Hospital Executives Predict Significant Shifts in Payer Mix, Revenue Cycle IT Budgets Post-COVID-19, According to Guidehouse

Analysis of HFMA Survey Cites Investing in Vendor Partnerships, Outsourcing, and Telehealth as Strategies for Cost Reduction, Consumer Engagement

WASHINGTON, Sept. 30, 2020 — Approximately 70% of hospital and health system leaders are preparing for an increase in post-COVID-19 self-pay consumers and Medicaid beneficiaries, and a decrease in commercial reimbursement, according to a Guidehouse Center for Health Insights analysis of an executive survey conducted by Healthcare Financial Management Association (HFMA).

More than 150 provider chief financial officers and revenue cycle executives responded to the survey, which takes an in-depth look at their projections over the next 12 months across key areas, including payer mix shifts, consumer and employee experience strategies, revenue cycle IT budgets, electronic health record (EHR) satisfaction, and price transparency preparedness.

Notably, 92% of executives have increased telehealth use, with 73% using it to better-engage patients and address consumer responsibility. Executives also cited financial counseling and payment plans (63%), as well as online portals for price estimates and payment (56%), as strategies to better-engage consumers.

“With health system margins primarily driven by elective services, the pandemic is gravely impacting provider revenue streams and payer mix,” said Timothy E. Kinney, Guidehouse partner. “As our economy labors post-pandemic, insured patients will struggle to shoulder greater cost sharing through high-deductible plans coupled with volatile unemployment rates. Healthcare leaders need to closely evaluate their payer mix and develop winning consumer experience strategies to overcome a slow recovery in patient volumes and an uptick in self-pay and Medicaid enrollees.”

Strategic Investments in Revenue Cycle IT Coupled with a Remote Workforce

Guidehouse found that providers are planning for marked revenue cycle IT budget decreases. Over the next 12 months, compared with 2019 survey results:

  • 35% of executives cited their organization’s IT budgets will increase, down from 69%.
  • 27% of executives cited IT budget decreases, up from 5%.

Collaboration with external entities, including vendor partnerships (37%) and outsourcing (32%), were the most often cited strategies for decreasing revenue cycle costs and increasing economies of scale, according to the survey. In addition, 27% of executives cited using advanced health IT, including robotic process automation.

For the revenue cycle management workforce, almost 90% of providers have shifted to remote arrangements. Of those, nearly half have decided to continue with remote options and are reassessing future space-use needs. Moreover, only 12% of executives expect staff to return to pre-pandemic arrangements.

“As the revenue cycle workforce goes remote and budgets tighten, health system leaders are evaluating strategic investments in vendor partnerships and outsourced services,” said Mary Beth Briscoe, FHFMA, FACHE, CPA, MBA, CMRP, a senior advisor to Guidehouse who formerly served as a health system CFO and HFMA national board chair. “While digital technologies will be a necessity post-COVID-19, they must be methodically selected to ensure they are unlocking long-term performance improvement opportunities.”

Adaptation to Electronic Health Records

As EHRs continue to mature, providers appear to be benefiting from their capabilities. However, only one-in-five executives cited a seamless transition with their EHR to using telehealth, which has been an essential component to engaging with patients during COVID-19. Among respondents, compared to 2019 survey results:

  • 42% cited EHR adoption benefits are outweighing challenges, up from 31%.
  • 68% cited they appropriately utilize available EHR functions, up from 59%.
  • 55% cited they quickly adapted to functional releases, up from 44%.

Price Transparency Compliance Concerns

Though the Centers for Medicare & Medicaid Services hospital price transparency rule is scheduled to go into effect on Jan. 1, 2021, only 12% of executives said their organizations are ready to comply, with one-third suggesting they are unprepared. Concerns about disclosing rates to payers, media, and consumers (38%), and lack of an analytics infrastructure (26%), are cited as the biggest obstacles for compliance.

The survey analysis was provided by the Guidehouse Center for Health Insights, a source for the latest health research, trends, and best practices. With multiple Best in KLAS awards, the Guidehouse Health team helps hospitals and health systems, government agencies, life sciences companies, and payers strategically redesign, revitalize, and transform their operations.

About Guidehouse
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