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Paper Billing Remains Prominent Among Health Care Providers; Price Transparency Improves

 

In a Waystar and HIMSS Analytics study of patients who visited a health care provider in the last year, new trends in price transparency and payments were revealed.  In particular, a majority of providers continue to issue paper statements, and cost estimates at time of service reflect improvement in price transparency, according to a news release on the Patient Payment Checkup Survey.

“Our second annual survey reveals that the health care industry is at a tipping point. Patients want to understand their health care expenses given how much they pay out of pocket,” Matthew Hawkins, CEO of Waystar a provider of revenue cycle technologies, said in the news release.  “At the same time, providers are looking for ways to increase patient satisfaction and simplify their revenue cycles.”

Key findings from the survey, including over 1,000 patients and approximately 900 financial executives in the health care industry, are: Nearly 100 percent of health care executives report that they bill patients using paper statements, however over half of patients said they would prefer to receive and pay their medical bills electronically.

Eighty-five percent of patients responding to the survey felt the same responsibility to pay for health care as they do other services, however less than 20 percent who have commercial insurance plans found it “easy to understand and convenient to pay for” health care costs.  Waystar also finds that cost estimates from their health provider help patients comprehend what they owe. Eighty-six percent of patients who received cost estimates report they understood their payment responsibility, which ultimately helps with faster and easier payment for providers.

However, less than one-third of patients surveyed said they know to ask for a cost estimate at their healthcare provider’s office while 87 percent of health care professionals participating in the survey say that they are able to offer their patients a cost estimate upon request.  “The survey indicates a significant difference between patients and their provider organizations in terms of perceived payment timeliness,” Waystar reports. 

Nearly half (48 percent) of providers said that it takes their patients over three months to pay the full balance of their bill, versus only 24 percent of patients thinking that it takes them longer than three months to pay their balance. “This perception gap may lie in the timing of payer reimbursement.  Patients may believe that they do not owe anything until their payers pay their share,” according to Waystar.

“Our survey reveals that patient consumerism is advancing quickly as organizations adopt advanced payment technology,” Hawkins concludes. “Patients have a higher expectation than they used to have.  It is important that lagging health care organizations improve their patient billing and payment methods faster to remain competitive. 

Patients are already seeking health care from providers whom they trust with both their health and their pocketbooks.  Providers who don’t provide transparency and convenience will be left behind.”

More information: https://bit.ly/2svglBL

 

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The Path to a Partnership

Mergers and acquisitions in the health care sector are expected to be robust in 2018 and continue to grow based on strong activity in the market, and trends such as the shift to value-based care models.  According to the Corporate Advisory Solutions (CAS) fourth quarter 2017 newsletter (https://bit.ly/2KjAn9R), at press time, mergers and acquisitions in the revenue cycle management sector have “remained consistent and we anticipate seeing a high level of activity in 2018.

Technological advances will dominate the conversation for RCM companies and health care providers. 2017 required health care organizations to respond to several challengaes and transformative trends, including the political landscape change, growing role of technology, and shift to value-based care.  USCB America’s recent merger and acquisition of RevSolve Inc. and J&L Teamworks, two health care-related industry leaders, is an example of this trend and how to stay ahead in the competitive marketplace.

RevSolve, a Scottsdale, Ariz.-based company formerly known as Collection Service Bureau Inc., is led by Chris Becraft. The ACA member company founded in 1964 was rebranded as RevSolve, a firm that prides itself on being “the best-in-class revenue solution for health care providers,” according to a press statement on the merger and acquisition released by the USCB America.

J&L Teamworks, also an ACA International member company, was established in 1990 in Lodi, Calif., as a receivables management services firm that works with hospitals, medical groups, clinics and physicians. The company, which was previously privately owned and managed by two business partners, is now part of USCB’s family of employee-owned companies.  

