Becker's Hospital Review

26 EXECUTIVE BRIEFING 2 EXECUTIVE BRIEFING SPONSORED BY The recipe for better RCM: a holistic view, actionable data and a trusted partner W hen the COVID-19 pandemic hit in 2020, elective procedures and other noncritical patient visits decreased to almost zero. This gave administrative teams at hospitals and health systems an opportunity to take a long, hard look at how they were handling the revenue cycle. Today, elective procedures and routine visits have resumed but healthcare organizations continue to experience intense financial stress and many wonder whether operations will soon become unsustainable. As such, healthcare leaders are seeking better ways to handle the revenue cycle. The key to more effective revenue cycle management is getting back to basics with people, processes and technology. Becker's Healthcare recently spoke with two healthcare experts from NTT DATA Services — Dr. Navesh Kandiyil, Healthcare Industry Consulting Director, and Rathish Moorthy, Healthcare Industry Managing Director — to learn more about how to overcome obstacles in these areas. It's time to look at the revenue cycle holistically Silos are an unfortunate reality when it comes to RCM. Every segment of the revenue cycle tends to be examined individually. Instead, healthcare organizations must take a holistic view — this is the only way to see the big picture, connect the dots, eliminate redundancy and maximize value. "The revenue cycle ties to other aspects of the enterprise," Mr. Moorthy said. "You have to look at the broader financial department, along with clinical operations, managed care and even supply chain. You need to have those deep dialogues to get a complete view." Dr. Kandiyil agreed, noting how looking at the revenue cycle holistically allows for cross-departmental alignment. "Two teams might inadvertently be doing the exact same thing because they aren't talking to each other," he said. Automation is one way to improve the employee experience Every element of the healthcare workforce is being taxed in brand new ways. Administrative employees are overburdened — not only due to the volume of work they face on a daily basis, but also due to the nature and complexity of their tasks. "When you look at burnout, a lot of it comes from the work that is on people's plates today," Dr. Kandiyil said. "The other element is employees realizing that they can get a job at a local store with a similar salary and half the headaches and stress." He emphasized that turnover in the front-end revenue cycle workforce is very high, largely due to the burden of tedious tasks like scheduling, registration, eligibility, enrollment and checking for benefits. One potential solution is to automate portions of the revenue cycle, such as scheduling, insurance verification, claims processing and denials management. To identify opportunity areas, teams must compare their ideal state to the current state. The goal is to enhance the revenue cycle and also to improve the employee experience. "Automation can improve work-life balance for teams and reduce employee fatigue," Dr. Kandiyil said. "You want to leverage technology in ways that make people feel that their work is meaningful." When evaluating the role that people play in the revenue cycle, however, organizations must use caution. Dr. Kandiyil advised not to present opportunities for change in ways that could be perceived as criticisms of how employees are doing their jobs. "The goal isn't to point fingers," he said. "It's a 'how do we all get better together' journey. If you don't lead from the front with these expectations, you will put pressure on frontline workers and leaders." Process enhancements maximize revenue and team performance Revenue leakage is a significant source of risk for hospitals and health systems. To address this problem, organizations need full visibility into their revenue cycle processes. "You're employing staff to do a job, but you may not be getting an ROI because they're set up to fail before they've even started," Dr. Kandiyil said. A good first step is to analyze whether all stages of the revenue cycle are communicating with one another. Dr. Kandiyil highlighted an example: How the bulk of denials come from the front end — where organizations leave a lot of money on the table — but oftentimes, no one in the front end is aware problems exist until someone from the back end tells them a denial occurred. To identify where improvements are needed, teams must have better insight into the process overall, he reiterated.

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