Healthcare providers and payers don't often see eye-to-eye on reimbursement issues. But that's ever the more reason to get them together in the same room, better yet at the same table.
That's what happened in Las Vegas recently, at the Symposium on Payment Solutions for Healthcare Providers and Payers.
During a roundtable discussion session at the Symposium, Joel Amar, a senior project consultant with Blue Cross Blue Shield of Florida, said payers must work to keep the lines of communication open with providers.
"We have provider liaisons with each of our hospital systems," Amar said.
Tracy Berry, senior vice president of revenue management, Centura Health in Denver, said one of the biggest challenges she faced was to create relationships with payers "so they believed our data from scorecards."
"You need to have regular meetings with payers to share data," Berry said. "We're working to automate our notification process, to streamline payers communications."
Christa Able, director of payer contracting at MultiCare Health System in Tacoma, Wash., said her conversations with payers typically revolve around "operational issues." Those discussions are focused on saving costs, she said, and often touch on reimbursement issues outside of the fee-for-service model.
"A change we're seeing in our discussions is a move away from the traditional fee-for-service model," Able said. "That's just not working anymore. We're talking with health plans about bundling payments, medical homes, methodologies that reward lower cost providers."
Berry noted that hospitals need to get very focused on metrics, and work on streamlining collection processes that are going to drive down costs.
Both Berry and Able concurred that the cost to collect outstanding balances is "astronomical." Berry said that one-third of Centura's bad debt placements are "balance after insurance." She said that discussions with payers had helped the health system focus more intently on point of service collections.
"We've doubled from one-half a percent of net revenue to 1 percent net revenue on the point-of-service piece, but that's still a small amount of money," Berry said. "The challenge of POS collections is often cultural. Hospitals in small communities know patients personally and its very hard to ask for money in those situations. Other hospitals don't have time to run the estimates at the point-of-service."
Developing standard processes for point of service collections is difficult, Able said, noting that this is another area where payer-provider dialogue can help.