“In today’s fast-paced and competitive environment, it becomes critical to look for avenues to retain tenured and successful employees and to broaden the services offered to our business partners,” said Albert Cadena, USCB America’s CEO and president.  The companies worked with CAS, a merger and acquisition advisory firm and ACA International member based in Philadelphia, throughout the process.

“In my almost 20 years of providing M&A advisory services to the outsourced business services sector, I have not seen a better fit culturally and operationally than what exists between RevSolve and USCB America,” Mark Russell, managing partner at CAS, said in a news release on the merger.  Cadena said the merger with RevSolve and J&L Teamworks was the opportunity he had been seeking.

“I have been searching for a merger/acquisition with companies who specialize in the health care side of our industry for the last eight years or so,” he said. “This was a direction and a goal we needed to move forward with in order to continue to be competitive in the marketplace, acquire talented employees and also to expand our geographical presence.”  Cadena added that the decision to seek agencies to merge with was motivated by needs of his clients in the health care space.

“Health care providers are seeking a partner to provide an array of services in revenue cycle management,” Cadena said.  “We also saw in the industry that smaller companies were seeking for an exit strategy and the expectations from the health care receivable side were making it difficult for some to compete.”  Meanwhile, Becraft shared his resolution for the future of the company.

“In deciding the next chapter of our 53-year-old company, we looked for a partnership that could bring further depth to our health care revenue cycle services, a commitment to expand our presence in Arizona, and a culture that complements ours and that of our clients,” Becraft said. “We nailed every criterion. We are also proud to now be a 100 percent employee-owned company as part of this merger, which is a tremendous benefit to current employees and a huge competitive advantage to acquiring the best talent for the future.

Our staff are really in top spirits about all of it. As employee owners, they have a chance to have more than just a career; they own part of the business.”  Like USCB America, RevSolve was also reviewing its strategic direction for the past few years and how it could capitalize on opportunities available through working with health care provider clients.

“We too needed to be larger, but more importantly, we need to be able to offer a deeper stack of revenue cycle services to our current and prospective clients,” Becraft said. “We had a lot of criteria that included market facing objectives, but also internal ones such as how can this help our employees grow in their careers with the company.”

With this in mind, RevSolve was faced with three choices, he said … “develop the services ourselves, acquire other companies or merge with a complementary company.”  And, according to Becraft, the merger makes sense given the same trend is going on in the health care market.  “Health care providers are merging at breakneck speed and their needs are growing ever larger and more complex,” Becraft said.

“The most successful revenue cycle companies are expanding their relationships across multiple lines of services with their clients.”  RevSolve and J&L Teamworks join a host of proud Employee Owners at USCB America, who offer a full enterprise of health care revenue cycle and management solutions, according to the press release from USCB. USCB America has been in business for over 100 years and has been an employee-owned company for almost two decades.

“In both J&L and RevSolve I have seen positive feedback for all the employees, as always the unknown is on the minds of all, and it’s up to USCB to continue on its path of bringing [us] all together as one family,” Cadena said. “I have seen a lot of employees excited about growth opportunities and the options to possibly transfer to other office locations.”

When asked his advice for other companies considering a merger, Cadena said start by taking a look at your long-term goals.  “For us it was to strengthen our family of companies and to continue to provide excellent service to our current and future clients,” Cadena said.

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How ASC’s Can Negotiate for Higher Out-of-Network Reimbursements

In recent times, ambulatory surgery centers (ASC’s) have been confronted with the challenge of effectively negotiating for the highest reimbursement rates on services rendered out-of-network (OON). This was not the case decades ago, specifically in the early 1990s, when providers didn’t have to negotiate on out-of-network services as they were fully reimbursed by payers.

Today, reimbursements for out-of-network services have become very complex. Payers have now developed many tactics to make it difficult for providers to receive their full compensation.

Amongst other tactics adopted, payers now hire vendors to negotiate the lowest reimbursement rates from providers. This has made it possible for providers to be paid very low rates, as low as 20 percent of the compensation due to them, if they fail to actively negotiate for the best rates.

