Shawn Yates

The right technology helps health care providers to weather uncertainty

March 21, 2017
On Jan. 20, Donald Trump became America’s 45th president, bringing with him a change in administration — the Republican Party now in control of the presidency, House and Senate. This means, among other objectives, that this administration has the ability to move forward with its GOP agenda for the health care industry. High on that priority list is a plan for far-reaching deregulation with a specific focus on repealing the Affordable Care Act.

While repealing the ACA suddenly and in its entirety is unlikely, repealing parts of the law is still predicted to leave more than 20 million Americans currently insured under the law without coverage. Republicans are already starting to move forward to quash significant portions of the law and recently, the Senate approved a budget resolution that defunds key monetary sections of the Affordable Care Act through a process known as budget reconciliation. This follows the game plan House Speaker Paul Ryan presented last year to dismantle the ACA over a two-year period.

Some of the key aspects of that plan include halting the expansion of Medicaid in those 19 states that have not yet implemented it, moving to Medicaid block grants and removing the CMS Innovation Center and the Medicare Independent Payment Advisory Board. It also includes eliminating individual and employer mandates, and reducing and restructuring the premium subsidies to payers that have helped consumers gain affordable coverage through the ACA’s insurance exchanges.

If these proposed changes take place, health care providers will find themselves with a new set of challenges to meet. Impacts to health care reimbursement over the next two years will cause out-of-pocket amounts to rise for patients, and tighter restrictions on Medicaid qualification will translate to more uninsured people and growth in high-deductible health plans. Let’s look at some of the key consequences of these changes and how technology can help health care providers weather the uncertainty.

Decreased profit margins
During the ACA’s creation, providers were forced to take reimbursement cuts to help pay for the program. This, combined with reimbursement losses for the more than 20 million people who will no longer have coverage, will create extreme pressure on providers’ already thin margins. Due to the budget deficit, it is highly unlikely Republicans will roll back those cuts, leaving providers in a position to do more with less by reducing their cost to collect to maintain positive margins.

Rapid growth of high-deductible plans
Employers will be forced to drive more of their workers to high-deductible health plans to survive the growing cost of health care. Providers’ dependency on the revenue generated by these health plans will similarly increase, meaning significant pressure on the accounts receivable process to bring in that cash quickly and efficiently.

How can technology help?
While these challenges may seem daunting, there is also opportunity. Working with the right technology and finding smart ways to integrate and automate processes can help health care organizations navigate these uncertain times, while continuing to focus on providing quality patient care. Providers should look to do the following:

• Integrate disparate patient accounting processes into one efficient system. Find a software solution that can easily take data from multiple systems and combine it into one single database. This combines your processes for efficiency and optimal performance.

• With a combined database, provide an easy, single-patient billing experience with many self-serve options to reduce labor-intensive patient accounting processes.

• Find key embedded data partners with the software that increases productivity through automated solutions, which increase productivity and cash recoveries. Finding the right technology helps providers to focus on the outliers and account exceptions, instead of spending time and resources you don’t have managing each and every one.

Take advantage of the constantly improving health care technology landscape and you’ll ways for your health care system to thrive no matter the shift in legislative winds.

About the author: Shawn Yates serves as director of healthcare product management for Ontario Systems, defining the company’s strategy for product and service offerings in the health care market. With over 20 years of experience working in the revenue cycle management space, Yates has a unique perspective on how technology can improve not only the provider, but the patient experience as well.