Policy & Regulation News

10 Standout Revenue Cycle Management Quotes of 2015

"Everyone in healthcare is smart. At the end of the day, can we do this? Yes."

By Jacqueline DiChiara

- Actions speak louder than words. But sometimes, the pen is indeed mightier than the sword. 

revenue cycle management ICD-10 king v.burwell

Here are 10 selected quotes (presented in no particular order), exclusive to RevCycleIntelligence.com from the last year that may make you stop and think. 

Talk of ICD-10 implementation, King v. Burwell, value-based care models, patient experience, CMS news, and EHR challenges made this year’s intriguing list.

10. Andrew Boyd, Assistant Professor of Biomedical and Health Information Sciences at the University of Illinois at Chicago:

You could be counting deposits and banks but call your variables apples and oranges which means nothing to someone else. ... 

When a clinician sees my three diagnosis codes map to five in a complex manner, they say, "I can’t run the report the same way. I have to make a new report." ... 

We want to make informed and intelligent decisions. ...

In five years will we love the data? Yes. …  We can train, educate, and dual code, but there’s a learning curve with 3 trillion dollars. That’s an expensive learning curve. …

Everyone in healthcare is smart. At the end of the day, can we do this? Yes.

9. David Muhlestein, PhD, Senior Director of Research of Development at Leavitt Partners:

Value-based models are not going to be the silver bullet that solves all of the healthcare cost problems in America.

But, they could lead to a lower growth in healthcare expenditures.

If you really are providing better care at a lower acuity setting then you’re going to end up with better health outcomes.

Value-based payments have a modest opportunity to lower the costs and a stronger opportunity to improve the quality of care.

8. Monte Sandler, Executive Vice President of NextGen RCM Services:

If you look at a traditional billing office, it’s a very reactive process.

Providers are providing care, documenting their services, and coding. A billing office is getting charges entered and bills out the door. Then, they basically wait until they get responses from clearinghouses or payers in the form of rejections and denials. Then, they react to those.

It’s a terribly inefficient process. It delays the payment cycle. It reduces the probability of payment. I’m a big proponent of flipping that whole cycle upside down to build a much more proactive revenue cycle.

Diligence is needed to scrub claims to make sure they’re clean before they go out the door. Every practice should know if a patient is eligible before the doctor sees the patient. … It’s solvable[.]

7. Gary Marlow, Vice President of Finance for Beverly Hospital and Addison Gilbert Hospital:

If the hospital is clean and the food is hot and presentable, it makes a difference to the patients. …

When patients come in the hospital, there’s usually either a health concern or a healthcare issue.

But for almost all of those patients, there’s a level of anxiety for them and their families. If a hospital has a cluttered hallway, what does that do to patient anxiety?

If there’s a clean hallway and the food’s presented properly, and they’re greeted warmly at the door – anything we can do to decrease anxiety is good for healthcare and patient experience.

6. Ralph S. Tyler, Partner Venable LLP, Former FDA Chief Counsel:

While the court’s decision in [King v Burwell] was undeniably an important one, it’s really a status quo decision. 

Was it really believable that Congress intended to deny subsidies to people who purchased insurance through federal exchanges, and what evidence supported that? What were the consequences of their position?

Were the Supreme Court to come out the opposite of the way it did, what was going to happen in the real world and what would be the impact on millions of people? …  To just brush that off and say Congress will take care of it was a pretty thin response.

5. Susan Feigin Harris, Esquire, Healthcare Partner at Baker & Hostetler:

The healthcare community needs certainty. … A lot of people have never heard of King v. Burwell, but they will be significantly impacted by the case in coming days. …

I don’t have the sense that there’s going to be an easy resolution. The American people have a right to look to Congress and say you need to resolve this, but I’m not sure that will come very quickly.

4. Josh Gray, athenahealth's Vice President of Research:

We don’t have a precise idea about how to optimize out-of-pocket obligations. Ideally patients would pay more out-of-pocket for services where the evidence of benefit is weak and paying less or nothing at all for services that are helpful.

The ACA has some unfinished work to do in terms of more carefully designing benefits structures so patients will not face financial pressures to skip beneficial care. 

It’s ironic that high-income, healthy individuals can receive care that might not have a proven benefit, but a person with lower income with serious diseases can only afford a high deductible plan and therefore have to pay more out of pocket when they receive care.

Therefore, they have to make some dreadful decisions about when to skip care that they can't comfortably afford.

3. Bruce Levinson, CRE’s Senior Vice President of Regulatory Intervention:

If a doctor's saying, "I get rated internally and if a patient gives me a bad rating, that makes me look bad – I'm going to soft-pedal it," why take the grief of having a patient potentially yell for trying to save their life? …

A rating system that encourages doctors to soft-pedal health information to patients is comparable to an education evaluation system that discourages teachers from challenging students.

Both avoid consumer friction but at a long-term cost to professional integrity and social responsibility.

2. James Spann, Simpler Healthcare's Practice Leader of Supply Chain & Logistics:

You have to have transparency with physicians, starting with product price and standardization and get them engaged, otherwise they’ll dig their heels in and say, “This is how I was trained. This is the product I’ve always used and I’m going to continue to use it."

Unless you have specific data and information to share with them, to drive down the total cost of ownership, they may lack interest.

Even if you have good data to share with them, they still may not be interested in making the change. That’s where the hospital executive leadership, and the clinical leadership need to be involved.

For the most part, doctors are reasonable.  They’re using a product because of its efficacy and quality, or because that’s what they’ve been trained to use. If they understand the total cost of ownership, doctors will be open to making different choices for the overall organization based on data and information.

1. Michael Creef, MD, independent family physician:

I picked EHR use up very quickly, was pleased with it, and was able to impart it to my colleagues.

Consequently, this has decreased the amount of time a patient was spending on paperwork and helped us to be able to get things rolling on a much faster basis.

Years ago, I said I wasn’t interested in electronic records. Now I’m not only interested in it, I’m teaching them, and I like it. …

You can teach old dogs new tricks, believe me. The oldest member of our group is 83 and even he’s come around to it. …

Things have changed. Physicians and other healthcare providers need to understand that they have to get on board with this, like it or not.