On a regular basis, hospitals use their chargemaster price as a base price when they are negotiating with private insurance providers, but it doesn’t stop there. Current market fluctuations are the ultimate decider, forcing the hospital and providers to agree upon a specific price. Other insurers like Medicaid and Medicare also have their own governmental price points that don’t take a hospital’s chargemaster into account. This means depending on where a hospital is located, resources used, and other factors, the profit they are making to invest back in their systems and employees could be dissimilar compared to other organizations that have given themselves leverage with competitive advantages.
To compensate for the pricing issues and to gain higher value within the public, hospitals can become more competitive by focusing and changing aspects of their system, such as updating a chaotic and disorganized chargemaster. By creating new systems and updating workflow management, hospitals can save money in the long run and may even find spots where they were significantly losing revenue!
How is Price Transparency Related?
Because of updated price transparency regulations, hospitals have had to work quickly to update their systems and make sure they have readily available information that can be published to the public. With that information, patients and other purchasers could compare and identify the best deals within hospitals and see who are the ones that aren’t pricing correctly based on their overall value of care. If hospitals haven’t dedicated time to improve their workflows before they provided that information, they most likely found they were losing significant amounts of money through outdated systems and also have their true goals misrepresented by the public information.
How Hospitals can Become More Competitive
Use Technology for Reporting
For decades, hospitals have been using unreliable technology and the human eye to collect and interpret data from reports. This can lead to missed costs, claims, and can even leave a healthcare organization non-compliant if they overlooked a major issue. The most successful hospitals use the newest technology to generate their reports as quality, strategic software can easily measure trends, revenue cycles, insurance claims, and much more. By investing in these updates, hospitals are also eliminating the labor needed to go over the reports, meaning that hospital employees can put their focus back into more important matters – not just trying to follow paper trails!
Measure Outcomes & Costs by Patients
Patient costs and outcomes go hand-in-hand because the quality of care a hospital can provide depends on accurate costs of treatments and resources used. First, a hospital will want to see how they can change their system for tracking the costs of resources used as a patient moves through a hospital’s care cycle. By monitoring each step clearly, an organization can better understand the true cost of care and start the management process.
Secondly, a hospital will also want to change its approach to measuring patient outcomes. Low outcomes are connected to higher costs and poor care while high outcomes are connected to lower costs and great care. If a hospital is spending a lot of money on a specific health issue but only a few cases have successful outcomes, that means they are not only wasting money, but they are also mismanaging other areas, such as patient-to-staff ratio or patient complaints. By measuring both factors together, a hospital can make the right changes that help their revenue stream and also allows them to find the strengths and weaknesses of their teams.
Organize Required Care Around Conditions
Using just primary or specialty care can quickly rack up costs. To compensate, many healthcare organizations have now blended the two into integrated practice units (IPUs). By organizing both specialty and general providers together to provide help with specific conditions, both hospitals and patients benefit immensely.
Patients can get deeper expertise of their specific conditions while providers in IPUs can give them a wider scope of care and treatment all at once. Over time, this can result in lower patient care costs, efficiency, and much better health outcomes, which will raise a hospital’s value.
Streamline Archaic Chargemasters
Updating a chargemaster has become more crucial than ever, especially with new price transparency rules requiring major optimization and change. As daunting as it can be, streamlining a chargemaster is incredibly beneficial to a hospital’s pricing strategy. As chargemasters become outdated, inaccurate information can lead to revenue leakage and noncompliance within contracts and agreements.
By investing in new chargemaster software, a hospital will have real-time access to any major changes or codes needed for their system, which can lead to faster final prices and calculations. Having an automated system also means that a hospital can find discrepancies almost immediately and repair them, helping gain missing revenue back that can be invested into bettering their workflow.
What Effects Occur if Hospitals Don’t Stay Competitive?
By not staying ahead of the curve and updating their workflow systems, hospitals can potentially lose thousands of dollars per year that would be able to be invested back into their organizations and help assist with better technology, patient care, resources, and more. Even if pricing is almost uncontrollable, hospitals don’t have to lose sight of their future goals as long as they implement the right systematic changes that will allow better transparency into their revenue streams.