Providers will therefore have to develop strategies to ensure they receive 100 percent of their reimbursements. Here are 2 tips to consider for a successful negotiation:

Be Deliberate and Persistent in Negotiations

When it comes to negotiating for out-of-network reimbursements with payers, providers must be both deliberate and persistent. Vendors hired by payers will do their best to discourage providers from receiving their reimbursements in full.

Vendors receive higher commissions when they successfully negotiate lower reimbursement rates for payers; as such, they would normally develop tactics to out-smart unsuspecting providers when negotiating on behalf of payers. 

Providers must therefore be proactive in the negotiation process. An experienced staff is well-versed in contract negotiation and should see to out-of-network negotiations with vendors. Your center can also recruit experienced out-of-network negotiators to join the company or be contracted to serve as agents for your ASC to negotiate with payers or vendors. 

No matter how long it takes, responding to each counteroffer and following up with appealed underpayments will make a big difference. Be persistent in the negotiation process by making multiple calls, sending emails, and even scheduling meetings to ensure that the highest possible reimbursement rates are received. This strong negotiation process should be employed even if your center has low volume of out-of-network patients.

Appropriate Use of Data

The effective use of data is another strategy that ASC’s need to consider adopting in order to effectively negotiate for higher reimbursement rates. One tactic that payers employ to give the lowest reimbursement rates to providers is offering a different rate for the same procedure previously handled by the provider.

For example, an insurance company that paid 70 percent on a similar case a year ago might want to now offer 40 percent. An ASC can negotiate for the same rate, or maybe even a higher one, if it has data on the previous transaction. 

Payers are often more proactive in collecting and keeping data than providers. Third-party vendors manage their data effectively and use it to negotiate the lowest reimbursements from providers.

Most providers however do not keep track of the data from their previous negotiations; hence the lower reimbursement rates. 

Therefore, if you want to increase your bottom line, learn to be a persistent negotiator and back your strategy with data. When this is done, out-of-network reimbursements can be higher than in-network reimbursements. Your center has the flexibility and opportunity to set higher reimbursement rates that can make up for low rates set by government payers.

 

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News & Notes

Seminar: Duties of Data Furnishers Under the FCRA

If you furnish data for consumer reports, you know the importance of applying the Fair Credit Reporting Act to your current business practices. ACA International will offer a CORE Curriculum seminar May 10 to help you incorporate the FCRA and Regulation V into your Compliance Management System. Participants will also learn how to recognize alerts and respond to claims of identity theft and fraud. Register here: https://bit.ly/2pInq0t

Health Care Prices Reach Five-Year High

Health care prices in February increased by 2.2 percent compared to 2016 and 2 percent in January, the highest rate recorded since January 2012, according to the Altarum Institute’s latest Health Sector Economic Indicators report.  National health spending increased by 4.6 percent compared to 2016. Altarum also reports the health care sector experienced modest job growth during the first two months of this year. https://bit.ly/2pHptCe

 

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Health Care Costs Continue to Impact Consumers’ Decisions to Seek Medical Treatment

 

A new national poll shows that the cost of health care continues to impact whether consumers seek recommended medical care or visit the doctor when they are sick or injured.  The survey, from NORC at the University of Chicago and the West Health Institute shows approximately 40 percent of respondents skip medical care and 44 percent said they didn’t go to the doctor when needed.

“The February survey of more than 1,300 adults offers new insights into how Americans feel about the costs of health care and how they report those costs affect their medical decisions and personal finances,” according to a news release from NORC at the University of Chicago, a nonpartisan research institution.

Other findings in the survey include:

About 30 percent of respondents reported that they had to decide between paying for medical bills or essentials such as food, heating or housing during the last year.

More people fear the medical bills that come with a serious illness over being sick (40 percent versus 33 percent, respectively.)

Respondents who said they skip recommended medical care were about two times more likely to fear getting sick (47 percent versus 24 percent, respectively) and the costs of care (60 percent versus 27 percent, respectively.)

