How to position ASC revenue cycle management for value-based care success

On Thursday, July 28, SourceMed held a webinar titled "A 360 view of value-based care: How to position your facility for success."

SourceMed Senior Vice President of Revenue Cycle Services Jho Outlaw, Vice President of Professional Services Walter Groszewski and Product Manager of Analytics Michael Cipoletti shared ways for ambulatory surgery centers (ASCs) to adapt their revenue cycle management (RCM) strategies for success in the value-based care world.

"It's about accessing the information you have and using it to drive actionable insights that help you achieve better financial, operational and clinical outcomes. Really leveraging the right data at the right time within your organization as well as across the entire ecosystem of care," said Mr. Groszewski.

The goal in value-based care has always been improving quality and controlling costs; what has emerged over the past few years is the convergence of healthcare technology to give greater data access and transparency to all stakeholders. Value-based care is dependent on the connectivity of the healthcare continuum.

"Value-based care is not a new concept; it’s been around in some form for years. Today, the momentum is accelerating and largely being driven by government mandates as well as next generation healthcare technology solutions," said Mr. Groszewski.

Many providers are taking a wait-and-see approach to value-based care; they have concerns about the metrics used to evaluate performance, which are still evolving. They are also concerned about the impact on cash flow — in a recent survey, 45% of respondents said they expect a drop in profits due to the move to value-based contracts.

Several value-based models emerging, which carry varying levels of risk, including:

• Pay-for-performance
• Patient centered medical home
• Bundled payments
• Accountable care organizations

One example is the Comprehensive Care for Joint Replacements (CJR) model, which holds participant hospitals in 67 regions financially accountable for the quality and cost of a CJR episode of care and incentivizes increased coordination of care among hospitals, physicians, and post-acute care providers. There are opportunities for outpatient facilities, including ASCs and rehabilitation therapy clinics, to participate within the CJR initiative.

The move to value-based care will require new RCM approaches. For example, most healthcare revenue cycle teams currently have an assembly line approach where people work separately; in the future, RCM teams will need to work together to focus on the outcome of each claim instead of the individual parts. Reporting will need to be more timely and analytics-driven going forward, with data that is dynamic and ecosystem-based.

"One thing that will not change in value-based RCM is the need to remain focused on key performance indicators (KPIs)," said Ms. Outlaw. "By closely monitoring KPIs, you can track key aspects of the revenue cycle that drive overall success as well as identify potential problem areas that need attention.” The top five revenue cycle KPIs she recommends to track are:

• Claims submission speed
• Accounts receivable greater than 90 days
• Cash collected as a percentage of net revenue
• Overall cost to collect
• Average claims worked per day

Focus on accurate reporting and look at results on a daily, weekly and monthly basis to keep teams informed and accountable. Benchmark yourself against industry best practices and question trends – both positive and negative – as they surface.

"Regardless of the payment model, the revenue cycle is all about data and people," said Ms. Outlaw. "If you reengineer your systems, you've done a lot but you must also adjust the expectations of the team by cultivating a results-only work environment."

An analytics-driven culture will be key to success under value-based models. The goal of analytics is to improve outcomes by gaining fact-based insights and knowledge to make improvements.

"I recommend that you start small and take an incremental approach with your analytics strategy," said Mr. Cipoletti. Figure out which measures you can pull out of a small amount of data; make sure the changes won't create a huge administrative burden. Starting small allows the organization to grow into bigger projects.

Collaboration and communication are essential to value-based models, and will help organizations advance more quickly and effectively. He emphasized that open-platform system interoperability and data sharing are critical, and will enable better decision-making. Secure and scalable cloud-based technology can play an important role in fostering success. He suggested that a good place to start an analytics strategy is by tracking your facility’s performance on certain quality measures such as patient burns and patient falls.

Mr. Groszewski discussed new roles that are emerging to better understand the value of care delivered and the populations that are being served; for example, the Chief Clinical Officer. An entirely new set of questions must be addressed in the value-based world. “At the end of the day, it’s about integration and collaboration. How do you integrate clinically, how do you tie your populations together, how do you manage risk across the ecosystem?” he stated. Continuity and coordination across the full patient experience will be key; providers must establish an end-to-end communication connection with patients to build confidence, satisfaction and loyalty – all of which impact the revenue cycle.

The SourceMed team concluded the webinar by discussing other approaches that ASCs should consider implementing for positive revenue cycle results under value-based care, for example: community networking, virtual care delivery including telehealth, and more scalable staffing models. "If you're not willing to be creative and evolve really fast, you'll be behind," said Ms. Outlaw.

Click here to see the full webinar replay, including five key takeaways and an audience-driven Q&A with the SourceMed presenters.

Click here to download the slides. 

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