Staffing continues to be the most significant challenge facing healthcare in 2022 – not just on the frontlines but in the back-office too. Small physician practices are finding it especially difficult to compete for skilled revenue cycle talent. To fill the gap, they must adopt RCM technology and learn to partner with service providers.
Healthcare IT Today recently sat down with Susan Kohler, Senior Vice President of Revenue Operations at Greenway Health, to discuss the challenges currently facing physician practices around revenue cycle management (RCM).
Challenge for Physician Practices
“The Great Resignation has really impacted the office staff,” explained Kohler. “It has really put pressure on our providers. They are stressed and worried about hiring the staff they need to support a critical function – the people submitting claims to payers and making sure they collect so that they can pay their employees, pay their practice, and pay their bills.”
Without sufficient staff or skills to submit claims in a timely manner to payers, these practices run the risk of falling short on revenue. This in turn may force them to cut staff, putting even greater pressure on those that remain. It is a vicious downward spiral that can be difficult to recover from.
Technology + Partners
According to Kohler, to address this challenge, physician practices must get comfortable with adopting new RCM technology that will help streamline the overall process and reduce the burden on existing staff. They must also learn to partner with external organizations who can augment or completely take over portions of the RCM process.
“We have to think not just about people, because there is always going to be a part of the process where you need people – like critical thinking and problem solving, but you also have some repetitive tasks that need to be worked through,” said Kohler. “That’s where you can bring in automation like bot technology. A bot can do the work and then the exceptions are managed by the people.”
Kohler also suggested that physician practices can look for partners to help alleviate their claims processing burden. There are many companies that specialize in RCM services and others that offer services for specific parts of the RCM process. Greenway Health, for example, falls into the latter category.
“We have GRS Select, which allows us to help with certain components of revenue cycle,” shared Kohler. “Maybe you need us to help post payments. Maybe you need us to help follow up with insurance companies. If there are small components like that, we can take those on for you.”
Bottom Line
In the years ahead, RCM will continue to become more complex. Already healthcare is having to deal with the challenge of prior authorizations which is disrupting standard processes and causing frustration for clinicians and patients alike. To stay ahead, practices must stop relying on a people-only approach. It is simply too risky given the increasing competition for talent.
Instead, practices need to look to a combination of people + technology + partners.
Watch the full interview with Susan Kohler and learn:
- The challenge practices have in competing with RCM service companies
- How the lack of standardization in prior authorizations is hurting practices
- How Greenway is able to maintain staffing levels
Greenway Health is a supporter of Healthcare IT Today.
To learn more about Greenway Health, visit them at: https://www.greenwayhealth.com/
Transcript
Colin Hung
Hi I’m Colin Hung with Healthcare IT Today and I’m sitting down with Susan Kohler, Senior Vice President of Revenue Operations at Greenway Health. Susan, welcome to the program.
Susan Kohler
Thanks very much glad to be here with you.
Colin Hung
Susan, before we got on camera, you were telling me about some of the staffing challenges that are gripping this part of the industry. Can you tell me a little more about that?
Susan Kohler
Yes. Absolutely. It’s interesting when you think about the Great Resignation happening not only in America, but around the world. It’s really impacted the service industry and hospitality. What people haven’t realized though, is that in healthcare industry it’s really impacted the office staff – those day-to-day people who go in and see your doctor, they meet and greet you. They are the ones doing all the back-office work for providers. They are feeling the strain and hearing about people quitting left and right – no notice, going to another place. So it has really put pressure on our providers.
When you think about it, they are really trying to put the focus on patients but now they are stressed and worried about hiring the staff they need to support a critical function which is supporting patients when they come into the office. But even more critical – the people submitting claims to payers and making sure they collect so that they can pay their employees, pay their practice, and pay their bills. It’s a very critical function.
Colin Hung
Because they are unable to hire this function, are you seeing any corresponding impacts downstream?
Susan Kohler
Yes. We are seeing providers being untimely when submitting claims. In the payer industry we only have so much time to submit claims. They don’t get a lot of grace. So now providers are starting to see a decrease in revenue where they now may have to let off staff or they themselves have to go without a paycheck.
If you think about it, we’re going through the COVID pandemic and providers are really stressed. Now there is a further stress of not being able to collect income and pay themselves.
Colin Hung
This seems like a vicious cycle.
Susan Kohler
That’s exactly right. How do they approach that? For a smaller practice, it’s even more challenging to them because even though they may only need to hire one or two people, when do they have the time to stop, interview, train, and bring in that person. It puts added strain and stress on an already stressed environment.
Colin Hung
I’m assuming it is hard to find these people in the first place? There’s not enough of them to go around, correct?
