For long, the healthcare industry has been struggling to embrace a consumer centric approach in order to make itself more acceptable and deliver the ultimate financial experience to patients. From what it seems, this struggle is set to end in 2020, as this happens to be the year of “transparency” as committed by the ruling dispensation. With adoption of drastic solutions to promote transparency, healthcare delivery is all set to witness a sea change with implications that can have a far-reaching impact in the way patient care and provider revenue cycle processes are managed. This blog talks about the two immediate impacts of this mandate and what it could possibly lead up to.
Price Transparency Impact May Lead to Price Rise and Confusion in 2020
In a bid to create greater transparency, the Trump administration wants hospitals and clinics to make price and quality information on treatments and procedures public from 2020.
The idea has met with lot of resistance from providers which is why confusion and chaos is expected to reign the industry by and large this year. And the reason is for the first time, providers will compete on cost.
Before we talk about the confusion, lets look into what price transparency is all about and the core elements of the enactment.
Why the Push for Price Transparency?
The Trump administrations to help protect patients and increase competition between these providers so that the value of healthcare, competition, and innovation in the healthcare system will increase.
The executive order basically gives everyone in the healthcare system 60 days to make their pricing information for all diagnostic testing, procedures, and medication publicly available in a way that is easy to understand.
Here are some essential points to keep in mind when it comes to designing policies to better protect patients with complete transparency in medical care prices:
- Focus transparency on services or products that can easily be purchased, like medical tests or prescription drugs
- Include important differentiators like the quality of care or health outcomes you can expect next to the price of each the medical product or service
- Make sure all pricing data is in the same format and can be found in the same place so comparing options is easier
- Give patients help in making the right decision by providing counsellors or apps to guide their decisions
- Encourage decision-making that is not restricted to one person’s opinion so that out-of-pocket expenses can be carefully considered before making any purchase
The problem with public price transparency is that proprietary information will no longer be private and good deals will be made public.
What Would Lead to the Confusion?
The biggest problem with transparency is the challenge of disclosing proprietary business information and the risks associated with such a task.
If a good deal gets revealed, then the chances of losing the deal due to disclosure are very high. This could cause prices to go up and kick in lot of confusion. This opens up the possibility of an unlawful collusion between two parties.
As a result, the effectiveness of selective contracting by health plans, that aims to cut down healthcare costs may get undermined thus imperiling the overall healthcare setup in the country.
Proof of Quality Care will Matter More in 2020
In 2020, the industry will also be more specific about quality care than ever before. Providers will be keener on ensuring the care they deliver is actually working so would bank heavily on evidence-based clinical criteria to measure the outcomes of treatment.
In fact, this would become a standard practice in 2020. The aspects that would be given due importance by providers would be — What did the care do the patients? What kind of difference did the treatment bring to their wellbeing? What were the measures taken to ensure standards of quality?
But before we understand the steps that would be taken by providers to improve quality care this year, lets understand the concept in broader terms.
What Is ‘Quality’ of Care?
Health facilities often have problems providing rapid emergency care to patients. Some reasons for this include lack of competent staff, unhygienic infrastructure, poor access to high quality medication, and poor documentation processes. Therefore, quality care can be defined as care that is provided without having the listed factors as hindrances.
How Do We Define ‘Quality’ of Care in 2020?
In the age of price transparency quality of care will take a big leap forward to improve the desired health outcomes. Therefore, healthcare provided in 2020 will consist of the following
Safe: Care that reduces risks and harm to the patient, from unnecessary medical errors to preventable injuries.
Effective: Care that is based on scientific research and knowledge, that backed by proven data.
Timely: Care that is given without any delays.
Efficient: Care that maximizes the use of resources and avoids wastage.
Equitable: Care that is not based on personal characteristics like ethnicity, gender, or economic status.
People-centric: Care that considers individual preferences and their cultures.
Standards for Improving Quality Care in Health Facilities in 2020
More Competent Healthcare Professionals
High quality care for patients involves having motivated and competent professionals and access to basic physical resources, from medicines and clean water to proper supplies and equipment. It also requires using standard practices in the referral process and information systems that can be audited.
