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. 

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.

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.

As their organizations make major adjustments to operations, healthcare leaders should be prepared for increased levels of workplace conflict. Fortunately, taking the right approach can turn a conflict into an impetus for positive change.

Healthcare organizations are experiencing change at a rapid pace as technological innovations and alternative payment models greatly impact operations — and people. As a leader, you can expect these changes to create workplace conflict. But you also should be assured that you can manage this conflict, and make it a productive rather than disruptive force, by using the following approaches.

“By failing to prepare, you are preparing to fail.” ― Benjamin Franklin

The COVID-19 pandemic has forced every industry to rethink how they do business — and the healthcare industry is one of the most heavily impacted. In this ever-changing set of circumstances, providers are challenged to determine the best way to adapt the delivery of care.

One tool they increasingly are turning to is telehealth services.

The appeal of telehealth right now is obvious. Patients appreciate being able to receive healthcare without risking exposure, while physicians appreciate being able to provide safe and convenient care.

Chicago, Ill. – Lumina Health Partners is launching a no cost webinar for healthcare providers to guide them in launching telehealth services. This webinar, taking place on March 26 at 10 a.m. CT will offer practical solutions on establishing telehealth services as well as information on how to properly document, code and bill for such services.

Value-based care (VCB) requires a keen focus on the Triple Aim: achieving better quality and patient outcomes while bending the cost curve. This is not done in silos; VBC is a team sport that requires collaboration across providers in all settings of care, from the doctor’s office in the ambulatory setting to the hospital to the post-acute setting, including effective transitions from one setting to the next. Coordinating care across the continuum and across all settings is key.

The U.S. healthcare system is steadily transitioning from fee-for-service (FFS) reimbursement to fee-for-value (FFV) payment. This change has already started to affect medical practice revenue, and it will have an even bigger impact in the years ahead.

Unfortunately, most physicians and practice managers understand only part of the FFV equation. Under FFV, they know the quality data they report to payers will affect their reimbursement, but many do not understand exactly how payers use these data to adjust payment.

What is the missing piece of this equation? Patient risk scoring.