“The high cost of health care has become a public health crisis that cuts across all ages as more Americans are delaying or going without recommended medical tests and treatments,” Zia Agha, chief medical officer at the West Health Institute, a nonprofit applied medical research organization based in San Diego, said in the news release. “According to this survey, most Americans do not feel they are getting a good value for their health care dollars, and the rising cost of health care is clearly having a direct consequence on American’s health-and financial well-being.”

Respondents to the survey also avoid medications due to the cost. “About one-in-three respondents report they did not fill a prescription or took less than the prescribed dose to save money. Dental care also suffered. Nearly half say they went without a routine cleaning or check up in the last year, and 39 percent say they did not go to the dentist when they needed treatment,” according to the news release.  They also experience financial consequences due to the cost of health care and medical bills are often unexpected.

Over half of survey respondents said they have serious financial consequences due to the costs of health care. The consequences include using all or most of their savings (36 percent); borrowing money or adding to their credit card debt (32 percent); and lowering contributions to a savings plan (41 percent.)  

Over half of survey respondents also said they received a medical bill for care they thought was paid for through their health insurance and a similar amount said they received bills at a higher amount than they expected. More than 25 percent of respondents said a medical bill was sent to a collection agency within the last year.  

ACA International members may find more information on health care collections and billing practices through ACA SearchPoint™ (https://www.acainternational.org/searchpoint) using the health care tag.

More information on the survey:  https://bit.ly/2GggwWK

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Top 3 Reasons Why Some ASC’s Fail

In today’s value-based setting, ambulatory surgery centers (ASC’s) are fast emerging as the preferred choice for outpatient surgical procedures. However, research by the Advisory Board shows that since 2009, nearly half of new ASC’s that open also close. 

The reality is that many surgery centers can falter if they fail to pay attention to critical areas of inefficiencies and risk.

Here are 3 common reasons why some ASC’s fail and how they can be avoided: 

1. Failure to Attract Cases with High Reimbursements

The ability of ASC’s to drive high case volume to their facilities has been identified as crucial to their long-term growth. In order to remain competitive in an environment with low reimbursements, ASC’s will need to target more cases with higher profits. 

Relying solely on procedures with low reimbursement rates will not position a center to stay ahead of the competition. ASC’s will need to expand their areas of specialization by adding new procedures with high reimbursements. For instance, procedures such as major spine cases and total joint replacements (TJR) have the potential to generate higher profits.

2. Failure to Prioritize Patient Care

The quality of care delivered to patients must be a major concern for ASC’s. This is becoming more important today considering the shift towards consumerism in healthcare. More than ever before, patient care is taking center stage as being one of the most crucial factors contributing to the success of a surgery center.  

A strong culture of patient care is required in centers to prevent infections, complications and low patient satisfaction ratings. According to Aziz Berjis, DPM, Founder and Director of Glendale Outpatient Surgery Center; the “patient care has to come first.” As long as ASC’s stick with a high level of quality in patient care they will continue to attract more patients.

3. Poorly Managed Contracts

Effectively managing payor contracts is crucial to the growth of a surgery center. However, centers face numerous challenges in successfully managing the contracts they have with payors. 

A common challenge is that ASC administrators are overly burdened with so many tasks that they are unable to dedicate the time and focus needed to effectively manage payor contracts, especially those that are soon expiring.

With careful planning, ASC’s can allocate more time to negotiating payor contracts. This can be done by either forming a team in the organization saddled with the responsibility of payor contract negotiation or by recruiting more hands if the present staff strength is low.

By paying more attention to payor relationships, ASC’s can negotiate contracts that will lead to significant cost reduction. This will in turn enable them to save more money to fund the growth of their centers.

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Healthcare Spending Expected to Increase at Faster Rate than Gross Domestic Product

The Center for Medicare and Medicaid Services’ Office of the Actuary projects growth in national health expenditures for 2017-2026 will be faster than the projected growth in the gross domestic product, according to a new report.  National health expenditure growth is expected to average 5.5 percent each year between 2017-2026.

