From adopting artificial intelligence to navigating staffing shortages, what is keeping you up at night? ImagineSoftware asked just that during a Revenue Cycle Management (RCM) panel discussion, interviewing industry leaders on current trends, challenges, and opportunities facing the healthcare industry today. In this article, learn how healthcare leaders are not only navigating such challenges, but also overcoming them with technology, training, and tricks of the trade.
What’s Keeping Today’s Practice Leaders Up at Night?
An RCM Panel Discussion
Panelists:
- Cristina Arredondo, Senior Manager of Revenue Cycle of SimonMed Imaging
- Jamie Dyer, Chief Outpatient Operations Officer of Central Oregon Radiology Associates
- Dianne Keen, Vice President of Strategy and Growth of AbbaDox
- Chip Schuneman, Chief Executive Officer of InterHealth Solutions
- Dr. Don Powell, President of Medical Management Specialists
Increasing Labor and Material Costs
Jamie Dyer, Chief Outpatient Operations Officer of Central Oregon Radiology Associates, explains, “Costs are just out of control. We've all seen the the labor increase, but supplies and anything we're purchasing, and service contracts are all going up... In addition, physician staffing is probably the highest it's ever been.”
Providing an anesthesiology perspective, Chip Schuneman, Chief Executive Officer of InterHealth Solutions, shares a similar experience with physician staffing as Dyer. “We’ve seen salaries almost double for CRNAs... You cannot perform enough procedures and actually collect enough from cases to actually pay them appropriately.”
“It's not just finding MDs, DOs, or CRNAs, but it's actually working on the staffing to ensure you have proper patient care, and really patient safety.”
Chip Schuneman, Chief Executive Officer of InterHealth Solutions
"Anesthesiologists are paid by time... Payers are paying $70 to $90 per unit timeframe, but Medicare and Medicaid are paying $20.12 - I think [that] is next year's rate. Well, that's ridiculous. That's a quarter of it. And then you have an aging population that is moving into Medicare. And so now more and more of your cases are Medicare cases that are paying 20, 25 to 30% of a commercial payer. So again, it's just not sustainable,” explains Schuneman.
Dr. Don Powell, President of Medical Management Specialists, brings a unique perspective, as a physician, stating, “It costs more to do business than it did 25 years ago. The problem is, especially with the Medicare Fee Schedule, from a physician standpoint, it hasn't increased in years. When we're talking decades compared to an average reimbursement to the hospitals, which is tied to cost index and whatnot. I think from a provider standpoint, that's one of the things that we have to do, advocate for increasing Medicare rates on an annual basis rather than fighting for scraps at the end.”
As physician salaries continue to increase, yet payer reimbursements are not following, it’s paramount to equip administrative teams with scheduling, eligibility, and billing tools – Gathering updated information, filling schedules, and accurately filing claims. ImagineOne™’s automation and artificial intelligence technology detects inaccurate information and can even correct it, leading to less denials and more revenue – making the most of both your providers and team’s time.
Maintaining Patient Experiences
Dr. Don Powell, an emergency medicine physician, offers insights from the day-to-day realities of the industry. He explains a multi-location system, where patients can be transferred to less busy clinics for an increased level of care and decreased wait times.
“If you're a group that's working at multiple different hospitals, especially within the same city, we can divert patients to areas that maybe aren't as busy... One place is burning down and the other is twiddling their thumbs at some point, so we can divert patients to the areas that are less busy.”
Dr. Don Powell, President of Medical Management Specialists
Observation Medicine is another method Dr. Powell recommends, encompassing management of selected patients for a specific timeframe, assessing their need for inpatient admission. Especially in emergency medicine, getting patients seen faster is the ultimate goal. Additional advancements to medicine, such as virtual follow-up care and telemedicine, offer patients the opportunity to receive care efficiently – while physicians are able to devote more time to their patients and their care.
Offering an anesthesiology perspective, Chip Schuneman shares his solution for the highest level of patient care, which is time with their physician.
“Our providers want to send time with the patients, and at the same time our providers want to get paid...” he chuckles and continues, “The reality is if we can allow the providers to spend time with the patients, the patients are going to have a better outcome, and they’re going to have a better perspective on the care that has been received, and will get better care. But we also have to make sure that the providers are being paid.”
Front-end errors, or FEEs, are a challenge preventing this from happening effectively. Inaccurate information leads to insurance denials, thus creating more work for administrative teams and losing all workflow efficiencies. ImagineOne™’s integrated technology detects and autocorrects inaccurate information, saving time with less human touch points.
An additional method of increasing patient engagement is receiving reviews. Cristina Arredondo, Senior Manager of Revenue Cycle of SimonMed Imaging, refers to this honest feedback being something most practices are lacking, however it is a monumental method for training staff and improving care. Arredondo shares, “If a patient is upset and we have tried different routes to meet their needs, the situation then comes to me. I take that as an opportunity to learn what happened... A lot of times I find out there was a procedure that wasn’t followed, or maybe there are some training opportunities.”
“Take those [challenges] as an opportunity for you to grow as a leader, because at the end of the day, remember leadership has a responsibility, and leadership is a privilege...”
