COVID-19 as a Catalyst for Change

How health systems can optimize revenues and resources

By Nimesh Shah, CEO, and Laura Chapman, VP of Product Management

The COVID-19 pandemic presents a paradox. Hospitals have never been more important to treating Americans, yet they have never been more financially challenged. U.S. hospitals saw an average 60 percent drop in physician patient volumes and a 55 percent drop in revenue, and hundreds of hospitals have furloughed staff to address the financial challenges. Bankruptcies are expected to accelerate in at-risk hospitals.

Ingenious Med customers saw physician-submitted charges reduced by 40 percent between March 1 and April 15. While submitted charges rebounded about 10 percent by late May, solving revenue challenges is still critical. Having the right tools and processes to optimize revenues and minimize costs remains essential beyond the pandemic’s peak.

New surveys indicate that not all patients are willing to return for care in the coming months. A Kaiser Family Foundation survey found that 32 percent of those who postponed medical care during the pandemic do not plan to return in the next three months. That means that volume losses won’t be recouped quickly, making it imperative to continue optimizing billings and collections.

postponed medical care during the pandemicWe recently hosted a webinar, Optimizing revenue and resources in the new normal… and beyond, with Jason Cook, Assistant Vice President, Medical Management at Scripps Health. Jason described the challenges Scripps has faced and how Ingenious Med has helped optimize its productivity and revenue during the pandemic. Scripps knew that its response to the crisis had to be nimble, and we knew that our solutions had to adapt quickly to serve the emerging needs of our customers. Recognizing the challenges faced by the market (as evidenced by Scripps’ experience), Ingenious Med created a host of new support features to address these emerging problems.

Managing productivity and performance

COVID-19 has dramatically impacted revenues, making it even more important for healthcare organizations to tightly manage costs, productivity and performance.

As Jason noted, COVID-19 did not impact every region or facility at Scripps equally. The health system needed timely, accurate data to track infected patients accurately and monitor staffing across facilities and regions. For example, Scripps facilities have observed widely varying distributions of COVID-19 cases across the health system, influenced by proximity to an international border, social distancing compliance and other community specific factors. Having that data from Ingenious Med helped Scripps efficiently deploy staff and other resources across these various locations.

mobile charge capture covid 19 flaggingIngenious Med created new flags that enabled customers to flag both patients with known COVID-19 infection and persons under investigation (PUI). Scripps used this functionality to deploy staff efficiently and avoid having high-risk staff treat COVID-19 patients. This also helped reduce PPE usage as clinicians could quickly identify patients that had been cleared for surgical procedures.

Using Ingenious Med, Scripps could see significant changes in cost per work RVU during the pandemic. This was due in part to the cancelation of all elective procedures, which created significant bed capacity early in the pandemic. Additionally, it found that total RVUs were down 47 percent, caused largely by a higher case mix during the pandemic where even non-COVID-19 patients had higher comorbidities than normal. Scripps is using this data to guide its current and future responses to COVID-19.

Supporting the acceleration of telemedicine for newer revenue streams

Telehealth visits provided some income relief for revenue-strapped providers. One Ingenious Med customer saw an 800 percent increase in telehealth visits in the few weeks after the pandemic hit, and expects over 25 percent of its clinic visits will be conducted via telehealth by late 2020. That spurred our development of new telemedicine modifiers and superbills to help customers capture this revenue.

telehealth during covid 19Scripps also moved quickly to ramp up its telemedicine capabilities to offset volume losses. After a 75 percent drop in daily ambulatory visits in mid-March, the widespread and rapid adoption of telemedicine has helped it rebound to 80 percent of normal visit volume, stabilizing its revenue cycle as well as improving care coordination. This reflects a larger trend of ⅔ of patients saying they would consider using telemedicine in the future.

Jason explained that telemedicine will continue playing a key role as systems evaluate how technology and virtual visits will remain a significant part of healthcare delivery.  It is possible that traditional large brick-and-mortar sites could be seen as an unnecessary burden on their balance sheet. Technology requiring only an iPad or remote monitoring equipment minimizes care delivery costs while creating new revenue streams and providing greater access to vulnerable patient populations.

Coordinating care and capturing revenue across the continuum

Many health systems today have a network of employed and affiliated physicians and strong relationships with skilled nursing facilities (SNFs). Many of these non-acute providers use disparate EHR systems, making it difficult to monitor and modify performance across care settings.

The Ingenious Med platform provided a way for Scripps to capture charges accurately and quickly for any of its physician groups that weren’t on Epic, and to interface with Epic’s billing platform for those groups. Scripps also used our solution to create interfaces between several of its SNF partners’ EHRs in its ACO, building HL7 interfaces between its EHRs and the IM platform. This enabled rounding providers to have access to immediate census data and ensure continuity of its revenue cycle in outlying institutions.

As the pandemic has continued to evolve, Scripps has found that it is providing more care in non-traditional locations. For example, as the pandemic trudges along, it has prepared to treat some SNF patients with COVID-19 in its acute care facilities under CMS Section 1135 waivers and also treated some home health patients in designated hotel or college dorm rooms established by the county Health  and Human Services agencies. That made it more critical to have a platform like Ingenious Med so it could understand where its patients were and be able to capture the revenue associated with those visits.

Analytics and AI

Another area where Scripps used our analytics was in tracking CARES Act-related data, which was critical to ensure reimbursement for unfunded patients.

Scripps is also partnering with many of its medical group partners as it prepares for a phased return of services. Having the data generated by Ingenious Med’s platform is key to evaluating the main drivers of work RVUs, encounter volumes and other metrics, which it will use to ensure that agreements enable groups to build a sustainable practice going forward.

A renewed focus on revenue integrity

As a result of COVID-19, we’ve seen a renewed customer focus on revenue integrity. Customers are working to identify missed revenue opportunities and capture revenue accurately the first time, catching problems upstream to minimize denials. Accounting for missing charges, finding all appropriate billable revenue per charge, having an easy-to-use tool at the point of care and finding ways to maximize reimbursement are more important than ever.

COVID-19 has enabled an alignment of financial motivations, consumer needs and demands and provider interest at a single point in time. It takes an orchestrated balance of these elements to sustain organizations post-COVID-19. That requires vendors to listen carefully as customer needs evolve, adapt their tools to meet those needs and get them in use quickly.