“Growth in national health spending is projected to be faster than projected growth in (gross domestic product) by 1.0 percentage points over 2017-2026.  As a result, the report projects the health share of GDP to rise from 17.9 percent in 2016 to 19.7 percent by 2026,” according to CMS.  The prospects for national health spending and enrollment over the next 10 years are expected to be influenced primarily by key economic and demographic factors:

 

Trends in disposable personal income;

Increases in prices for medical goods and services; and

Shifts in enrollment from private health insurance to Medicare that result from the continued aging of the baby-boom generation into Medicare eligibility.

 

“[The] report from the independent CMS Office of the Actuary shows that healthcare spending is expected to continue growing more quickly than the rest of the economy,” CMS Administrator Seema Verma said in a news release. “This is yet another call to action for CMS to increase market competition and consumer choice within our programs to help control costs and ensure that our programs are available for future generations.”

Additional findings from the report, according to CMS, include:

Total national health spending growth: Growth is projected to have been 4.6 percent in 2017, up slightly from 4.3 percent growth in 2016, as a result of i) accelerating growth in Medicare spending, ii) slightly faster growth in prices for healthcare goods and services, and iii) increases in premiums for insurance purchased through the Marketplaces. In 2018, total health spending is projected to grow by 5.3 percent, driven partly by growth in personal healthcare prices.

Medicare: Among the major payers for healthcare over the 2017-2026 period, Medicare is projected to experience the most rapid annual growth at 7.4 percent, largely driven by enrollment growth and faster growth in utilization from recent near-historically low rates.

Private health insurance: Private health insurance spending is projected to average 4.7 percent over 2017- 2026, the slowest of the major payers, reflecting low enrollment growth and downward pressure on utilization growth influenced by: i) lagged impact of slowing growth in income in 2016 and 2017, ii) increasing prevalence of high-deductible health plans, and iii) to a lesser extent, repeal of the penalty associated with individual mandate.

Personal healthcare spending: Over 2017-2026, growth in personal healthcare spending is projected to average 5.5 percent. Among the factors, personal healthcare price growth is anticipated to be the largest factor at 2.5 percentage points, growth in the use and intensity of goods and services is expected to contribute 1.7 percentage points of total growth, and population growth (0.9 percentage point) and changing demographics (0.5 percentage point) account for the remaining growth.

Insured share of the population: The proportion of the population with health insurance is projected to decrease from 91.1 percent in 2016 to 89.3 percent in 2026, due in part to the elimination of the penalty payments associated with the individual mandate and also to a continuation of a downward trend in the offering and take-up of employer-sponsored health insurance.

More information: http://go.cms.gov/2HkbBEP

 

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3 Strategies to Improve Financial Relationships with Patients

One of the realities that US healthcare providers must face is the increasing number of privately purchased health plans. High-deductible health plans (HDHPs) have low monthly premiums but require patients to pay a high amount out-of-pocket for care.

With yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) for HDHPs capped at $6,650 for an individualor twice the amount for a family, most patients in the United States find it difficult to offset their medical expenses from a median household income of about $57,600. A survey by the Federal Reserve Board also showed that almost 50 percent of their respondents report finding it difficult to make an unexpected medical expense as little as $400.

This means that the greater financial risk (of default in payments by patients) has been shifted to providers. This situation calls for better financial relationships with patients who now have a significant responsibility.

Here are 3 tips to consider to build a better financial relationship with your patients:

1. Start Financial Conversation Early

Traditionally, providers delay the financial conversation until after care has been given to patients; although the clinical conversation is often initiated earlier on in the process. With the shift towards patient self-pay arrangements, providers need to start discussing patient financial obligations early in the process.

Providers need to open flexible and clear channels of financial communication with patients well before the care has been provided. Conversation on financial responsibilities should also be handled with finesse to prevent a negative response from patients. Payment options available to patients should be clearly stated without any hidden terms and conditions. In a value-based system, this will go a long way in building trust with patients.

