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More risk shifting to hospitals, pressuring revenue cycle, experts say

Consumerism is also posing a risk challenge for healthcare, as insurers hold the reins on information on deductibles that providers could use.

Susan Morse, Senior Editor

Joe Nichols of Health Data Consulting questions Mayo Clinic revenue cycle chief Mark Norby.Joe Nichols of Health Data Consulting questions Mayo Clinic revenue cycle chief Mark Norby.

The boundary between being a provider and a payer is blurring as hospitals face more risk, according to Joe Nichols of Health Data Consulting, prompting health systems to make changes to keep from losing too much money.

Nichols posed the question to Mark Norby, chair of enterprise revenue cycle for the Mayo Clinic, during the Revenue Cycle Solutions Summit Monday in Atlanta. Nichols said historically providers have not done well in taking on risk because they have to go big or go home.

"If you dabble in this, you've got a problem," Nichols said.

Norby said the Mayo Clinic - one of the largest and most esteemed healthcare providers in the United States - has not gone big, but is already managing its own health plan to own both sides of that risk.

"It's a very delicate situation in that it ends up in the provider taking on more risk every day," Norby said.

The health system is now conducting a risk-based analysis and should have a plan in 2016, he said.

Consumerism is also posing a risk challenge for healthcare, as insurers hold the reins on information on deductibles that providers could use to give patients an estimate of their out-of-pocket costs.

"Patients want a defined knowledge of how much I'm going to owe," Norby said. "That's difficult for us to calculate at this point."

Risk can also affect internal change, as well. Norby said that about a decade ago, Mayo approached clinical documentation from a financial focus, thinking, if they could show physicians what they were leaving on the table because of a lack of documentation, the doctors would react the way they, as the financial people, had.

That didn't happen, he said. The idea got little traction in the hospital and zero traction in the clinics.

In 2009, they realized the way to a physician's heart was through quality, not documentation, Norby said.

Mayo Clinic initiated score cards and displayed the data points to physicians that showed how the patients viewed the Mayo Clinic.

"It was shocking for them," Norby said, and immediately they wanted to know what to do to change any negative feedback.

"We started a program, it's been enhanced over two to three years," he said. "We're in the process of creating standardization and have a good relationship with physicians."

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