The revenue cycle of the future will put the patient first, a dramatic change of course that experts on the HIMSS Revenue Cycle Task Force say is direly needed in healthcare.
The task force on Monday unveiled its idea for a streamlined revenue cycle system in a digital infographic, the product of weeks of collaboration among key players in medicine, consulting and technology.
“Our vision is a fully transparent financial experience for the patient,” said John Showalter, CIO at the University of Mississippi Health Center and a member of the task force.
The group’s vision hinges on four major players in the patient’s revenue cycle experience — the patient, the provider, the health plan and financial institutions — and outlines a step-by-step experience for which the industry needs to aim.
First is the research, appointment scheduling and registration, a process that can be much easier for the patient through the creation of a Health Data Intelligence Hub that links all clinical electronic records with financial ones.
In this step, the healthcare provider receives the appointment request through the hub, confirms health plan coverage and gathers medical history, using the hub to collect information from outside sources.
The second step is a revamped check-in process, which is made to be very fast and lacking any surprises due to the info shared during the scheduling step and through insurance and other paperwork being managed digitally through the hub.
Step three is the discussion and planning that happens between the provider and the patient, which includes not only the clinical information but the financial realities of the care as well.
“What we learned is either the provider or the providers’ office really needs the patient financial experience in real-time as possible,” Showalter said. “If a physician orders a prescription and it’s a $150 prescription and you haven’t met your deductible, maybe they need to go with a secondary medication that’s not quite as effective and it’s $5.”
The last step is the check-out, and in the task force’s model it would be very much aligned with the patient’s electronic health record. Through the hub, the provider coordinates patient availability with provider availability to schedule appointments, follow up care and order medications. At this point, the patient should have full understanding of their financial liability and have sorted out payment or financing.
“We’re very much aware that with the 600 percent increase in high-deductible plans the financial burden on patients is frequently the reason that they don’t complete the care after visits. We don’t want that visit to be completed until those challenges are met,” Showalter said.
“For us the fundamental underpinning is the need to integrate the clinical situation with the financial situation and move most of that financial work to the front-end,” said Sandra Wolfskill, director, healthcare finance and revenue cycle, at the Healthcare Financial Management Association.
While some attendees the group’s vision as makes the process look easier than it really is, Wolfskill said the vision is really meant to lay the groundwork for more discussion.
“There are exceptions to every step,” she said, “That’s why this process is not an overnight creation. It takes time.”
Stuart Hanson, director at Citi Retail Services said most of the investment on the patient experience side has been on the clinical side, but the panel’s work aims to bring that focus to the financial side of care delivery.
The work now, is in refining the model and creating the technology to improve the revenue cycle experience as soon as possible.
“We currently lack the technology to get to our vision,” Showalter said.