2. Understand the Patient’s Ability to Pay

A major challenge with self-pay is that not all patients are alike with regards to their understanding and response to their financial obligations. While some patients understand the provider’s billing process well, others simply do not. In fact, for some, the process is seen as complex and confusing, which makes self-pay a rather tedious exercise.

Being able to understand patients well will help providers determine who needs more help regarding their ability to pay. In-house research can be conducted to segment patients according to their propensity to pay and to personalize the collection approach. Such research should be designed to elicit response from patients in the most transparent manner.

3. Introduce Patient Financing Option 

Identifying those who are most likely to default on payments is not enough. Providers need to introduce flexible payment and financing options to them in a friendly way. With the shift towards consumerism in healthcare, patients expect a “consumer experience” from providers.

Communication with patients about their financial obligations will therefore have to done with personalization in mind. Each patient should be able to access an automated online platform that offers customized information on their financial obligations and the flexible payments plans they can choose from. Providers that offer an outstanding consumer experience to patients will reap the rewards in their bottom line.  

At MnetHealth, we can help build a better financial relationship with your patients. We are experienced at optimizing self-pay collections by offering innovative financial solutions that simplify the payment process for both patients and providers. By leveraging our online platform, patients can access state of the art payment engagement solutions that will greatly benefit your practice.

 

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News & Notes

Revenue Cycle Trends to Watch in 2018

Medicare alternative payment models, value-based care and hospital mergers are among the top revenue cycle trends to watch in 2018, according to Revcycleintellingence.com. Providers are still in the midst of the transition to value-based care and the strategies for turning away from fee-for-service may continue to change in 2018. This transition will help providers attract patients through affordable, high-quality care in alternative payment models. http://bit.ly/2rkJCB7

 

CMS Announces New Voluntary Bundled Payment Model

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation announced the launch of a new voluntary bundled payment model in January. “Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform.  Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality,” according to CMS. http://go.cms.gov/2qQ7lc3

 

We Want to Hear from You

Pulse is published for ACA healthcare collection agencies to provide current industry information for healthcare providers. ACA International welcomes article ideas and submissions for consideration in Pulse. Ideas may be submitted to ACA’s Communications Department at comm@acainternational.org.

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Millennials Lag in Paying Medical Bills

Millennials Lag in Paying Medical Bills

Millennials are paying their medical bills at a slower rate than other generations, such as Gen X and Baby Boomers, according to research from TransUnion’s Healthcare Millennial Report.  “Despite the vast majority of Millennials having health insurance, they tend to pay their medical bills at a slower rate than other generations,” according to a news release on the report. “In fact, in 2016, 74 percent of Millennials did not pay their medical bills in full, compared to 68 percent for Gen X and 60 percent for Baby Boomers. 

Yet, seven in 10 Millennials said they would pay their medical bills in full if they had the money to do so.” TransUnion also found that 57 percent of Millennials have “little to no understanding of their health insurance benefits. This is significantly lower than other generations, including Gen X (50 percent) and Baby Boomers (42 percent).”

“Millennials are facing a tough road—in some ways they were placed at an early disadvantage compared to previous generations. As Millennials were just entering the workforce and likely had less disposable income, both insurers and employers began cost-shifting payments,” Jonathan Wiik, principal of Healthcare Strategy at TransUnion Healthcare, said in the news release.

“Despite these challenges, our research indicates that Millennials are indeed interested in responsibly paying their medical debts, while at the same time, healthcare providers will need to get innovative to make the payment process more manageable for Millennials.”

According to the report, including TransUnion healthcare data and information from an October 2017 survey of 1,576 consumers, about half of Millennials (46 percent) would be more likely to pay their medical bills if they had an estimate of their healthcare costs at the time of service with their healthcare provider.

