Cost vs Experience: Rewiring the RCM Workforce for a Hybrid Reality

Join us as Ovation Healthcare’s Executive Advisor, Jessie Neitzer, speaks with President of Revenue Cycle Management, Scott Cooper, about the future of revenue cycle management and how healthcare organizations can create cost savings without compromising the patient experience through a hybrid operating model. 

As financial pressures and workforce challenges continue to impact healthcare organizations, this episode explores why the future of revenue cycle management is not about choosing between cost and patient satisfaction but understanding where each function belongs. Listeners will gain insights into the strategic advantages of hybrid models, key operational considerations and how hospitals can balance performance, patient engagement, and long-term sustainability.

If you’re interested in learning how Ovation Healthcare can help your hospital evaluate and implement a hybrid revenue cycle strategy, please email info@ovationhc.com.

Transcript

SPEAKER_00 0:00

Hey everyone, we are thrilled you are here to join us to talk about balancing revenue cycle costs and the patient experience. I'm today's host, Jesse Knitzer. I'm an executive strategic advisor with ovation healthcare. And in today's episode, I'm speaking with Scott Cooper, the president of our Revenue Cycle Management Services. Thanks for joining me, Scott.

SPEAKER_01 0:21

Thanks for having me, Jesse. Excited to be here.

SPEAKER_00 0:24

Should we just jump into the questions?

SPEAKER_01 0:26

Let's do it. Yeah, that's mine as well.

SPEAKER_00 0:29

All right. Um, well, I think one of the first things that comes up is understanding what happens when you have an effort to cut cost, but you also are working to maintain or improve quality, and you never want to let that patient experience go by the wayside. So, in your opinion, how does a hybrid revenue cycle address those issues? How does it contribute? And also how what challenges may you have to overcome?

SPEAKER_01 1:01

Yeah, I think it's uh, I mean, it's weird, right? I think the the cost pressures that hospitals are facing are almost in direct conflict with their mission or their goal. Um, and because of just the macro environment and the pressures they're facing, you know, in order to, in order to make sure that they're successful and healthy, they're faced with these decisions that they may not want to have to make or in direct conflict with things like patient care, patient experience, and quality. And I think um the way we think about it from a ref cycle perspective is there's really two things that we can do to help uh make sure that you're balancing, balancing that kind of conflict, so to speak. So um one, we we we really do like this idea of hey, you've got this hybrid ref cycle operating model. So traditionally you've got whatever 10, 20, 30, 1000, 4,000 rev cycle people, depending on how big your hospital is, obviously. And um for the most part, they're either in the community, they're in the hospital, they're stateside post-COVID, maybe they're remote across the country. Um, but the truth is it's it's kind of at a higher, kind of at a at a higher cost point um for the hospital and and contributes to that, to that financial pressure that they're facing. Um the idea of offshoring has been around in RevCyle forever, 10, 15, 20 years. Uh, I myself lived in India three years uh doing this for for different organizations uh many, many years ago. Um and I think there was this really big swing towards offshore everything, it's gonna give you all this cost savings. But then there was a really big uh, you know, quality impact potentially as a result of that. Um, and I think the the prevailing theory and one that we've employed at ovation over the last couple of years is really this hybrid idea of the stuff that's really hard or really impactful or is gonna uh impact the patient experience or is gonna have a touch point with the patient, those are the kinds of things you really want to keep with your traditional road cycle team. You want to keep them on shore. You want to make sure that the person in the community is talking to somebody else in the community, you know, at the as the at that registration point as an example. Um, but some of the more high volume transactional, non-patient-facing things you can do offshore. So, hey, low balance AR or some of the, you know, kind of pro fee type coding where it's a lot of volume, not a ton of overall impact, never going to talk to a patient. Um, and really can be done at a more optimal price point um before we even, you know, get to the idea of AI inefficiencies. So um there's the cost side of it, and blending that onshore, offshore, or hybrid model um, I really think addresses the cost pressure that you see while also maintaining the kind of structural integrity of the quality of your rep cycle. You've got a hybrid team, they're working together, you've got audit, you know, you've got automation theoretically, you've got a bunch of accountability, you've got dashboards, you're making sure that you're tracking um performance. Um, and as a result, theoretically, you can also get a lot of upside. Uh, so it's not just, hey, there's the cost efficiency, but hey, we can actually do this better because of how we're structured or because of how we're set up. And by doing it better, we're actually getting more yield. So you're you're you're getting kind of the cost uh benefit, and then also theoretically, an upside benefit.

SPEAKER_00 4:39

Well, that balance seems to be something that's really hard to achieve. What um systems do you put in place to make sure that the communication stays fluid, that there's not gaps, that the people have the information they need at the right time? Um, how do the systems help the people to do the right thing, create less frustration for them? Um, how have you um managed through that process?

