The Journey

Transforming the Patient-Provider Experience

Written, edited and curated by Loyale founder Dan Peterson, The Journey explores ideas and innovation to enrich the patient-provider relationship

Financial Recovery for Health Systems is at Least a Year Away. Going Digital Can Accelerate It

Posted by Kevin Fleming, Chief Executive Officer on Jun 24, 2020 10:52:27 AM

The resounding success of telehealth in the American Healthcare industry’s response to the COVID-19 crisis is a clear indication of growing consumer preference for safer, more convenient and more affordable access to healthcare. As healthcare finally pivots into its own digital age, it must be sure to include every dimension of the patient care experience - especially the financial.


worried hospital executive


According to survey results published just last week by the American Medical Group Association (AMGA), “most medical groups and health systems expect to overcome COVID-19 revenue losses in a year or more, but about a quarter are still unsure when or if they will ever return to pre-COVID levels.” Noting the responses of leaders at 59 of the nation’s preeminent integrated health systems and 36 independent medical groups, survey results indicated that, “Nearly 23 percent of health system respondents said that they could not pinpoint when their revenues will return to pre-coronavirus levels.”


Healthcare providers of all sizes and types experienced a severe disruption in operations and revenue as the COVID-19 public health crisis began. Almost immediately, the health crisis led to a financial crisis - as providers invested heavily in supplies and capabilities to serve infected patients and revenues plummeted because elective and other “non-essential” procedures were cancelled or delayed to minimize the risk of patient exposure to COVID-19.

Other key findings in the survey results include the following:


  • Forty one percent of healthcare systems are forecasting it will be at least a year before revenues return to pre-COVID levels
  • Nearly twenty three percent of healthcare systems said it’s still unknown when their revenues will return to normal
  • Ninety two percent of healthcare systems expect an increase in personal protective equipment expenses (PPE)
  • Eight seven percent of healthcare systems expect increases in telehealth infrastructure costs


Some provider relief has been distributed by the government through the Coronavirus Aid, Relief and Economic Security (CARES) Act, enacted on March 27 of this year created a provider relief fund of $100 billion, but providers agree that more will be needed to help prevent lasting damage to the American healthcare system. “Health systems and medical groups are operating under a cloud of financial uncertainty that threatens their ability to continue to deliver the best care to their communities,” AMGA President and CEO Jerry Penso, M.D., M.B.A is quoted as saying. “We continue to urge congress to provide additional funding to stabilize the front lines of the COVID-19 crisis.”


That funding is struggling to make it through Congress. On May 15, the House of Representatives approved the Health and Economic Recovery Omnibus Emergency Solution (HEROES) Act, which would provide additional $100 billion - but the senate has not yet taken action on the bill. In a letter to senate leadership on behalf of its members, AMGA urged legislators to pass this critical relief, noting that, “This situation requires immediate assistance if our members are to survive and continue meeting the needs of patients - both during and after the pandemic.”


Expanding Access to Telehealth Virtual Care - A COVID-19 Success Story


One unchallengeable outcome of healthcare’s response to the COVID-19 crisis has been the tremendous success of telehealth. As a safe and cost-effective alternative to in-person office visits, telehealth was encouraged by temporarily relaxed restrictions and improved reimbursements from the Center for Medicare and Medicaid Services (CMS). The not-so-surprising result? The use and utility of telehealth has exploded during the last few months.


Noting that, “The public health emergency has forced providers across the nation to reevaluate the way they deliver care”, the AGMA letter points out that, “This pandemic has exposed the underlying flaws in the site-of-service limitations for telehealth services and how these limitations neglect the needs of many Medicare beneficiaries.” Given patient acceptance of telehealth and the attractive provider economics of care delivery via telehealth, permanently lifting Medicare’s restrictions makes sense - for providers and for patients.


Physicians agree. Writing on behalf of the American College of Physicians (ACP), Jacquiline Fincher, MD, MACP, President, composed a letter to CMS Administrator Seema Verma regarding, “ACP Recommendations for Maintaining Certain Telehealth Policies and Waivers after the Public Health Emergency.” In it, Ms. Fincher points out that, “In order to help reduce the spread of COVID-19, while providing as much ongoing and routine care to their patient populations as is feasible, physician practices across the country have worked to quickly shift much of their patient care services to virtual visits.”


Arguing that, “ the patient care and revenue opportunities afforded by telehealth functionality will continue to play a significant role within the U.S. healthcare system and care delivery models, even after the Public Health Emergency is lifted, “ the ACP seeks a number of revised policies to permanently extend telehealth and other “contactless” care delivery models by ensuring that they remain unencumbered by pre-COVID economic and competitive limitations.


Virtual Patient Care Outside the Clinical Experience


Health Systems, hospitals and other healthcare providers understand that patients’ experiences aren’t confined to medical considerations only. For many (if not most) patients, the financial dimension of care is pivotal to their overall patient-provider encounter. With more patients opting to interact with their providers digitally using telehealth or telephone (audio-only) services, they must now also interact with all the other provider participants in their care episode. These include admissions, registration - and perhaps most important - billing and payment.


With no in-office visit to secure the necessary patient information to confirm insurance eligibility, determine deductibles or calculate copayments, it becomes necessary to either handle these labor-intensive procedures over the phone or to deliver digitally. Digital delivery offers several compelling economic advantages. First, they can be automated to dramatically reduce the amount of staff time needed for most patient registrations. Second, digital patient financial engagement improves service by putting valuable personal patient information at their fingertips, right when they need it.


For example, Loyale Healthcare’s Patient Financial Manager™ is configured by some healthcare providers to automate the patient’s financial registration and insurance eligibility processes. With many Americans making care decisions based on their ability to afford their out-of-pocket, we also empower providers and patients with pre-service cost estimates. Even more important in the COVID and post-COVID eras, the platform makes it possible for healthcare providers to offer multiple payment scenarios, all personalized to optimize affordability and improve the probability of payment.


When the Customer is Always Right


Long before the COVID-10 Public Health Emergency began, healthcare consumers were making different choices about whether, where and how they wanted their healthcare. The crisis, in this instance, has accelerated an important consumer and social trend that was already under way. For decades, the healthcare industry was immune to the disruptions that affected nearly every other sector of the American economy. But when patients began bearing more and more of the financial responsibility for their care (now more than one third of provider revenue), that began to shift. We explored this phenomenon in an article published last summer, observing that millennials and younger generations were abandoning traditional primary care physician care delivery models in favor of more convenience and better value.


The COVID-19 crisis has accelerated and expanded that sentiment across the population at large. For the last three months, Americans have been working, socializing and shopping online and they’ve found out it works. Now, with more and more of them experiencing perfectly satisfactory care delivery via telehealth, the genie is out of the bottle.


We at Loyale agree with the industry leaders cited in this article. Telehealth will continue to be an important part of the American healthcare landscape long after the COVID-19 crisis is over. At this important inflection point, it is imperative for healthcare providers to consider the breadth of their care delivery and to ensure that patients’ financial experiences are at least as successful as their clinical experiences. For providers, success will depend on it.

Topics: Patient Financial Engagement, Healthcare Disruption, COVID-19, Hospital Financial Recovery, Digital Financial Transformation

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