“Healthcare providers looking to improve cash flow from Millennial patients should look for ways to encourage payments at the time of service while offering more educational tools to ensure they better understand the complex healthcare landscape,” John Yount, vice president for Healthcare Solutions at TransUnion, said in the news release. Additional findings from the TransUnion Healthcare report include:

35 percent of Millennials do not plan for medical or healthcare expenses as part of their budget.

51 percent of Millennials do not feel prepared to manage healthcare/medical expenses; compared to 42 percent of Gen-Xers and 33 percent of Baby Boomers.

40 percent of Millennials compare the cost of services by healthcare provider compared to 29 percent of Gen- Xers and 22 percent of Baby Boomers.

More information: http://bit.ly/2EVPrHj

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3 Tips That Can Help ASC’s Capitalize on Today’s Outpatient Growth

3 Tips That Can Help ASC-Mnet Health

The transition towards value-based care in the U.S. health system has accompanied the rise of Ambulatory Surgery Centers (ASC’s) which are quickly becoming the norm for outpatient surgery today. There are currently 5,500 ASC’s in the U.S. and this number is estimated to increase to between 8,000 and 10,000 over the course of the next decade.

With surgery increasingly shifting towards the outpatient model, hospitals and health systems are also expanding into the ambulatory surgery space by either partnering with ASC’s or establishing their own to increase surgical reimbursements. According to Regent Surgical Health, the volume of surgeries conducted in inpatient facilities between 2006 and 2013 fell by 17 percent, while those performed in outpatient facilities, including ASC’s, increased by 33 percent.

ASC’s can capitalize on this transition and see a significant increase in their revenue. Here’s 3 tips for ASC’s in an ever-changing outpatient surgery landscape:

1. Open New Doors of Partnership with Independent Surgeons

With an increase in demand for outpatient surgery, patients are looking for quality services at the lowest possible cost. ASC’s should consider entering into partnerships with surgeons to increase case volumes by being able to continually provide quality services at low cost. According to Marilyn Denegre-Rumbin, Cardinal Health's Director of Payer and Reimbursement Strategy, this partnership can take different forms. An ASC facility can partner with independent surgeons or those that work with both hospitals and ASC’s. Another form of partnership would be to offer ownership claims to those interested in partnering or looking to start their centers.

2. Target Private Payers

Private payers are known to prefer ASC’s over hospitals because of the lower reimbursement rates that go to ASC’s for similar surgical procedures performed in hospital settings. An ASC owner can take advantage of this by leveraging payer data to search for employers. The success of this strategy would however be hinged on whether it generates increased case volume to the center or not. And improving the quality of services offered to payers and patients is crucial to attracting greater case volume and revenue to a center.

3. Take advantage of the shift towards healthcare consumerism

Consumerism is fast gaining traction in the healthcare space as patients are taking advantage of the transition to value-based care. This is because of being able to freely choose between surgery centers that offer the highest quality at lowest possible cost. ASC’s must therefore understand how to attract greater case volume to their centers in a landscape centered on consumer purchasing preferences.

ASC’s also need to be aware that to succeed in this new landscape, they need to supply patients with information and decision support tools, financial incentives, rewards and other benefits that encourage personal involvement.

With patients finding it increasingly difficult to offset their out-of-pocket medical expenses, offering low cost payment options can be adopted by ASC’s as an incentive to drive case volume to their centers. For instance, a facility can offer a payment plan for patients unable to meet their emergency surgery expenses that allows them to make smaller installment payments spread out over a few months.

What Mnet Health Offers

At Mnet Health, we work to provide flexible payment options for patients and providers, especially for Ambulatory Surgery Centers (ASC’s) that rely on repeat business and referrals. Mnet Health’s flagship product, MedDraft offers a payment option that enables providers and patients to easily resolve patient medical bills through a short-term, zero-interest payment schedule. By leveraging the MedDraft online platform, patients gain access to an interest-free payment plan which can ultimately help drive greater case volume to an ASC facility.

