LUMINA Insights Blog

Updated: December 6, 2021

There are many mechanisms healthcare organizations can use to accelerate their financial recovery efforts post-COVID-19. 

When examining these mechanisms, financial leaders' questions often boil down to two essential concerns: How effective is it? And how long will it take for us to see results?

The revenue cycle lands at the top of the heap when it comes to quick but highly effective ways to accelerate revenue. It also plays a critical role in improving the patient experience and health of populations while reducing the cost of care. 

By improving revenue cycle efficiencies, healthcare financial leaders can gain a vital "quick win" in their financial recovery timeline.

I recently taught a 2-day HFMA seminar on Revenue Cycle Essentials and KPIs (key performance indicators). Here, I’ll summarize the challenges revenue cycle leaders are experiencing today, as well as key factors for success. 

Most health systems have invested heavily in primary care practices in the last decade. The good news is this strategy is paying off. Research shows that primary care providers are key to engaging patients, coordinating care, controlling costs and ensuring the best outcomes. For healthcare organizations, a strong primary care strategy is key to succeeding under value-based care.

Owning a primary care practice is tougher than ever — nearly 4,000 primary care practices had to close their doors during covid. That means about 8% of all physicians shuttered their business at least on an interim basis in just the last 12 months, many pertinently.

Virtual Continuing Medical Education conference for physicians and executive leaders set for October

Lumina Leadership Institute (LLI) and Interstate Postgraduate Medical Association’s (IPMA) Ascent Physician Leadership are collaborating to host “Leading for Results: Building a Collaborative Leadership Model,” a virtual Continuing Medical Education (CME) conference for physician and executive leaders on Thursday, Oct. 14, 10 a.m. to 1 p.m. CT.

Healthcare organizations are experiencing change at a rapid pace; hospitals are merging, large medical groups are forming, and clinically integrated networks and integrated delivery networks are acquiring hospitals and physicians.

These business transactions also have a direct effect on the most valuable asset any healthcare organization has: its employees. Although the human side of these transactions is seldom talked about, failing to address employee issues can be expensive in both cost and reputation, and can lead to unresolved conflict.

Lumina Health Partners Introduces an Up-Skill Solution for Stressed Healthcare Executives and Physician Leaders

Chicago, IL - Healthcare organizations and hospitals across the country are estimated to lose millions caused in part by unprepared leaders and apparent increasing physician burnout. In response, Lumina Health Partners, a Chicago-based healthcare advisory firm, is launching the Lumina Leadership Institute (LLI) to help healthcare organizations better equip executives and physicians to effectively navigate today’s environment, where strategic objectives in business and clinical areas require stronger, more competent leaders.

The new CMS 2021 Physician Fee Schedule (PFS) went into effect on January 1, 2021. Most of the final rule consists of expected policy refinements, but the regulations do include some significant changes that will impact medical practice productivity, strategy and revenue.

To take full advantage of the new fee schedule, physicians and medical practice leaders should focus on three immediate priorities:

COVID-19 has decimated fee-for-service (FFS) revenue. To stay in the game, healthcare providers can use a chess-inspired strategy to rebuild the revenue cycle while preparing for value-based care.

The COVID-19 pandemic has triggered major financial losses for hospitals, health systems and medical groups. Healthcare organizations now face the double challenge of rebuilding FFS revenue while continuing to transition toward value-based payment.

While U.S. providers have suffered profound financial losses because of COVID-19, health insurance companies have actually benefited from the pandemic. Providers require effective strategies to achieve a more equitable balance.

Healthcare utilization has dropped sharply as a result of COVID-19, causing most hospitals to experience a major drop in revenue and margin. But for most commercial payers, lower utilization has slashed claims expenses and created a  huge financial windfall.

For example, United  Healthcare’s net income doubled during the first  wave of the pandemic, jumping from $3.3 billion  (2019 Q2) to $6.6 billion (2020 Q2).^a 

Although these market dynamics clearly seem unfair to providers, there is no reason  that providers should simply accept the status  quo. As they struggle to recover financially from COVID-19, hospitals and health systems should  not hesitate to look to insurers to share their  excessive surpluses. 

Right now, the biggest potential opportunities for providers are in contracting with insurers. Financial leaders should focus on three broad areas where they should seek to renegotiate existing contracts and lay the groundwork  for beneficial new partnerships.