More Effective Communication
Patients should know what is happening at all times and know their rights as well. They should receive medical care with dignity and respect and should have access to any support that they might need. As price transparency becomes most important aspect of treatment this year, healthcare providers will go out of their way to keep patients informed at every stage of the treatment process.
Community Engagement
Service providers should activity engage with the community they are serving in order to build trust and motivate more members to seek help when it’s needed. In an effort to be more accessible to patients’ healthcare providers will seek new ways to reach out to patients this year so that they can create more awareness and have direct connection with them.
RCM Will Play a Lead in Taking the Stress Out of High Out-of-Pocket Costs
Revenue cycle managers will go out of their way to keep patients away from the competition by providing them with tools to help them manage their high out-of-pocket costs.
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This is because high out-of-pocket costs do not affect only the uninsured but also the insured, when they have to pay money out of their pockets after the insurance is paid. Making out of the pocket options easy and painless would help RCM managers help their business stay afloat in 2020
Some of the features that are likely to be offered in 2020, besides transparent pricing, would be interest-free payment plans, online self-service, and other attractive payment arrangements.
How RCM Managers Will Use Transparency to Their Advantage
In the era of price transparency, RCM managers will insist on doing two things to beat competition- provide real-time access to cost estimates and provide a price estimate and abide by it.
Though the best way of providing the right cost estimate to patients is through online tools, most of these tools are not much reliable in making accurate costs.
Therefore, RCM managers will continue their dependence on online tools but will link it to a patient experience coordinator who would play the key role of managing all patient pricing, and communications. This would serve as a first step towards improving trust between patients and health care providers and also help them stick to the cost estimates.
The next step towards meeting price transparency would be towards building end-to-end financial visibility across the revenue cycle continuum is.
To this effect, RCM managers will embrace technologies and centralized operational processes to unify existing disparate operations. This would help them get a complete and holistic data capture, of treatments and procedures and better predict outcomes in order to meet the dual requirements of providing correct pricing prior to care and achieving higher quality revenue capture.
Therefore in 2020, healthcare organizations are more likely to tie up with technology partners to take interoperability to highest levels. At the same time, there would be greater reliance on data acquisition and data access so that useful data can be put in the hands of physicians when and where it is needed.
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As transparency becomes the norm in 2020, chances of patients getting deterred by high payment costs and moving away to cheaper players is all set to intensify. To ward off this pressure, RCM managers would step up their efforts to push for interest free payment plans in 2020. As a result, hospitals are more likely to come up with different and attractive interest free plans based on a patient’s ability to pay and other easy terms.
In 2020, RCM managers will also step up their efforts to empower patients with online self-service, in order to take process transparency to new levels. This essentially means enabling patients to self-schedule appointments at their convenience from any device at all locations across the network.
Technologies like, RPA, machine learning, and cognitive automation will be integrated with digital self-service platforms, to offer personalized and end-to-end experience to patients.
One such area might be patient payment. Aside from using tools and coordinators to give a clear estimation to patient, RCM managers will also use data-driven algorithms to predict a patient’s ability and willingness to pay their healthcare bill. Based on this prediction, an appropriately tailored interest-free treatment plan would be presented to the patient through the providers app, website, or kiosk. All this can revolutionize patient experience in ways such as:
From 2020, patients will be empowered to schedule appointments, pay bills and manage healthcare finances on their own. This would be very much like offering the same convenience as offered by airlines, banks or retailers to their customers.
From 2020, patients will no longer have to wait for months for knowing their bills because RCM bottle necks will take a back seat. AI and Predictive modeling will be leveraged to provide patients with accurate statements and turnaround.
As healthcare transparency requirements continue to evolve, healthcare providers are bracing for slimmer profits, shrinking reimbursements, rising claim denials, patient satisfaction -tied reimbursement process etc. Therefore, come 2020 and competition will reach such a feverish pitch that providers would be forced to focus on quality care by outsourcing not a segment of their RCM process but the whole of their RCM process to third party providers.
Who We Are & What Makes Our Views Convincing
This article is brought to you by OutsourceRCM, an enterprise-class solution provider for end-to-end revenue cycle management. With over 10 years of experience in managing RCM processes, we stand witness to the many transformational changes that have taken place in the RCM domain. It is through this expert understanding that we forecast the healthcare trends for the upcoming year.
