Dealing with uncertainty
"I would say one of the biggest challenges is the uncertainty of future revenue streams as we move toward population health management from the traditional healthcare model," he says. "How do we continue to give top-quality care under shrinking revenue models and still invest in care out in our community, outside of our four walls?"
Reilly is also concerned with creating a revenue cycle process that adds value to the patient experience. "If they don't think the process is adding value … that can distort the patient's point of view about their experience and how satisfied they are. And in the days of transparency, all of that gets reported. It's out there on the Medicare website."
In addition to the challenges posed by forces outside of the hospital, there is also an important internal struggle for hospitals to contend with, Reilly says. "You still have to partner with clinicians—that's one of the most important challenges for a lot of organizations, to partner with clinicians to ensure appropriate documentation and coding. If you don't have a really streamlined process on the front end, it is going to result in denials on the back end."
Reilly sums it up with a comment that echoes much of what I heard in my conversations with all three healthcare leaders: "In the end, it all stems from having an efficient revenue cycle system and from collecting the right information at the right time."