Sheila Augustine, CHFP (’07, ’19), is the Director of Patient Financial Services at Nebraska Medicine and a two-time graduate of the Clarkson College Health Care Business program. She has spent years in the health care industry and is skilled in helping patients and organizations navigate Medicaid, the Health Insurance Portability and Accountability Act (HIPAA), medical billing, health care information technology issues and revenue cycles. Her thoughts regarding issues within medical practice management were recently shared on the website, Healthcare Tech Outlook.
What are the challenges faced by the current Medical Practice Management sector?
One of the biggest challenges in the healthcare sector across medical management or hospital groups is the high deductible plan, which shifts more responsibility toward the patient before their insurance benefits kick in. This is causing a higher out-of-pocket payment for patients, and they take a longer time to make payments. We're starting to see denial from payers in all industries within healthcare; their requirements are much more stringent than they once were, with reimbursement from commercial payers taking longer than it used to.
What are the means to overcome these challenges?
To help patients bear the weight that comes with high deductible plans, a medical management group or a hospital can offer multiple payment options for their patients. As a result, patient financing is a huge component within the industry, where the payment can be received upfront from the banks or lending companies. They then take over the job of billing the patient, while the hospitals remain a service provider.
Relationships and communication established with the insurance provider can help in lessening the denial of payments. Both insurance companies and providers are running a business to get paid. An open, honest approach benefits the relationship between providers, payers, and patients as well.
Educating the patients on their expected liability of payment, giving them an estimate of cost before procedures, getting their insurance coverage, and checking if they qualify for any financial or governmental aid can help patients in avoiding any payment related backlash. It goes back to the patient experience, of which billing has become a major part.
Our company partnered with a bank in 2016 to offer patient financing, which was very beneficial both to the patient and us. A payment arrangement we proposed that enabled patients to pay the bills in six easy installments has been received well. Our financial counselors live in the hospital and clinics and provide support to the patients when they have questions. The systems we have put in place can help us alert a financial counselor to see the patient. Probably the biggest initiative we took was working up more estimated costs on services we were providing so that patients knew their expected liability before coming to their appointment.
What is your take on mitigating payment discrepancies in Medical Practice Management?
From a leadership standpoint, having your staff working at their best is also a challenge. I expect my staff to be accountable for their actions. As I work with them side- by-side from the same work queue, I wouldn't expect them to do something that I wouldn't do myself.
The performance of the hospital group can be affected on a daily, weekly, or monthly basis by various factors such as pending payments, bad debt, and charity. Staff obtains its tasks from the work queues on a daily basis and is better positioned to know the work progress. There must be open communication in the meetings with the team to improve on the work process; the suggestions of the teams must be considered to solve any arising problems. The revenue cycle steering committee within the company has a better chance of resolving any issues as its workforce is distributed across departments such as finance and pair relations among the others.
What are some pointers to remember while choosing a solution provider?
There are a few points to take note of while selecting a solution provider. The rate of return must justify the money invested. A service provider’s ability to save money by reducing costs accrued through physical statements, printing, and postage and outsourced customer care can help in choosing them. But various providers must be considered and weighed against their comparability and compatibility before making a choice. After a partner is found, tasks that are challenging, but unimportant can be delegated to them.
What would be your advice for a colleague?
Understand what your staff does on a day to day basis. It will make you more valuable as a leader. You don’t have to be able to do the job as quickly and efficiently as them but maneuver through and find the answers. This will also inspire respect from the staff. Relationship building is the key to healthcare, whether internally with your colleagues or externally with patients and payers; because many areas impact the billing of hospitals or physicians. Relationships built in such ways help in communicating the news about a change aspect coming up or discussing issues.
Where do you think the future of Medical Practice Management is headed?
I see that a lot of healthcare systems are being bought out by bigger ones. What will happen to critical access hospitals, or private practice physicians who are on their own? Will the smaller areas be able to sustain on their own? Or will they end up joining a larger provider group because the market is so competitive? There is a future that’s uncertain but intriguing. Another aspect to be noted is the insurance reimbursement and its methodology. They continue to evolve and shift to programs like quality and value-based care, which will become part of the larger quality strategy to reform how healthcare is delivered and paid.
