BY ALEXANDRA WILSON PECCI
The pandemic crisis is disrupting the revenue cycle, including the revenue ramifications of cancelling elective procedures.
The global COVID-19 pandemic has sent the entire world into turmoil, including negatively affecting the U.S. economy, causing a ripple effect down to healthcare organization revenue cycles.
Many elements of this crisis are already changing the revenue cycle, from forcing revenue cycle leaders to expand remote work options to more employees, to the revenue ramifications of cancelling elective procedures.
And more changes are coming every day, including systems like CommonSpirit saying it will suspend billing for COVID-19 tests and treatments.
Here are three ways COVID-19 is upending the revenue cycle.
1. THE NEED FOR REMOTE WORK CAPABILITIES BECOMES URGENT
Despite the employee demand for flexibility, money-saving opportunities, and as a recruitment incentive, some revenue cycle leaders have been hesitant to allow their employees to work remotely, due to concerns about remote credit card processing and worker productivity at home.
But with people around the world being urged to practice "social distancing," the need to allow revenue cycle employees to work from home has escalated.
Revenue cycles that were already moving toward a remote workforce now must ramp up their efforts in the wake of the COVID-19 pandemic.
Among them is Hennepin Healthcare in Minneapolis, which previously had its coders, coding educators, coding auditors, coding support specialists, coding coordinators, and transcriptionists fully remote, while also extending the telecommute option to revenue cycle business analysts, revenue integrity analysts and specialists, and clinical documentation specialists.
"Over the last few weeks, we've transitioned all of our telecommuter positions to fully remote work. Our managers are also fully remote," Jessica Johnson, middle revenue cycle director at Hennepin Healthcare, tells HealthLeaders.
They’re also ramping up work-at-home capabilities for other employees, too.
"We are currently working to send most of our HIM team home, although we will keep a minimal amount of staff on-site to be available for specific tasks," she says. "In addition, we are using the social distancing rules."
Atlanta-based Piedmont Healthcare is also sending employees out of the office as COVID-19 sweeps through the country.
"There are groups within the revenue cycle that have been sent home—the majority using their own equipment," says Laura C. Dowling, executive director of revenue cycle services. "And our IT group has had to speed up their support model to handle the additional internet volume/load."
That's not the only challenge involved.
"I expect it to be next week before the leaders are able to settle into the new normal around monitoring staff productivity and quality—not to mention how to effectively manage remote staff," she adds.
Monitoring and managing remote revenue cycle staff can be doable, though, and revenue cycles that choose to expand their remote work options can learn from organizations that have done so successfully.
For instance, John Muir Health in California requires that remote employees have daily check-ins with their supervisors and are accessible by phone, email, or Skype during work hours, and the organization's Epic system has employee dashboards to monitor their work times and volumes, Joshua Welch, revenue cycle executive director, told HealthLeaders.
2. VIRTUAL CARE (AND GETTING PAID FOR IT) IS EXPANDING
Earlier this month, President Trump signed an $8.3 billion emergency funding measure that includes the provision to lift restrictions on telehealth services for Medicare beneficiaries.
"Video visits are payable because of this emergency bill," Elizabeth Jaggers, MBA, CPA, administrative director of University of Iowa Physicians at University of Iowa Health Care, told HealthLeaders at the MGMA Financial Conference earlier this month. "This could totally change the way we deliver healthcare."
UI Health Care has been delivering virtual care—and getting paid for it—through its eConsult program, which Jaggers detailed during the conference. Such a program could provide a model for other institutions that are facing resource shortages during the pandemic.
UI Health Care implemented eConsult among 16 specialties, allowing its primary care providers to electronically communicate with, get advice from, and create a care plan with a specialist, eliminating the need for an in-person specialist visit.
The program was first funded by a grant and then funded internally, but now UI Health Care is getting reimbursed for it.
"Medicare decided to cover these codes," and so will more payers in time, thanks to diligent work from UI Health, Jaggers said during the presentation.
"We've had to negotiate with our payers a lot," Jaggers told HealthLeaders. For instance, they negotiated with Iowa Medicaid to cover those codes effective July 1, 2020, which she called "a huge win for the population."
She also anticipates that Wellmark Blue Cross and Blue Shield, Iowa's largest commercial payer, will cover them, too (they've been in negotiations to do so) because UI Health Care been able to show payers the success of the program, she says.
For instance, UI Health Care time studies show that eConsult takes clinicians eight minutes, versus an in-person, 30-minute specialist appointment that may take three weeks to get on the schedule.
Ultimately, Jaggers says UI Health Care aims to replace low-acuity visits with eConsult and "backfill those with the complex patients who absolutely need to see a specialist face to face."
"Our goal is to increase reimbursement and revenue through this and also decrease the patient volume," she says.
3. ELECTIVE SURGERIES GET POSTPONED
Revenue cycle professionals have increasingly been encouraging patients who can't afford their out-of-pocket costs to postpone elective procedures until they have a payment plan in place.
But postponing elective surgeries to free up resources during a pandemic is brand-new territory.
That's what CMS officially recommended yesterday. The new guidance calls for "all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak," according to a press release.
Even before CMS issued its guidance, though, several hospitals announced plans to cancel elective surgeries after urging from U.S. Surgeon General Jerome Adams.
New York–based Northwell Health began canceling elective surgeries and procedures in its hospitals on Monday, March 16 until April 15, it announced. The guidelines will not apply to emergency surgeries.
It’s also asking providers to reschedule other non-essential visits and is expanding telehealth access to its practitioners.
Atlanta-based Emory Healthcare and Michigan-based Beaumont Health announced similar steps.
Such cancellations will likely cause a major financial blow to many healthcare organizations.
For instance, orthopedic surgeons—who often perform elective procedures like hip and knee replacements—average $533,000 in starting salary while generating six times that much in hospital revenue, according to the Merritt Hawkins 2019 Physician Inpatient/Outpatient Revenue Survey.
Alexandra Wilson Pecci is an editor for HealthLeaders.