Healthcare providers must weigh high value vs. high prices, revenue cycle pros say

It's not about cost, but value, according to a panel of revenue cycle professionals who work in health systems that often charge more for care than other providers.

"We're one of those higher-priced providers," said Benjie Johnson, chief officer of Integrated Revenue Cycle for the University of Michigan Health Center during the Revenue Cycle Solutions Summit in Atlanta. 

The university health system has fixed costs associated with the hospital's mission, she said. The question she and others ask is, "What is the value of the University of Michigan? Why does it cost more and what does it mean? We look to see if we can lower our costs."

[Also: Intermountain revenue cycle VP: Hospitals are on the hook for price transparency]

"The consistent theme here is value and the value your organization brings," said Stanley Nachimson, president of Nachimson Advisors.

Short-term thinking focuses on cost, according to Jeffrey Hurst, senior vice president of Finance for Florida Hospital. The challenge is getting to a population health perspective in which the hospital builds a relationship with the patient over time.

"The challenge right now is that's an academic conversation," Hurst said. "I think the challenge we have in healthcare is most people tend to be short-term oriented. "

Adam Gobin, director of Revenue Cycle Management for Emory Healthcare, said value is how health systems such as theirs will be paid. If a patient comes in for a hip replacement and is also diagnosed with diabetes, that visit represents value in population health.

[Also: Hospital-physician integration driving up medical prices, JAMA study says]

Emory employs metrics that are easy to track in order to save the health system money, Gobin said.

"We've got people assigned to specific roles, that's all they're focused on," he said. "We use predictive analytics to stop claims from going out that will be denied."

Emory historically looked at claims to see where they got denials. That has been changed to looking at what's getting paid, he said.

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Some oncology claims, representing a large dollar amount, were paid in 60 days, while others were paid in 15 days and they wanted to know why.

"You're missing what's getting paid when you look at what's being denied," Gobin said.

Hurst said Florida has a similar philosophy. A year-and-a-half ago the health system started having staff work with physicians on the correct clinical documentation.

"We're trying to get away from denial management," he said, "and get to denial avoidance."

Twitter: @SusanJMorse