Q&A: Texas healthcare expert Shawn Yates projects 2017 industry changes, offers tips
Yates is taking a stab at predicting how certain trends and events will play out over the coming year.
The healthcare landscape has been changing dramatically over the past several years, and with a new administration rolling into Washington, more dramatic changes are likely afoot. With President-Elect Donald Trump and many Congressional Republicans vowing to repeal and replace the Affordable Care Act, Shawn Yates, director of healthcare product management at Ontario Systems, is taking a stab at predicting how certain trends and events will play out over the coming year.
The one thing that's certain? Nothing is certain. But Ontario Systems' thought leaders have cobbled together some educated prognostications.
Q: How will healthcare providers use big data?
A: Big data will become a big part of what providers look at for 2017 and beyond. The immediate focus you have seen is with clinical and population health but more and more providers are expanding the utilization of this in areas of the revenue cycle.
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Q: Is there a profitability crisis affecting healthcare?
A: Yes. Just this week the top five largest not-for-profit hospitals posted earnings and even though all posted positive revenue growth only one had margin growth and several had no margin at all. This all stems from cuts in reimbursements from the ACA and budget reductions by the federal government. Combine this with the rise of HDHPs and providers are struggling to meet basic survival margins. This is why we are seeing the escalation of mergers and acquisitions. Additive: with the election and the unraveling of the ACA expected by the GOP this will put even more pressure on providers as the insurance benefits of having some revenue come in on what use to be uninsured patients will shift back the other way and they will no longer get this benefit on a sizable portion of this population experts are predicting.
Q: How can providers keep up with the regulations and demands set by government while still aiming to provide quality care?
A: The key is to have the tools in place to help you monitor the activity. More and more focus is moving to how you interact with the consumer. This means providers need to understand what their outsourcing vendors are doing. Thus having tools to not only track performance but how they handle critical items like complaints is extremely important. Having these tools in one platform along with your workflow helps you manage the process and keep an eye on all aspects of patient interaction including the outsourcing vendors.
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Q: Are patient reviews of providers and healthcare rankings accurate? If no, why not?
A: I think this is relative to how you interpret them and use them. How is the survey administered, when and in what context? These are things that all impact the results. For example, if you do a survey right before a patient leaves that day is this annoying, do they respond differently by having to wait? When you send it to their home, and the billing is off or (there is) some other issue post-service, this affects the survey. In the end, only one thing really matters: You are only as good as your customer thinks you are. So my advice is keep these simple and focus on the main components of satisfaction and listen to what your patients have to say. When they do speak do something about it as well. The worst thing to do is to have a survey where patients complain about something and you do nothing about it.
Q: Will the self-pay issue continue to affect patients and healthcare networks in 2017? What steps can hospitals take in order to gather money-owed without breaking compliance or upsetting patients?
A: Yes. Self pay will continue to grow but I think this will happen twofold now. If the ACA was not going to be repealed or unraveled then the underinsured with HDHPs would be the main issue. But now I think we will see the continued growth of HDHPs and the uninsured again like we had 10 years ago. This means to survive providers need to have very efficient processes in place and automate as much as possible, engage patients with as many self-service options as possible and manage all of this on a single platform. Providers do not have time to manage multiple systems so put everything on one system with one process. One patient, one process, one system.
Q: What is the biggest financial concern for healthcare networks in 2017?
A: What is going to happen with the ACA? People are theorizing right now and I think we have some general direction but this is the biggest concern for 2017.
Q: Will hospitals continue to turn to mergers and acquisitions to secure financial stability?
A: Yes. With the ACA unraveling, making a positive margin will become even harder. The smaller health systems will just not have the financial backing to survive the downturns, which will lead to this activity growing.
Q: What are the top three to five services or solutions healthcare business operators or IT directors should have in place in 2017?
A: 1. Segmentation strategy for self-pay. Self pay is going to get worse with the breakdown of the ACA. Having solid strategies will be critical to handle this. 2. Fully automated insurance follow-up process. There are great tools to automate this to almost a 100 percent nature so utilize this to make the most of your reps. 3. Build a highly productive denial management process. By utilizing subcategories for CARC codes, tracking this with reporting and trending and utilizing this on one system will increase productivity and cash recoveries dramatically. 4. Create one process for all of the revenue cycle. If you have disparate systems or affiliates then combine them into one process. Separate processes breed inefficiency so when you move these data sets into one combined system you will have a productivity boost and a better cost to collect, leading to a bottom line improvement.
Twitter: @JELagasse
