Revenue In Healthcare Innovation Series: Blake Madden

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In a recent webinar, industry experts Dan Murdoch from Adonis and Blake Madden from Hospitalogy engage in a compelling discussion on the evolving landscape of healthcare, focusing on issues of price transparency, operational challenges, and the promising role of technology.

Price Transparency: An Elusive Goal

According to Blake, the CMS (Centers for Medicare & Medicaid Services) has started fining hospitals that do not comply with price transparency requirements. These requirements, part of a larger movement towards healthcare consumerism, mandate that hospitals disclose their charge master rates, negotiated rates, and other pricing information. Surprisingly, many hospitals are choosing to pay the fines rather than disclose their rates, citing the significant overhead burden of compliance.

Blake further elaborates that these fines, though initially perceived as a minor inconvenience, may lead to public scrutiny and erode the trust that patients place in healthcare institutions. Hospitals opting to pay fines instead of providing transparency might be viewed as having something to hide—whether that is exorbitant prices, confusing billing practices, or other controversial issues.

Dan highlights that the intent behind this legislation is clear and universally supported; it aims to protect the consumers of healthcare—us. We all want to know what we are paying for before receiving a service, and this legislation aims to ensure this. However, Dan underlines that while the goal is clear and agreeable, the operational reality of achieving this is immensely complex. He points out that the healthcare pricing structure is intricate, with various codes, billing practices, and insurance considerations making the transition towards transparency a daunting undertaking.

Additionally, Dan emphasizes that adapting to these transparency requirements requires not only a shift in administrative practices but also a cultural shift within healthcare institutions. It calls for a new ethos that prioritizes patient awareness and empowerment as core values.

Operational Realities: The Big Challenge

Dan emphasizes that the transition to price transparency has exposed significant operational challenges in healthcare systems. Hospitals are complex entities with varying services, codes, and business lines, and integrating all of these into a coherent and transparent pricing system is no easy task.

He elaborates that the complexities of healthcare operations—from various departments and specialties to the nuances of patient care—can make standardizing price information akin to solving a vast, intricate puzzle. Each hospital has its unique structure and services, and aligning these with a standardized pricing model is far from straightforward.

To illustrate the challenge, Dan points to the numbers: in April alone, 730 warnings were issued to hospitals regarding price transparency, and 269 corrective action plans were requested. He predicts that enforcement will only increase, and while the fines may seem nominal now, they may grow to significantly affect hospitals' bottom lines.

Dan also touches upon the possibility of unintended consequences. For instance, in an effort to simplify and clarify pricing for patients, some hospitals might opt to reduce services or discontinue certain discounts, which could potentially lead to a reduction in accessibility and affordability for a significant segment of the patient population.

Furthermore, Dan raises concerns about the readiness of hospitals to undertake such a substantial change. Hospitals already strained with the demands of patient care, particularly in the midst of challenges like the COVID-19 pandemic, may find this added administrative burden overwhelming.

The Role of Data and Technology

According to Dan, the solution begins with leveraging data and technology. Healthcare systems are already generating vast amounts of data daily. The key, in his opinion, is to integrate these disparate systems and datasets into a unified technology platform. Such a platform can help healthcare providers not just comply with regulations but also streamline operations and improve patient experiences.

Blake refers to this as the ‘iPhone moment’ for healthcare—a time when an innovative technology could transform the industry, much like the iPhone did for mobile technology. This technology, whether it involves artificial intelligence, machine learning, or other advanced analytics tools, could have a significant impact on various areas, from revenue cycle management to administrative processes.

For example, Blake mentions the potential of data analytics and AI in reducing claim denials, easing the burden on call centers, and making patient billing more transparent, thereby reducing the number of itemized bill requests from patients.

Hospital Rankings and Controversies

The conversation then transitions to the recent U.S. News rankings of hospitals, which Blake highlights as traditionally being the ‘gold standard’ for vetting hospital performance and quality. However, this year’s rankings have stirred controversy, as some believe that they do not adequately account for health equity or social determinants of health.

In a notable trend, Blake points out that some high-regarded academic medical centers have voluntarily dropped off the list, indicating a potential shift towards hospitals wanting to define their value independently of such rankings.

A Path Forward

Dan concludes the discussion with optimism. Despite the challenges, he sees immense room for improvement in healthcare and believes that solving the economic challenges associated with existing models can free up resources for other critical areas, such as labor. This, in turn, can lead to better patient experiences and more predictable revenue outcomes.

For Dan and Blake, the ‘iPhone moment’ for healthcare isn’t just a theory—it’s a clear and present opportunity. They emphasize that with the right application of data and technology, the healthcare industry can navigate its complexities and emerge more streamlined, transparent, and patient-friendly than ever before.

Conclusion

As healthcare evolves into a more consumer-centric model, the industry faces significant operational challenges, especially regarding price transparency. The experts, Dan and Blake, believe that technology and data analytics are at the center of the solution, potentially leading to an 'iPhone moment'—a transformative juncture that could redefine the healthcare landscape for the better.

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