle management do you see health systems making, and how would you advise them to fix those problems?

Too many health organizations seem to just rely on what has worked in the past and don’t take a proactive approach to evaluating and streamlining their RCM process and improving their day-to-day workflow. The clients I see who wait until a situation where change must happen put their teams under pressure and unneeded stress, as well as putting their organization through unnecessary financial burdens. Often we see systems that have had great processes and margins, but they don’t continue to evaluate their process and eventually find themselves in financial distress. Trying to replicate old processes and old workflows in either a new system or in new business models doesn’t work.

To truly optimize revenue cycle management, especially in an era with shrinking margins and increased complexity, you must transform the way business is done to maximize the benefit of the tools that have been acquired. This, again, is where having a trusted RCM partner is crucial to help provide insights about RCM tools and workflow and evaluate if they are being utilized properly.

Providers also need a unified approach across their systems to revenue cycle and patient engagement. Providers need to implement a disciplined, strategic planning processes, set their core objectives and then unify across IT, revenue cycle Management and finance to achieve their goals. We often find our clients work in a segmented approach, with patient access leadership and patient accounts leadership not working on the same team.

As systems gradually transition fee-for-service to risk-based payment models, how do CFOs and healthcare finance leaders balance the payor mix? Is maximizing revenue possible in that situation?

First and foremost, it’s important to acknowledge that the tail on fee-for-service reimbursement is likely to be longer than we’d care to admit. Many of our clients are shifting to risk-based contracts for specific care bundles while still managing the bulk of their business in a traditional fee-for-service world. So it’s important, in the interim, to ensure they are still able to focus on both payment models.

Moving forward, as health systems take on more risk-based payment models, I think the conversation shifts to balancing their patient populations and managing the health, not just the care, as well as keeping the loyalty of those populations will be a larger factor in their revenue cycle, than trying to perfect the payor mix situation. In all likelihood, clients will still have multiple payors to manage.

The winners in that scenario are the health systems that can understand their populations and how to best engage them, understand the health status of those populations and understand how well they can manage the health of those populations. Their ability to use analytics – especially predictive analytics – will drive how well they’ll be able to negotiate at-risk contracts in the future and, thereby, maximize revenue.

You're leading Experian's sales team and I'm sure talking to clients all the time. Truthfully, how worried are finance leaders about all the policy changes in healthcare, whether it's MACRA or the prospect of the Affordable Care Act being repealed?

Health care systems and finance leaders in general are used to lots of regulatory change in the healthcare sector. They continue to have to respond and adjust to regulatory demands, market changes, declining reimbursement models and payor changes over the last 10 years that keeps these leaders in an ever-changing world with new pressures each day. How worried are they? It depends on the C-level leader. We have yet to see the impact of these changes so I think the ones that are prepared, yet strategic, in the decisions they make in the coming months and years will be positioned well as we start to see the changes take effect.

Specific to the ACA repeal and replace, I think there’s some concern. Clearly the current proposal introduces the potential for additional uninsured patients for many health systems.