HFMA’s Dr. Jim Landman and Cerner’s Jeff Hurst Talk Revenue Cycle
As our industry shifts from volume-based to valued-based care, clinicians will no longer be paid for the services they provide, but instead the documentation of services they provide. That’s why clinical and financial alignment is essential.
Recently we spoke with Dr. Jim Landman, director of Healthcare Finance Policy, Perspectives and Analysis with the Healthcare Financial Management Association (HFMA), and Jeff Hurst, senior vice president of Revenue Cycle Management and president of RevWorks with Cerner. They discussed how technology, best practices, consumerism and market trends are evolving the revenue cycle.
Dr. Landman will share more insight during his keynote session at Cerner’s Revenue Management Symposium, 8 a.m., CST, Monday, Nov. 14: Market trends, regulatory change and the role of health IT: shifting to value-based care. Attend Dr. Landman’s keynote and nearly 50 other revenue cycle-focused sessions, at Cerner Health Conference Nov. 14-17, in Kansas City, Missouri.
Q&A with Dr. Jim Landman and Jeff Hurst
Why is revenue cycle management important to health care today and in the future?
Jim: Clinical and financial data are crucial as we move into the era of value-based payment and physicians become increasingly more responsible for capturing accurate clinical documentation. Also, the revenue cycle plays a critical role in helping patients navigate the system as they become more involved in the finances of their care.
Jeff: There’s more and more pressure for health care providers to improve their value proposition, which often translates to lower costs for consumers and lower revenue stream for providers. Providers need to figure out how to optimize their revenue and payment streams to ensure they’re collecting every single dollar they’re entitled to for the care they provide.
Managing the health of populations and overall business are closely intertwined. How will alternative payment models (APMs) and other challenges impact the overall ‘business of health care’ as the industry shifts to value-based care?
Jim: The biggest risk for organizations is to do nothing. Now is the time to experiment with APMs and dip your toes in the water. One of the big takeaways from recent CMS reports is that APMs take time. There is a correlation between the number of years an organization has spent in a program and its success with achieving savings under the accountable care organization model. What’s troubling our members is where do you transition, where do you shift from a fee-for-service base to a valued-based model?
Jeff: Transitioning from fee-for-service to valued-based care is really like jumping from one speeding train to another. But the reality of APMs is that they drive better outcomes, not just from a financial perspective, but from a clinical perspective as well. The better acronym for APMs would be, incentive payment models (IPMs). Organizations need to create incentives, measures and metrics of success that drive optimal performance to deliver the best clinical outcome for their patients that is also aligned with the economic incentive.
How is the role of the health care consumer changing, and how will it impact how health care systems care for their patients and run their overall business?
Jeff: The big buzzword in health care today is transparency. At the end of the day, consumers make decisions based on their individual finances. The biggest question is not how consumers will change, but whether they’re armed with the right information. The only thing worse than making a decision with no information is making a decision with bad information and the health care industry has a responsibility to better educate consumers to make more informed decisions.
Jim: The important thing to acknowledge is that the rise of consumer heath hasn’t really been a consumer-driven choice. Consumers are now in a position where they’re being asked to interact with the market, but prices and other information haven’t readily been available. Organizations can help consumers understand their financial responsibility and provide them with information that’s going to help them make the right informed decisions about their care.
How should organizations think differently in order to be successful in the next few years of significant change?
Jeff: First, there needs to be a stronger focus on the consumer. Not just from a clinical care perspective, but an information and education perspective. Second, organizations need to be more adaptable. Health care today is unlike anything I’ve seen or experienced in the past 20 years and it’s only going to move at a faster pace. Third, organizations need to understand how to leverage technology to optimize shifts in payment models and standardize best practice processes. Finally, creating clinical and financial alignment is essential.
Jim: Organizations need to take a hard look at their legacy services, what they’ve been doing well and not doing well. When organizations move to value-based payment models there’s a lot of investments in intellectual property, analytics, care management, etc. and they need to think about how they’re cutting costs, reconfiguring costs and being as efficient as they can in their traditional areas of operation.
What are some of the leading resources and tools that can help organizations navigate this change?
Jim: At the most general level, the revenue cycle needs to think about how it can automate, centralize and outsource strategically to free up labor resources to dedicate to the patient-facing side of the revenue cycle and make other investments that improve the consumer experience.
Jeff: The industry is changing at a fast pace and there’s no point in recreating the wheel if you can replicate processes that already exist. The more you can rely on peer-to-peer information or organizations like HFMA, and incorporate best practice recommendations into your clinical processes, the better. Technology evolution and integrated platforms are really the wave of the future and can help optimize your business and clinical outcomes.