Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Why Successful Healthcare Executives Focus on Education

By Jacqueline DiChiara

- The Affordable Care Act (ACA) aims to increase the number of people with health insurance by expanding Medicaid coverage nationwide. Are targets being hit or merely glossed over?

Medicaid coverage affordable care act

Medicare Part D beneficiaries make up the bulk of the Medicare population. Next year’s premiums are expected to “remain stable,” said the Centers for Medicare & Medicaid Services, at around $32 per month, a slight drop compared to the last several years.

But many patients still remain uninsured, according to research from the Kaiser Family Foundation:

Even under the ACA, many uninsured people cite the high cost of insurance as the main reason they lack coverage. In 2014, 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for public coverage. In addition, undocumented immigrants are ineligible for Medicaid or Marketplace coverage.

Ginalisa Monterroso, CEO of Medicaid Advisory Group, chatted with to offer insight into where healthcare executives are falling behind and what can be done to advance the industry.

READ MORE: Healthcare Execs Ponder Financial Impact of Possible ACA Repeal How can healthcare executives achieve greater savings and minimize overall losses?

Monterroso: Internally, all healthcare facilities should have an education component. Hospitals are losing money. Everybody's walking in with the wrong insurance. Everybody's walking in with the wrong drug coverage. What the executives are missing internally is that education component.

If they would just figure out a system where every person that walks gets a little screening to say, “Hey, you have the wrong insurance. This is not going to cover you,” and then make a recommendation.

Number one, you're going to get the patient to come back to you because you just gave them really great information.

Number two, they're not going to have an open receivable. They’re going to get paid for their services, for everything that they've done. Across the board, everybody's missing that education component because everyone needs to be educated.

READ MORE: Executive Order Calls for ACA Financial, Marketplace Flexibility What is primarily causing this general lack of education for executives across the industry?

GM: It's a very old model that people just inherit. For a CFO or CEO who was in the industry 20 years ago, nothing's changed. It's impossible for health facilities to stay up because they don't want to think outside the box to figure out what they need.

They don't listen to patients. There's just so much going on internally financially where they lose the person they need to focus on.

I would be so happy to maybe see a 30-year old CEO in a hospital. I know everything will be so condensed, technology really up to par, the system will be really fast.

But right now they say, "This is what I'm used to and everybody's just going to have to work on this model."

READ MORE: Healthcare C-Suite, Earned Incentive Compensation Down in 2016

We need to educate so when people walk into a hospital, they have the right insurance. The hospital complains, “We're losing money. We have all of these open receivables.”

Alright, so what are you going to do to fix that? You need to act. Make sure that everyone has the right insurance, knows where to go, what to do, and what papers to send.

If every healthcare facility was to invest in that, believe me, they would be winning in every way. What are end-of-year top focuses? How can we promote education across the board?

GM: At the end of the year, they're looking at money and looking at every patient who walked in with the wrong insurance where they were billed and got paid. Or they prescribed all this expensive medication and when they go to bill the pharmacy component, it wasn't covered.

We all have to let doctors be doctors and let them do their work, but also put in a system where executives are making sure there's checks and balances. There's a lot of awareness. Do we have a long road ahead of us? We do. People just need to be a little more understanding.

I always tell people it's not going to be 100 percent, but I honestly believe it could be 80 percent. And how do we get to at least 80 percent unless everybody is educating themselves?

The executives are internally fixing what may be the problem, which may be the admitting process, the insurance process, and still be able to give quality of care on the physician end.

Physicians and nurses start to get into the whole finance component because they feel like if they make this recommendation, it would be too expensive. We need them to just be medical and let them treat. Don’t put them in a position where they have to compromise their parents’ care. 


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