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Managing revenue cycle in consumer-based healthcare

por John R. Fischer, Senior Reporter | July 18, 2022
Business Affairs
From the July 2022 issue of HealthCare Business News magazine

Healthcare is becoming consumer-centric, with patients demanding more choices in the entire care process, from scheduling appointments to how they pay their medical bills. New technologies like Apple Pay and shifts to value-based care are giving them a greater say here and making them feel more in control of their healthcare journey.

But for providers, this has introduced new challenges that have added pressures on their already tighter budgets and dwindling reimbursements. Additionally, they are facing higher labor costs, shorter staffing and the ongoing effects of the pandemic, all of which have forced them to reevaluate their care delivery models, including for revenue cycle management.

“Hospitals and health systems are struggling to keep the lights on because the cost of labor is going up and margins are going down. How can they invest in the future? How can they invest in programs to help define the patient population across the continuum with a longer return on the investment rather than an immediate one,” Dr. James Fee, co-chief executive officer of Enjoin, told HCB News.

Fee says that moving forward, providers will need to be more strategic in how they handle their expenses, revenue streams and patient demands. He and other experts sat down to discuss how providers can do this, while investing more in and enhancing their RCM operations.

The consumer experience
In the past, revenue was based on one encounter, which made reimbursement easy and immediate. But replacing fee-for-service with value-based care has made this more complicated with an exponential number of factors to consider, resulting in longer wait times for compensation. This has proved difficult during the pandemic, with budgets and margins waning more and expenses going up. Also increasing costs is the great resignation of workers nationwide, including nurses, doctors and staff at hospitals.

Meanwhile, consumers are thinking about expenses differently, seeking to pay medical bills retail style with their phones and iPads. They also want more flexible payment plans, billing transparency before care, and more effective communication with clinicians.

Casey Williams, senior vice president of patient engagement and payment applications for RevSpring, says meeting these demands is crucial to holding on to a customer’s loyalty. “Organizations are perfecting those experiences, so that you continue to walk back in the door and use their businesses. Healthcare is starting directly or has started to recognize that over the last two or three years.”

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