How Emergency Departments Can Overcome Revenue Cycle Challenges

September 21, 2020 - The COVID-19 pandemic has exacerbated several of the emergency department’s most pressing challenges while creating new financial and operational obstacles for emergency providers to overcome. 

Foremost, emergency department (ED) visits declined by 42 percent during the early pandemic period compared to the same period the previous year, according to data from the Centers for Disease Control and Prevention (CDC).  Many groups saw volume losses in excess of 50 percent with pediatric volume losses of 60 to70 percent. While certain ED adult volumes are trending up or back to normal, the pediatric ED volumes remain down year over year.

While some of the decline indicated the success of shelter-in-place orders and other measures taken to stop the spread of the novel coronavirus, the drastic reduction also suggested that patients with serious conditions were avoiding the emergency department.  These lost ED volumes are unlike the losses in scheduled surgeries and procedures, which are and have been rescheduled. The ED volumes will not be rescheduled and are lost.

Such extreme reductions in emergency department visits also pose a major challenge to the sustainability of healthcare’s safety-net.  Over 20 percent of rural hospitals according to a 2019 Navigant study were financially insolvent pre-COVID-19 and when rural hospitals and EDs close mortality rates increase 5 to 6 percent in rural areas.

Many emergency departments in rural or underserved communities are seeing a decline in patient volume—likely a positive outcome from official recommendations to stay home. But this is one of several economic realities that puts emergency departments that already operate on razor thin margins in a precarious position and forces difficult decisions to remain operational, according to the American College of Emergency Physicians (ACEP).

Emergency departments are cutting benefits and reducing shifts to maintain financial stability. But ACEP likens these actions to “signing a ‘Do Not Resuscitate’ order for many emergency departments.”

Keeping the revenue cycle stable is key to maintaining that necessary and oftentimes the only source of care available to patients now and after the pandemic.

Automate revenue cycle functions

The revenue cycle is a complex, multi-step process that requires an entire team of staff members. During a pandemic, however, finding and keeping a team of qualified medical professionals is difficult.

With the volume losses and increased PPE and labor expenses, the Medical Group Management Association (MGMA) report stated that approximately half of physician practices had to furlough staff at the start of the pandemic, while nearly a quarter were forced to permanently lay off employees.

Hiring personnel to follow up on claim denials, aging accounts receivable, and patient statements is expensive and challenging for emergency departments in the current economic climate. Emergency departments are analyzing every cost and expense and cannot afford to increase revenue cycle management (RCM) costs in this environment.

Automation in the RCM process is key to reducing costs, avoiding costly errors and time-consuming workflows.

Emergency departments should implement RCM solutions that automate routine revenue cycle functions, such as following up with payers throughout the claims management process. Technology provides real-time follow-up, freeing up a smaller revenue cycle team to work on more complex, value-adding revenue cycle management activities. 

Avoiding “bolt on” applications and solutions also facilitates a direct communication link to enhance the patient experience—to meet patients where they are with texting, interactive voice response, call centers, mobile apps and live chat functions.

Bolster patient registration

Patient registration is oftentimes an emergency department’s weakest revenue cycle link.

Collecting accurate and complete patient information is a major challenge in the fast-paced environment of emergency medicine — and in many cases, it can be nearly impossible.

Yet, complete and accurate patient registration data is crucial to timely payment from both payers and patients.

The COVID-19 pandemic is only making this step in the revenue cycle more critical.

Two in five work-age adults do not have stable health coverage because of pandemic-related job losses, the Commonwealth Fund recently reported. Unemployment is at record levels and COBRA benefits are expensive to extend commercial health insurance policies.  With no apparent COBRA funding or relief coming from Congress, these unemployed patients — many of whom do not otherwise have access to healthcare — will convert to self-pay in states that have not expanded Medicaid and to Medicaid in the states that have expanded Medicaid.

Solutions that automate the aggregation of patient data and verify and/or identify insurance options can also support RCM optimization in a constantly evolving and unstable healthcare environment. 

Utilize business intelligence, data analytics

Emergency medicine is unpredictable, especially amid a global pandemic, but business intelligence and data analytics offer emergency departments predictability.

Tracking utilization, physician productivity, average days in A/R, and other top revenue cycle management KPIs is key to maintaining financial stability and revenue cycle efficiency, especially in emergency departments where volumes have declined and expenses increased to respond to the pandemic. 

Emergency departments should also strive to dive deeper into financial data.

Even prior to COVID-19, emergency departments operated on razor-thin margins due to a payer mix skewed heavily toward public payers. And for most emergency departments, the large increases in unemployment and commensurate losses in commercial insurance have placed additional strains on their economic model.

Understanding performance by payer, condition, or other variables allows emergency departments to quickly identify opportunities for improvement and adapt to sudden shifts in performance, which are likely to occur coming out of a pandemic.

Data dashboards in practice management systems and other business intelligence analytics also give providers the information they need to know about the future of their facilities. The tools allow emergency department leaders to employ a data-driven strategy for revenue cycle recovery after the pandemic.

Across these strategies, selecting a trusted technology partner is crucial. The right partner can offer the measures of predictability that emergency departments must have during an uncertain time. Jeff Fowler, National VP of Business Development in Emergency Medicine with Zotec Partners, agrees.

“Automation, business intelligence, and analytics are increasingly important for the survival of emergency departments, but a technology partner also needs to balance the provider’s need for real-time information with the delicate patient experience during a time of emergency,” he says.

Balancing both sides of the emergency department’s financial experience is key to overcoming the challenges presented by COVID-19.