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HIMSS20 Revenue Cycle Optimization Forum puts the focus on patient-centric solutions

What's important to the patient is a care plan that integrates shared decision-making on both treatment and cost, speaker says.

Susan Morse, Senior Editor

Each year during its Global Health Conference, HIMSS hosts a day-long forum on all things revenue cycle.

This year, the 2020 Revenue Cycle Optimization Forum is being held from 8 a.m. to 4:30 p.m., Monday, March 9, in the Rosen Centre Junior Ballroom in Orlando, Florida.

The importance of having a patient-centric revenue cycle is again dominating the conversation, but this year there is the added urgency of price transparency in rules released by the Centers for Medicare and Medicaid Services.

One rule which has gone into effect requires hospitals to post their chargemaster prices. The other more controversial rule, which is being fought by hospital organizations, is for providers to post their negotiated rates with payers.

The goal is for patients to know the price of the services they're getting, and to choose the provider which offers the least expensive option.

But will these rules work in giving patients real price transparency? Neither gives insured patients the exact cost of what they will end up paying for a service.

"There's a mixed feeling on this master list of costs," said Revenue Cycle speaker Rebekah Angove. "At the end of the day, it's not super helpful to patients. It doesn't tell them what their portion will be."

Also, she said, pricing information that comes with a large price tag can be a barrier to seeking care due to sticker shock.

Angove knows the patient experience first-hand from her work with the Patient Advocate Foundation in Virginia. The vice president for Patient Experience and Program Evaluation is speaking at two of the forum's sessions, Revenue in the Age of Shifting Payer Landscape and Experiences with Financial Distress.

"Increasingly patients are being burdened with more of the costs of healthcare," Angove said. "They have bills they can't read. The general population doesn't have the training to understand the billing. Many times decisions are being made about treatment without costs being brought up."

What patients really need, she said, is a discussion with their physician, or nurse practitioner or someone else at the practice, about an estimate of their particular out-of-pocket costs at the time of care.

"What we're not really capturing," she said, "is did your doctor have a conversation around cost and was that integrated in your decision-making?"

This can be as simple as the physician asking if the patient has any financial concerns. If the answer is "yes," there should be a staff person available in real time who can address payment plans or other solutions. There may also be lower cost treatment options available.

To get to the real cost of care to the patient, what's needed is an interoperable system that connects provider, payer and patient information.

Current data systems are not designed to interface with the consumer, though work is being done to make interoperability a reality.

"In the age of technology and information, we can make an app that can do it. We can connect the insurance information with the diagnosis code," Angove said. "We can do this."

The cost to healthcare from the lack of a unified care and cost plan can be measured from the number of readmissions due to patients getting sicker because they haven't filled an expensive prescription, or have put off care they can't afford; and from unpaid medical bills.

Hospitals do a good job at patient satisfaction from the hospitality standpoint, Angove said. They have reduced wait times, made check-in easier and even made bill paying more convenient through digital solutions.

"We're really looking at what truly is important to patients and integrating those conversations into shared decision-making," Angove said. "We'd really like to see this integrated into shared decision making at the point of care."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com