Susan Kohler
That’s right. It’s a combination of factors. There’s not enough of them around and these small practices are now competing with larger revenue cycle management companies. As we went into COVID, those large companies realized that people could indeed work remotely. Now I’m a small physician practice, I want you in my office, present, doing the work and you are competing against these larger companies that say ‘we don’t need you to come in, we’ll let you work from home’. That person is saying “great, I can stay at home and work in my pajamas. I have my dog with me, my kids are home with me. Why would I want to go into a physician’s office when I can stay at home?”
Now they are competing against other companies that are not only willing to pay them and let them stay at home.
Colin Hung
How is Greenway trying to help providers with this situation?
Susan Kohler
That’s a great question. So we’ve actually had our clients come to us: “Hey can you help us. We’ve just lost 3 billers. We haven’t submitted claims in a month. How can you help us?” That’s when we step up and say: “Hey we have GRS Select, which allows us to help with certain components of your revenue cycle.” Maybe you need us to help post payments. Maybe you need us to help follow up with insurance companies. If there are small components like that, we can take those on for you.
Then you may ask: “Susan, how do you find the staff? How have you solved that problem?” We look to multiple sources to bring in our resources. We’re ramping up staff in our Bangalore office. We have two vendors working with us. What I’m doing is dispersing the risk. I have three resources continuously bringing in the resources and training them. So if one of them leaves, I’ve got two others I can turn to. I’m not dependent on one company maintaining my business. This allows us to be in a stable place.
Have had some instability? Yes, we’ve had some…just like everybody has in the industry. The key is how do you solve for it? People is one part of it.
Colin Hung
So you’re able to do things at a bigger scale as well, because of how many customers you have. You can allow people to work in different places and you have a much bigger pool of potential resources – therefore dividing the risk as you mentioned earlier.
Susan Kohler
That is correct.
Colin Hung
But as a health IT company, you must be able to bring some technology to solving this as well.
Susan Kohler
Oh yes, that’s a key part of it. As an IT company we have to think not just about people, because there is always going to be a part of the process where you need people – like critical thinking and problem solving, but you also have some repetitive tasks that need to be worked through. That’s where you can bring in automation like bot technology where some of those repetitive tasks – a bot can do the work and then the exceptions are managed by the people.
So when you think about that, you can really grow and scale in supporting clients. When you have a large client come in and you may have needed 100 employees to handle the work, with technology you can do the same amount of work with 50 employees. So now you can go out and hire 100 and put 50 on one client and 50 on another because of the automation. It’s a great way to solve for some of the labor shortage.
Colin Hung
As you look at revenue cycle, what is the most exciting for you?
Susan Kohler
I think the automation is the exciting part. I mean we are in 2022. I talk to many clients who say that we can’t just go by people anymore. I say they are right. People should complement it (the process). We should use the technology to feed information to people.
I have a great example. I was talking with a client and they said: ‘We implemented this artificial intelligence and when we did that, one of the payers change their rules. Within three days the AI told us. It would have taken a human being reviewing data and reports for a month before they would have detected a change had been made.
Colin Hung
It would have taken a while to see the rejected claims and to know there was something new?
Susan Kohler
Yes. The AI in three days said: ‘Hey, flag, there is a problem here.” Now a person was able to say: “Oh okay this payer now requires submission of medical records. I can now start doing that.” It prevents denied claims and rework to process those claims.
Colin Hung
Looking long-term at the revenue cycle space, we hear a lot of the challenges coming down the pipe with Prior Authorizations which has a workflow issue and definitely has an impact on patient experience as well. We are starting to see my patient pay issues and challenges. What are you seeing that has you worried or perhaps what are the opportunities you are seeing?
Susan Kohler
I would say that I see opportunity. The Office of the National Coordinator which regulates the EHR industry, is coming out with an RFI to get some information and feelings from payers, EHR vendors as well as practices around standardizing prior authorization and incorporating those requirements into EHR. What’s great about that, is that it’s something that payers, providers, and patients have been asking for since I’ve been in healthcare.
It’s a huge problem. It’s labor intensive. Every payer has their own form, their own requirements. By getting to standardized process, standardized form, standardized requirements and with EHRs adopting FHIR-enabled APIS along with payers, you could now send electronic prior auths. Even better, work with AI companies who now have developed platforms that learns and knows what the payers require and extracts the records you need to submit with the prior auth. It learns over time that these are the documents and evidence you need. Now it takes less time for a person to package up the materials and submit it to a payer.
It streamlines the process, reduces the time, improves efficiency, and most of all, gives practices the time with their patients rather than the paperwork.
Colin Hung
Final question, if I was a manager or executive director of a practice, facing down a revenue cycle challenge, what advice would you give to me?
Susan Kohler
I would say don’t use labor as your only solution. You need to understand there is a lot of technology, even if you don’t partner with Greenway. You have to look at what technology options are out there and let the technology solve the small problems for you. Use your people for complex, critical issues.
Colin Hung
Susan, thanks so much for sharing this information with us today.
Susan Kohler
Thank you. It’s been wonderful.