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Financial Impact of Patient No-Shows

 

Case cancellations are bad news for any practice. Cancellations result in empty operating rooms (ORs) and wreak havoc with schedules. When patients fail to show up for their scheduled surgery, practices suffer a loss of time and resources, and their revenue is negatively affected. Reasons for patient “no-shows” vary from patient to patient and practice to practice - ranging from personal reasons, to medical and financial related issues. 

A survey by the Outpatient Surgery Magazine reveals that an inability to pay for surgery procedures, as a result of high out-of-pocket expenses, is typically the prime reason for case cancellation by patients. A stunning 43.8 percent of respondents attributed cancellations to their inability to meet their out-of-pocket medical obligations. Thus, many patients today make cancellations simply because they believe they are unable to afford medical expenses not covered by insurance.

In general, healthcare facilities need at least a 3-day cancellation notice to fill the schedule with someone else on their waiting list or offer the slot to another surgeon. The survey reveals that only 34.4 percent of patients cancel a few days before their scheduled surgery. Patients usually give too little notice - 46.9 percent cancel the day before the surgery and 15.6 percent cancel on the day of surgery.

While cancellations are inevitable, they pose a major challenge for practices when they become a regular occurrence. One noteworthy point is that a practice can significantly reduce their occurrence of cancellations by following best practices. Here’s 3 tips you can adopt to reduce cancellations by patients, particularly cancellations related to their financial situation:  

Engage with Patients Early 

Multiple touchpoint strategies such as having patients provide information on their health history online, collecting copays in advance, reminding patients before the surgery date through email, text, or phone call can be helpful to prevent case cancellations. However, practices likely need to probe further, as the decisions for cancellations are most often personal to patients. 

Even with plenty of patient engagement, many patients will still end up not showing up for surgery after several phone calls, email reminders, and/or automated text messages. Sadly, some decline to show up for a scheduled surgery even after consenting because they have not raised sufficient funds to cover for their medical expenses. Last minute cancellations would not be surprising under this situation. A medical practice needs to probe deeper by conducting some research or surveying their patients.

Know the Patient’s Ability to Pay 

Patients will not hesitate to cancel their appointments when they find that they cannot meet their financial obligations for a surgery. A “same-day cancellation” study was conducted at a teaching hospital and revealed that 71.6 percent of cancellations are related to financial issues.  One solution is to partner with a patient financial servicing company who can identify patients’ propensity to pay and offer financial services they can afford.

This will help sort out the complexities involved in coinsurance and copay arrangements. As such, many cancellations can be avoided altogether.

Collect Ahead of Time & Introduce Patient Financial Solutions 

Collecting copays, coinsurance and deductibles well in advance of a surgery is a key strategy to reduce case cancellations. Doing so; patients already have a measure of “skin in the game” and are therefore less likely to cancel. Collecting the patient’s responsibility can be done anywhere from 1 week to 3 days before the scheduled surgery. 

However, some patients might be able to pay their copay but have difficulty in meeting their deductibles. This is where patient financial solutions come in to play. A practice can implement zero or low-interest payment plans to ease the financial burden of patients. Flexible payment plans enable patients to easily settle their out-of-pocket obligations and serve as a motivation for them to show up on their scheduled surgery dates. 

Can You Predict and Eliminate Cancellations and “No Shows?”

Samaurai Physician thinks so.  Advances in artificial intelligence and analytics have allowed Samurai Physician, an emerging partner with Mnet, to accurately and consistently predict and eliminate cancellations and no shows.  Samurai Physician offers Katana – a “no show” solution that not only predicts the patients that won’t show but also makes use of “smart action” to cure the problem. 

What Mnet Health Offers

Mnet Health is highly experienced in optimizing self-pay collections in a responsible way through finance solutions that leverage technology to simplify the payment process for patients and providers.  What makes Mnet unique is the patient call center which ensures that both patients and providers achieve the best outcomes in patient collection through trained agents and intelligent use of patient ability-to-pay scoring technology. Mnet excels in patient financial education, offering sensible finance options and unparalleled focus on delivering a high-quality financial services experience to patients.

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