Cristina Arredondo, Senior Manager of Revenue Cycle of SimonMed Imaging
Staffing Challenges, Burnout, and Quality of Life
Through the COVID-19 pandemic and beyond, physicians and healthcare professionals faced escalating amounts of burnout from long hours, stress, and administrative burdens. As a result, emotional exhaustion, job satisfaction decline, and falling patient care quality have been experienced. Chip Schuneman expressed, "We are losing more and more really good providers because they're just done... we've got to figure out how to improve that quality of life. Some of it is workflow, some of it is scheduling, some of it's just giving them time with patients."
To counteract this, a multipronged approach including improved workflow, adequate staffing, flexible scheduling, and more patient time is paramount. Only through enhancing providers' life quality can groups hope to retain skilled professionals and maintain high-quality patient care.
In addition, there is a growing crisis of early retirement among healthcare professionals that stems from excessive stress, dissatisfaction, and disproportionate compensation. The strenuous environment—marked by long work hours, high patient volumes, administrative loads, and emotional pressures—is driving many to their limits. Solutions need to address administrative reform and compensation structures for the health sector's sustainability.
Dianne Keen, Vice President of Strategy and Growth at AbbaDox, a radiology practice and imaging center expert, chimes in with her perspective – arming your staff with the tools to provide the highest level of patient care. “One of the biggest things we can do as operation leaders is being able to provide the tools that our staff needs to do their job...We talk about how busy everyone is, and we see the turnover, and so often in these organizations the tools aren’t there,” Keen explains.
Keen advises healthcare leaders to “invest in tools, invest in our people, invest in their training...” She explains the best way to understand your team’s needs is to “really get in there” and experience practices from their teams’ point of view.
“We don’t always stop and listen to see where the pain points really lie, we assume we know... Really get in there, to be able to be in the centers and watching and witnessing that interaction, so we are watching the stress-level of our staff, we’re seeing if they do have the tools they need to be efficient. The bottom-line is so your staff can do the best job possible to be able to take care of that patient.”
Dianne Keen, Vice President of Strategy and Growth at AbbaDox
Training and providing resources to both seasoned and new staff is especially important, as noted by Cristina Arredondo. Arredondo shares ImagineEmpower, ImagineSoftware’s training platform, with new team members to bring them up to speed in an effective way. She also urges practices to reach out directly to payers for training opportunities/webinars they may offer, helping her team remain engaged.
Recruiting and retaining physicians and staff are at the forefront of all healthcare leaders’ minds. Jamie Dyer recommends, “You really have to have a nothing's off the table approach.” Versus previous philosophies of “saying no,” Jamie shares how flexible schedules, benefits, investing in students and their continued training, and recruiting from their local area have all proven to be effective in onboarding and maintaining her team’s success.
Technology, such as ImagineOne™, leverages artificial intelligence to automate routine tasks, relieving the administrative load. Greater control over scheduling, billing, and operations can balance professional and personal commitments, reducing burnout.
Payer Consolidation and its Implications
Consolidation among healthcare insurers, such as UnitedHealth Group and Blue Cross Blue Shield, is reshaping the healthcare industry dramatically. While these mergers bring opportunities, such as operational efficiencies and potentially lower premiums, it also raises challenges like reduced competition, higher consumer prices, and increased complexity due to multiple insurance plans.
Jamie Dyer states, "The consolidation trend in the payer side of healthcare is worrying. It's leading to increased complexity and a lack of adequate payment for providers."
Regulatory scrutiny over antitrust issues and backlash from providers and consumers are potential ramifications of this trend. Despite the intention to meet diverse needs, the introduction of numerous plans could confuse policyholders, potentially leading to lower satisfaction and fewer enrollments. This issue emphasizes how vital it is for insurers to balance growth and diversification with stakeholder satisfaction.
Artificial Intelligence in Healthcare
Artificial Intelligence (AI) tools can be used throughout the entire healthcare industry – From using ChatGPT to draft payer letters to using ImagineOne™’s RCM platform to file claims and post payments. But how are you leveraging AI in your medical practice today?
“I think it's important to understand on the anesthesia side, there's still about 50% of anesthesiologists that are dealing with paper charts...”
Chip Schuneman, Chief Executive Officer of Inner Health Solutions
Schuneman continues, “I know that sounds bizarre in the technology space, but we've implemented an AI tool that actually scans backs of charts that we receive from our ASCs and hospitals on a day-to-day basis and image them in it sorts the paperwork by patient automatically...” While investing in and implementing this tremendous amount of technology is necessary, Schuneman highlights the importance of training teams to use this technology to its fullest.
“Using AI to get accurate bills to patients... that sort of thing is huge. And it's a time saver because we're not taking 600 calls an hour anymore. We're taking 300 calls an hour. We're not dealing with irritated patients because they got a wrong bill or didn't get their secondary bill or other things.”
Chip Schuneman, Chief Executive Officer of Inner Health Solutions
In conclusion, all healthcare and practice leaders seem to have similar challenges on their minds, stemming from the rapidly changing industry. From payer consolidation leading to possible efficiencies and cost reductions, but also increased complexity, reduced competition, and potential regulatory intervention, leaders must be ready to adapt.
“In this rapidly evolving healthcare landscape, we must pivot from being reactive to proactive. It's high time we sought innovative solutions, fostered unity within our community, and made our voices heard in the decision-making sphere. Remember, even the smallest voice can lead a chorus for change."
Dianne Keen, Vice President of Strategy and Growth at AbbaDox
As the sector continues to evolve, it's a shared responsibility to ensure that the pursuit of economic efficiency doesn't override the fundamental goal of healthcare: providing high-quality care to all.