The pediatric revenue cycle: how to bolster the bottom line and support the mission of children’s hospitals
Children’s hospitals offer critical, compassionate care for our nation’s most vulnerable patients year after year. While managing the fallout of the COVID-19 pandemic, hospital leaders have had to navigate a set of demanding challenges, both familiar and new, including resource limitations and families becoming responsible for a greater portion of medical bills.
Becker’s Hospital Review recently brought together pediatric healthcare leaders from around the country to discuss these pressing topics at its Pediatric Leadership Virtual Forum in February 2021. Heather Kawamoto, Waystar’s VP of Product Strategy, joined a panel of revenue cycle leaders from three large children’s hospitals to discuss the challenges and opportunities for pediatric hospitals.
As a refresher and for those who were unable to attend, below are five key takeaways from the event.
1. High Medicaid payer mix requires dedicated + specialized tools
On average, about half of children’s hospitals’ payments come from Medicaid. Managing Medicaid and state-managed care plans makes for a highly complex revenue cycle and a unique set of challenges for reimbursement.
Hospitals can ease this burden by using technology that helps them untangle this complexity. For example, the right technology partner can alert users of managed care or out-of-network plans, automate prior authorizations, find undetected insurance coverage or missed charges unique to children’s hospitals, and provide a customized claims ecosystem to manage highly specialized claims and expedite reimbursement.
2. Families are responsible for a greater portion of cost
The number of patients and families on high-deductible healthcare plans (HDHPs) increased 162% in the past 10 years, skyrocketing even before the pandemic hit. This, coupled with widespread loss of employer-based healthcare benefits (particularly affecting the millennial generation) makes a difficult financial environment for families and providers alike.
That’s why It’s never been more crucial for hospitals of all kinds, but especially pediatric ones, to build a holistic and empathetic engagement strategy in which technology can play a key role. Doing so allows providers to reduce financial stress for families by providing smarter, richer insights, such as when would be appropriate to collect vs. when to apply charity, while easing administrative burdens on teams that in turn let them prioritize patients, not payments. Similarly, creating a convenient digital payment experience improves the financial experience for families and increases the likelihood of payment.
3. Hospitals are reimagining care delivery thanks to COVID-19
With children practicing social distancing and wearing masks to avert the spread of germs, hospitals can’t count on the acute visits or specialized surgeries they would normally provide. Inpatient stays have declined with fewer acute visits, while many are electing to delay care or procedures until they feel safer.
In an effort to more strongly compete and expand patient reach, children’s hospitals are fostering mutually beneficial relationships with primary care providers, pediatricians, and ambulatory surgery sites to extend business beyond hospital walls. Coordination with these lower acuity settings not only promotes healthier communities, but it helps to bend the cost curve and get paid for health.
As hospitals form these meaningful business partnerships, they must take better advantage of technology that streamlines operations and the revenue cycle in these ambulatory settings.
4. Telehealth has transformed pediatric care
The government’s public health emergency pivot to reimbursement of telehealth care has resulted in a massive increase in children’s hospital telehealth visits, much like other hospitals throughout the country. Most hospitals now feel they have a handle on telehealth care, and panel leaders expect that telehealth will significantly contribute to their future operating and profitability models.
Telehealth options are an advantage and convenience to patients and their families, especially for families with a child who has a complex medical condition. Telehealth also has allowed hospitals to reach rural patients who otherwise have limited access to pediatric care. Panelists also noted that telehealth has allowed their organizations to provide more timely, convenient behavioral health care, thereby expanding their care offerings.
5. Children’s hospitals seek innovation for future success
Facing challenges in care delivery, payer mix, the COVID-19 pandemic and more, children’s hospital leaders are embracing new, innovative approaches to ensure revenue growth and success in their communities. They are imagining futures with technologically simplified processes, improved patient access, further community and geographic reach, and a revenue cycle that puts patients and their families at the center.
Children’s hospitals are contemplating how they can redesign the revenue cycle around their patients and their families, and it seems clear that automation and expanding the care continuum will be key for future success.
The wrap up
Children’s hospitals will always be challenged by the difficult juggling act of balancing highly specialized care for patients facing unique challenges with the need to grow revenue to support said care. The Pediatric Leadership Virtual Forum offered an encouraging reminder that those challenges will be faced by highly skilled and driven providers, united in pursuit of world-class care and the innovations that will help them achieve it.
Learn how Waystar is helping children’s hospitals build family-centric revenue cycles.
