How Anesthesiologists Can Keep The Revenue Cycle From Going Under

October 19, 2020 - Ensuring financial stability and maintaining a smooth revenue cycle has gotten harder and harder for independent anesthesia practices.

Many anesthesiologists are being forced out of networks as private insurers terminate their physician contracts with little to no notice, according to the American Society of Anesthesiologists (ASA). Furthermore, a new Medicare reimbursement rule is seeking to increase payment rates for certain services, which would mean cuts in other areas of the Physician Fee Schedule, including those most commonly used by anesthesiologists.

On top of all this, anesthesia practices are up against one of the greatest public health emergencies of the time – COVID-19.

A recent survey of anesthesia administrators and executive members of ASA found more than 90 percent of practice respondents reported case volume decreases by over 50 percent – most were at 70 to 80 percent – since the declaration of the national emergency and the cancelation of nearly all elective and non-emergent care.

Communities are resuming normal operations since the height of the pandemic earlier this year but coming back from drastic volume, and subsequently, revenue declines will be tough for independent practices. But it is not impossible – in fact, financial stability and profitability are still achievable goals for practices.

Strategies for overcoming COVID-19, other revenue challenges

Revenue cycle management optimization is crucial to overcoming the financial and operational challenges brought on by COVID-19 and other events in the healthcare industry, like unexpected payer contract terminations.

A critical first step in the optimization process is leveraging data analytics and automation to streamline revenue cycle processes and increase efficiency. Despite troves of technological advancements in healthcare, the revenue cycle is still a largely manual process. About 88 percent of providers, for example, rely on paper bills and statements to collect patient payments in this digital world. Consequently, most providers reported that collections usually takes over a month, making patient receivables a top primary revenue concern for respondents.

Seeking out improvements for employee utilization and operating room productivity is one way to leverage the data. A well-managed operating room not only results in high surgical turnover, but also reduced postoperative complications and improved patient-centric outcomes. Groups can achieve significant improvements in efficiency by analyzing operating room data and devising strategies for maximizing the most common delays, while subsequently measuring physician accountability, streamlining procedures, enhancing interdisciplinary teamwork, and collecting accurate data.

Technology solutions automate key revenue cycle management functions, like coding, payer follow-up for claims and the generation of patient statements, which can increase top-line revenue while reducing expensive labor costs and the risk of human error.

Since inaccurately billed cases could mean lost revenue, it’s important to utilize coding processes that accurately capture services to maximize base units, for instance seeking a system that automatically files the correct payer code combinations even when the payer is not known at the time of coding.

Additionally, practices can seek out partners to help automate revenue cycle management for optimal financial performance. Technology implementation is a hefty investment for physician practices, and practices have many options when it comes to point solutions for revenue cycle management.

Outsourcing revenue cycle management to a third-party partner can help practice leaders determine the right balance of automation and technology for their individual practice. The right partner, for example, can help practices overcome the challenges of disparate EHR and technology systems to optimize revenue cycle management without multiple, costly fixes.

Practices can also choose their level of integration with a third-party partner. One size does not fit all, and practice leaders can choose to outsource parts of the revenue cycle to a partner for optimal performance. This enables practice leaders to focus on bigger-picture opportunities to capture revenue and engage patients.

Focus on the patient as the new payer

While revenue cycle management optimization will support practice efforts to maintain financial stability, practice leaders should also keep an eye on the future of healthcare – increased consumerism and patients as the new payer.

Patients are becoming more responsible for the costs of care – annual premiums for families have reached over $20,500 a year and the average deductible has increased to $1,655 for single coverage, according to the Kaiser Family Foundation – and the COVID-19 pandemic is likely to push more costs to patients.

More than two of five working-age adults do not have stable health coverage because of COVID-19, the Commonwealth Fund recently found. Furthermore, one-third of this population reported having medical bill problems.

“Currently, anesthesiologists find themselves increasingly working in this new business-to-consumer model, and they need to transform themselves and excel in their ability to connect, bill, and collect from thousands of individual payers rather than scores of corporate payers,” says Mike Conklin, a regional vice president of business development with Zotec Partners.

Revenue cycle management optimization should prioritize the patient experience to safeguard practice revenue as patients manage higher out-of-pocket costs and demand more from their financial experience with providers. This could be especially important if Medicare decides to further reduce reimbursement rates for services commonly billed by anesthesiologists.

Patients are seeking more convenient, digital ways to connect with their providers and pay medical bills. To survive in the current landscape, practices should invest in consumer-facing solutions that patients can use to determine expected costs for services, pay medical bills, and connect providers with questions.

These solutions can also automate and improve front-end processes by engaging the patient early on with the financial experience. The more improvements on the front-end translates to less headaches and claim delays down the line.

“Anesthesiologists wanting to improve their patient satisfaction ratings, decrease bad debt, and gain an edge on the competition should create multiple traditional and non-traditional options to interact with patients, and especially taking into consideration the electronic and mobile demands of today’s patient consumers,” Conklin explains. “Whatever the direction, it is essential to no longer just believe insurance carriers are going to pay for services rendered and ignore the third largest payer…the patient, which ultimately affects the bottom line.”