“Speed to innovate must never be the same again in healthcare. We can identify, analyze, and act to address opportunities quickly and must do so in a new healthcare world that will require a delicate blend of agility and compassion.” - Jason Wolf, CEO, The Beryl Institute, Nashville, TN¹
COVID-19 has shut off major revenue streams for healthcare providers – by some estimates, U.S. hospitals are losing $50 billion each month²– and the future rebound of patient volume is not guaranteed. While guidance from the Centers for Medicare and Medicaid Services (CMS) on April 20³ allows for scheduling non-emergent, non-COVID-19 healthcare services again, how and when each health system ramps up those services will vary widely by location, driven by each region’s COVID-19 caseload and by service line, understanding that some electives are more elective than others.
As the volume of active COVID-19 cases subsides, health systems may experience two very different scenarios: 1) a huge influx of elective appointments across the board or in specific service lines, which could overwhelm available capacity; or 2) an ongoing drop in demand due to patient fear and anxiety. Add to the mix, new patient expectations for telehealth and mobile self-service – capabilities that quickly became more prevalent during the crisis.
Successful health systems will move beyond point solutions to transform and enable processes with purpose-built technology for patient acquisition, booking management, intelligent analytics, and automation – drawing patients back to their health system and optimizing utilization across all resources and settings. With four critical considerations in mind, health system leaders can navigate this uncertain recovery period:
Each health system has its own phased approach for resuming normal services, depending on the status of COVID-19 activity in their region. The key question is: How do I respond quickly and flexibly to either optimize my capacity utilization or generate more volume? In such a fluid environment where the COVID-19 caseload may continually fluctuate, you need to be able to respond quickly to determine what services should be available, while leveraging all care options, such as telehealth. In addition, you need to continue to minimize contact using remote and self-service options – all while managing virus screenings and ensuring staff and patient safety.
Prior to the pandemic, health systems often had limited visibility into their capacity across all resources, let alone how it was being used. Now more than ever, you need a reliable line of sight into your health system’s supply of available appointments, across geographies, modalities, and care settings, to not only utilize it effectively, but also ensure patients and referring providers don’t end up frustrated with long wait times.
The challenges associated with matching the right patient with the right resources under the right clinical/administrative circumstances – including billing and insurance requirements – have only increased. For example, now that more care is being delivered virtually, are you equipped to guide patients to telehealth visits when that setting is most appropriate for their needs? If there’s a big influx of demand for MRI services and your schedule fills up at certain locations, can you adapt quickly? Can you see how to balance utilization better across locations? What if you increased hours at the busiest locations and paid staff overtime? How will you ensure authorizations and other administrative functions don’t create bottlenecks?
With timely data and analytics, you can make real-time decisions about hours of operation, staff overtime, and care settings (including telehealth) across service lines and locations to match capacity with current demand on an ongoing basis. Add to that technology tools that digitize and automate the entire process from orders and scheduling through intake, while giving patients mobile self-service access on their own devices. In parallel, those technology tools enable referring provider staff to act on behalf of their patients, while staying informed about the care patients receive. With that, you can emerge from this crisis markedly better positioned than before it began.
Historically, healthcare providers may have had data that showed when volume was down but little insight into what action to take to correct it. After such dramatic volume reductions as the industry has recently experienced, actively managing the demand side of the equation is just as important as managing the supply side. For many health systems, that means managing demand that returns organically while simultaneously pursuing demand that might otherwise be lost.
The key is an in-depth understanding of potential demand in your community. This requires systematic analysis of your order and referral backlog, canceled appointments, and other unfulfilled services, along with historical trends by service line across the enterprise. The demand may vary considerably by service line as some elective services are more urgent that others, for example cancer treatments versus age-based diagnostics, like colonoscopies. Across the board, consider adjusting care processes to leverage telehealth, for example by offering preparatory or follow-up care as virtual visits as appropriate.
Armed with that information and workflow tools, such as electronic orders, automated prior authorizations, and worklists, you can efficiently prioritize more urgent services, identify outstanding orders and cancelled appointments, review revenue cycle tasks, update lapsed authorizations, and get those patients rescheduled as quickly as possible. For less-urgent electives, those data analytics and workflow tools can also help you proactively contact and book patients with unfulfilled services. Making sure patients receive services in a timely manner requires ongoing insight using current metrics, such as underutilized capacity and third-next-availability.
The “new normal” for healthcare in the U.S. and the best path toward regaining lost revenue is for health systems to actively assess demand and available capacity – and optimize for both. That means proactively reaching out to the community of consumers, patients and referring providers to assure them it’s safe to come back to your health system. Highlight measures in place that provide both safety and convenience, such as:
While communicating these fundamentals, you can proceed with outreach on two critical fronts:
Reschedule Current Patients: Contact patients directly who either had scheduled services cancelled or had orders/referrals for services left unfulfilled.
Reach Out to Providers: Give special attention to referring providers, including personal contact (via virtual meetings and phone calls), to not only inform them about safety procedures and services available for their patients, but also services that make it easier for them, such as electronic orders, scheduling on behalf of their patients, authorizations, patient self-service, plus ongoing patient status information.
For health systems to survive the industry upheaval created by this pandemic, they need to do more than simply hang out an “open for business” sign. Prior to the pandemic, most health systems had limited aggregate data and lacked visibility into factors such as appointment capacity and resource utilization across the enterprise. What’s needed is a rigorous plan to proactively engage their constituents and bring back volumes. Doing this well in midst of a 100-year transformation of healthcare supply and demand requires having the analytical sophistication in place to attack the problem systematically and flexibly while delivering experiences that foster patient and provider confidence and loyalty. A true partner who can deliver purpose-built tools and hardwire market-leading expertise throughout the patient’s revenue cycle journey will provide a significant competitive edge while navigating financial recovery through uncertain times.
1. Molpis, Jim.. What Will Never Be The Same Again in Healthcare? , Health Leaders, April 28, 2020.
2. Chang, Alisa. “U.S. Hospitals Hit By Financial 'Triple Whammy' During Coronavirus Pandemic,” NPR, April 23, 2020.
3. Opening Up America Again. Centers for Medicare & Medicaid Services Recommendations, April 20, 2020.
As R1 RCM’s Senior Vice President of Product and Technology, Joe Polaris leads the company’s product strategy development and roadmap execution. He has been with R1 RCM for 12 years and has developed deep front-line revenue cycle expertise holding positions such as Revenue Cycle Site Lead and Director of Operations, where he built innovative end-to-end processes that have increased the financial stability for hospitals and health systems.