SPEAKER_01 5:09

Yeah, I think there's um it's probably two or three very distinct things that I think we do well that has contributed to the success of this model. Um, one, um we have technology that helps enable this, right? So we've got teams uh in offshore, or we've got teams uh offshore. Um they're working in our technology, in our workflow. They've got our reports. Um, anything they do is also happening uh, you know, real time. We can see it in the same systems that our own onshore teams are using. So I think one is creating that uniformity of systems and technology that our onshore and offshore teams are using. That's one. Um, two, we treat our offshore team members just as though they're onshore team members. So, you know, there's an offshore team manager and supervisor and quality and kind of all the things that you would expect. But, you know, on our weekly calls or our weekly huddles with our onshore team, the director or the manager is meeting with their team, they're also meeting with the leader of the offshore team. So we're treating them as though it's one organization, one team. It's not us and them. Uh, and that creates this kind of symbiotic, let's make sure we're working appropriately and and bringing, bringing kind of success to the Rev cycle. Um, and then three, we hold them accountable just like we hold our onshore uh teams accountable. So, to this idea of one team, you know, if we've got a productivity goal of, I'm making this up, 40 claims that you're supposed to work today, the onshore teams and the offshore teams have the same goals. Um, they're aligned in goals. We're measuring productivity, we're measuring quality, we're measuring efficiency, we're measuring the outcomes and the success of the activities that they're taking. Um, and it's really all about performance management. Uh so I think those are the three. It's kind of technology and uniformity, it's treating us as one team, and then it's this idea of kind of performance managing the whole system, regardless of onshore or offshore.

SPEAKER_00 7:07

That makes a lot of sense. So if I'm in the hospital trying to navigate what this looks like, I'm concerned about the documentation being in my EHR. But at the same time, I also know that my EHR is not super efficient. I've got problems within that system. Like I don't really have a way to manage my team's productivity. Where does this workflow live? And do I have to go somewhere separate from my electronic record to access the current state of the account?

SPEAKER_01 7:43

Nope. Your electronic record uh is the source of truth. Uh we have our own proprietary workflow systems that we use. So when we do new client implementations, again, regardless of onshore, offshore, hybrid, whatever it may be, um, we're taking data from your system and we're basically pulling that into our system. And so we're using our system purely for workflow to help us make sure we got the right butts in the right seats, we got the right people working on follow-up versus denials. We're segmenting the work that there is to do so we can uh say, hey, here's a bunch of really old stuff. It's probably going to be deprioritized. Here's a bunch of really new stuff. This is the stuff you want to go after. So we've kind of got this smart segmentation of claims and who does what work. Um, the work itself, regardless of onshore or offshore, this hybrid model, um, the work itself happens in our workflow system, but then the information actually goes back into the EHR. So we're taking your source of truth. It remains a source of truth. All of the notes, all the activities, all the actions that are taken in our system end up back in your system. So that still remains the one source of truth. And you don't run into this kind of do we run into issues of people stepping on each other's toes and hey, you took a bunch of activities, but there's no record of it. Like it's always going to be your system. Ours is somewhat of a, let's call it a bolt on, for lack of a better term, that feeds information back and forth.

SPEAKER_00 9:05

Gotcha. Okay, that's helpful. Thank you. Um, you talked a little bit about this earlier about what's appropriate for onshore versus offshore and how you make those decisions. I'm curious, like how you go about evaluating that process. Is it unique to each um individual entity? Is it something you just have basic recommendations for? Where have you seen it go wrong? Um, and what do you do up front to make it go right?

SPEAKER_01 9:37

So, our our strategy has been pretty clear for the last couple of years. One, um, we don't have anybody offshore talking to a patient. So uh they're not doing our early out functions where they're calling patients for billing, they're not doing registration or remote, you know, pre-registration or scheduling. We don't have anybody offshore talk to a patient, and that's a very deliberate decision. Not everybody does that. That's a decision that we have made internally to ovation to stick to. Um, so that's that's one. I think um two, there's still this North Star of kind of what I alluded to before of hey, the things that are going to be really like high volume, high transactional, low intensity, low kind of complexity, that's the stuff we want to live offshore. Um, so if you think about charge entry, or you think about payment posting, or you think about eligibility verification, or somebody's literally just going on a website and trying to see if they've got insurance for their visit, um, that's the kind of stuff that lives offshore um versus onshore. And and we make sure that we're keeping our onshore resources um focused on the higher value, higher complexity, higher ROI type of activities, um, like clinical denials, uh, like um inpatient coding, like early out, where you have a patient interaction and you're calling them asking about their bill. Um, that's the second thing. Um the the third thing is in in most cases, um we do this in conjunction or in partnership with our clients. Um, so you know, we have a conversation up front, uh, even in the proposal, even before we saw, even before we kind of lock things down, um, we're saying, hey, there's different models you can choose from. Uh, and when we go to when we go to propose something to uh to a new client, we say, hey, you know, here's our traditional all onshore. This is what you're used to, here's the value, here's the cost, here's the ROI kind of thing. Um, but we also offer the option of, hey, we can do this hybrid model. We're really good at this hybrid model, and we think it's going to give you the same, the same quality, the same output, but an even higher ROI because we can do it at a lower cost point. And what we're able to then do is say, hey, it's price one versus price two. And we actually give many of our clients uh the option. I think what we found over the last couple of years is that um because of the success we've had with this hybrid operating model, and because we've been able to show and demonstrate the success of that with many of our clients, um, that that has really become the kind of prominent or preeminent model that most people want. Because, you know, we're talking to the CFOs, they're trying to make a decision. Uh, obviously they're they're making sure that their quality and patient experience and everything are at the forefront, but everybody's got a bottom line. Everybody's be feeling the cost pressure. You know, the one big beautiful bill I think is making things uh even more difficult for many of our independent community rural hospitals. Um, and and ultimately when it comes down to the budget, you know, there's a cost of X versus a cost of Y, and one is lower than the other. And if you if you can get the same output for a lower cost, you're gonna choose that option. And I think that's just kind of where where things are headed.

SPEAKER_00 12:56

So that's all for this segment of our discussion with Scott Cooper. In the next episode, we'll explore the hybrid revenue cycle model and how organizations balance cost, quality, and patient experience. Be sure to follow Vatian Healthcare on LinkedIn and subscribe so you don't miss part two.