The Healthcare Financial Management Association's Revenue Cycle Strategies Conference got underway Thursday with a series of preconference seminars focused on improving operations in the hospital business office.
Michael Nowicki, professor of health administration at Texas State University, warned hospital executives that they can't afford to cede outpatient care to physician practices. He said physician groups would likely continue to build their own outpatient surgery centers and other facilities, threatening hospital revenue streams.
"Hospitals must retain outpatient activity in order stay financially relevant," Nowicki said during a seminar titled "Healthcare Financial Essentials for the Revenue Cycle Leader." In a worst-case scenario, he speculated, hospitals would end up treating only inpatients, dependent on Medicare and Medicaid patients, while physician-owned facilities focused on high-dollar outpatient procedures.
Nowicki said hospitals must recognize that sometimes they are partners with physicians and other times they are financial competitors.
While identifying some of the top economic and political issues affecting healthcare finance professionals, Nowicki said U.S. healthcare spending in 2009 would probably fall somewhere between 18 percent and 20 percent of the gross domestic product. If healthcare spending grows at the same rate between now and 2050, he said, approximately 40 percent of the GDP will be spent on healthcare in that year.
"If that happens, there will be only two major components of the U.S. economy – healthcare consumers and healthcare providers," he said.
Another preconference seminar was dedicated to denials management. Led by Christine Fontaine, director of revenue cycle operations at the Shore Health System in Easton, Md., this seminar taught best practices for increasing health system revenue through denial reductions.
Fontaine discussed topics such as clinical charging, medical necessity reviews, identification of denials and using technology for denial capture.
A primary focus of attendee discussion was improving communication between the business office and clinical departments. Many attendees complained about clinical departments in the hospital that are authorized to bill for one procedure, but perform additional procedures that are later denied.
"It's true that clinicians need to communicate better with revenue cycle," Fontaine said. "Automation is key, and if you don't have tools like charge capture, you need to get them."