Top 5 Mistakes in Claims Management – And How to Avoid Them
Claims management accuracy and efficiency are crucial for hospital billing, accounting and finance professionals. However, common missteps can cause...
By Greg Lanier, Chief Growth Officer, FinThrive
2023 HFMA Annual did not disappoint! I was honored to be at such an electric event amongst many health system, hospital, provider, and business partner leaders across the country. The Gaylord Opryland Resort was beautiful and provided the perfect venue to network with peers and learn about current themes as we work to advance our challenging industry. Over 3,400 attended this year and you could sense many were thrilled to get back together and reconnect.
It was a year for transitions at HFMA. Ann Jordan took over the reins as HFMA CEO from Joe Fifer, who is retiring after 11 years of service. Joe tearfully thanked all his colleagues and partners that were with him throughout the journey. Ann shared her vision and commitment to HFMA and playfully spoke about the “big shoes to fill.” Thank you, Joe, for your time and commitment to HFMA!
The MAP awards were also handed out for outstanding key performance indicator (KPI) achievements in the field. Congrats to Christus St. Michael, Liberty, University of Texas MD Anderson, Ballad, Covenant, Ohio Health, ThedaCare, and St. Francis. I commend these organizations for their performance and excellence in revenue management.
I attended many of the sessions outside the exhibit hall. The CFO panels were all very insightful as the various leaders highlighted their financial recovery strategies. Reducing expenses and accelerating revenue were recurring themes presented as top priorities in those sessions, along with an emphasis on the unsustainability of expenses outpacing revenues. There was also a focus on the need for providers to remain laser-focused on their strategic objectives and make some hard decisions about where they want to be financially next year. The group highlighted the importance of business partners (rather than vendors) in getting organizations to the finish line. So far, joint agreements, in which both providers and business partners have skin in the game, have proven to show tremendous progress. Another key takeaway was the CFO talk track around the importance of AI, specifically automation. Despite past hesitancy from organizations, providers will not be able to “hire out of this one” and must look to automation to fill the labor gap and insulate it for the future.
There were also some interesting sessions presented on SDOH and labor. Brian Urban from FinThrive presented a Utica University study, highlighting the important role socioeconomic (SES) data plays in driving health and wellness – significantly beyond that of episodic acute healthcare visits. He shared that socioeconomic data is “always on” like a faucet, adding data-rich insights about consumer risk. This information is typically not available in current datasets and having a partner deliver them at the point of care can drive better outcomes for patients, providers, and payers.
Jamie Davis (SSM Health) and Jonathan Wiik (FinThrive) spoke on the labor crisis and how AI can help. It was a packed room, and Wiik highlighted that the labor crisis is a long-term issue – one that will be here for years rather than months. Various organizations’ mitigation strategies were shared, and Ms. Davis masterfully outlined the stages of AI from direct connections, through bots, and onto machine learning. “If you can offshore it, you can automate it” she proclaimed, as automation has come a long way in streamlining mundane workflows. Jonathan wrapped up the presentation with use cases and ROI, followed by a Q&A session.
Many sessions covered revenue cycle optimization. There was a focus on consolidating point solutions to a platform, leveraging a vendor management firm, and aligning on goals with business partners. It was observed that there is an increased reliance on business partners to help deliver an organization’s goals, especially in a lean labor market. Over half of the hospitals suffer from severe workforce shortages. Coupled with payer payment delays due to their own staffing challenges, the work is not getting any easier. During the sessions, some organizations highlighted the use of automation – specifically robotic process automation (RPA) – to tackle “low-hanging fruit” tasks that can free up time and deliver cash quickly.
The conference also focused on patient engagement. This time it was more about ensuring the patient remains loyal to the provider. I heard from multiple sources that friction in access and billing is the number one reason a consumer will leave their choice of business. It is no different for providers – patients will vote with their legs, no matter how well the care was performed. If the billing is difficult, they will go to where it is easier next time. This is exacerbated by high out-of-pocket costs. As we approach thousands of dollars in patient financial responsibility before health plan benefits come in, patients are in the driver’s seat for choosing where they get care. Healthcare consumerism is gaining a lot of traction, and providers know it.
The keynote on day three came from Dr. Thomas Fisher. As an emergency physician from the University of Chicago, he shared how challenging it was to see patients come in repeatedly for the same illness. He pointed out that disparities in access and income have manifested in health equity issues. In his published book, “The Emergency,” he passionately pleads for our country to start treating the disease of inequity rather than the symptom of overutilization. He and his organization are closely examining mortality rates, outcomes, spend, and utilization in various ZIP codes to better understand where interventions to at-risk populations can be applied. It was inspiring!
Kevin Holloran from Fitch Ratings provided a somber outlook for the second half of 2023. Since we were in Nashville, he remarked “Not-for-profit hospitals in 2022 were much like a sad country western song – ‘my margins are fallin’ for youuuuuu’”. He indicated that 2022 will go down as a historically bad year for hospitals and 2023 will not be that much better. “We are in a transitional period,” he said, and emphasized that 2024 should be “break even” for most in the industry. Days cash on hand was reported as a significant decline among Fitch-rated organizations, dropping from 266 days to 221 (-17%). Cash-to-debt ratios are also on the decline while outstanding A/R days are climbing. Mr. Holloran summarized that with all this transition, there is a need to “reconstruct the old way of doing healthcare.” Revaluating nurse to bed ratios, diversifying revenue beyond inpatient beds, and enhancing payer relations were all strategies presented. “Solving labor is the number one way out of this mess,” he shared, “and the industry appears to be well on its way of doing just that – but it will take time.”
HFMA Annual ended on day four with sessions on agency relations, transparent financial counseling, and innovative pharmaceutical pricing to help offset challenges in a post-pandemic era. As I reflect on the challenges in our industry, I am also inspired. We have the tools to fix this, and the desire. We all need to come together — patient, provider, payer, and business partners — to further our impact on the industry and this conference was a great start.
About the Author
Greg Lanier
Chief Growth Officer, FinThrive
Greg Lanier is responsible for leading FinThrive's growth initiatives and sales team. Greg has more than 25 years' experience developing and implementing strategic initiatives to increase and accelerate growth across organizations. Greg is a proven high performance team builder and leader where he had success leading commercial teams at Oracle, SAP, Workday and other prominent companies.
