Health Care Revenue Research Articles

Beyond Automation: Redefining Healthcare Revenue Cycles through RPA, NLP and Gen AI

Beyond Automation: Redefining Healthcare Revenue Cycles through RPA, NLP and Gen AI

Current Applications of Artificial Intelligence in Billing Practices and Clinical Plastic Surgery

Summary: Integration of artificial intelligence (AI), specifically with natural language processing and machine learning, holds tremendous potential to enhance both clinical practices and administrative workflows within plastic surgery. AI has been applied to various aspects of patient care in plastic surgery, including postoperative free flap monitoring, evaluating preoperative risk assessments, and analyzing clinical documentation. Previous studies have demonstrated the ability to interpret current procedural terminology codes from clinical documentation using natural language processing. Various automated medical billing companies have used AI to improve the revenue management cycle at hospitals nationwide. Additionally, AI has been piloted by insurance companies to streamline the prior authorization process. AI implementation holds potential to enhance billing practices and maximize healthcare revenue for practicing physicians.

Downstream Revenue Realized by Facilities Placing Inflatable Penile Prosthesis in Medicare Beneficiaries to Treat Erectile Dysfunction

ObjectivesTo quantify the incremental downstream revenue generated from subsequent treatment of men who received an inflatable penile prosthesis (IPP) to treat erectile dysfunction (ED), compared to men without ED. MethodsThe 100% Medicare Standard Analytic Files were used to conduct a retrospective claims analysis of the 5-year revenue generated by patients receiving IPP to treat their ED, compared to a propensity-matched cohort of men without ED. Men aged 65 years or older with ED who underwent IPP implantation (Current Procedural Terminology® 54405) in a hospital outpatient setting between January 1, 2016 and December 31, 2021, and who had continuous Medicare Parts A and B enrollment for 12 months pre-index IPP and five years post-index IPP discharge date were included in the study. Men without ED but with comparable characteristics were identified and used as a comparator group. Revenue received by hospitals from Medicare was defined as the sum of payments for patient services, other payor-paid amounts, patient deductibles, copayments, and coinsurance. Revenue was inflated to 2022 US dollars. The mean values and their corresponding standard deviations (SD) are reported. ResultsAfter matching, there were 2,905 men with ED who received an IPP and 7,462 men without ED. The IPP cohort showed a significantly higher 5-year cumulative revenue (mean=$34,571 [SD=$50,234]) compared to the men without ED (mean=$3,189 [SD=$11,527]). When stratified by diagnosis type, the differences in revenue were $10,258 for circulatory disease, $2,646 for diabetes, $2,013 for urology, and $1,043 for prostate cancer. Significantly more IPP patients had at least one health encounter for these conditions over the 5-year follow-up period than their matched controls (55.0% versus 7.8% for circulatory, 46.7% versus 16.8% for urology, 19.3% versus 3.6% for diabetes, and 19.0% versus 3.0% for prostate cancer). ConclusionsMen with ED who received IPP generated substantially higher revenue for the healthcare system over a 5-year period, nearly ten times as much, compared to men without ED, excluding the initial cost of the IPP procedure. The presence of ED, coupled with IPP usage, is associated with significantly increased healthcare revenue across a range of medical conditions compared to men without ED. These findings emphasize the financial implications for advanced ED programs to improve access to necessary care for these patients. Healthcare facilities may leverage these insights to effectively allocate resources to deliver critical healthcare to men with ED.

Implications and future strategies on cost management for hospitals during and after COVID-19

The coronavirus disease (COVID-19) pandemic is throwing a new factor into hospitals calculations about how to proceed with current and future healthcare strategy implementations. As entire nations encourage their populations to remain stay home, quarantine, avoid coming out and wear masks till lockdown open, while healthcare providers doctors, nurses, technicians and other administrative staffs are more active than ever in response to the outbreak of the novel coronavirus. We expect a significant increase in costs after the pandemic due to change in services and infrastructure, use of personal protective equipment and extra sanitization used by medical staff. To identify ways to improve liquidity, cash flow and cost management due to damage done by COVID -19, we systematically reviewed journals on cost management in hospitals, reports from healthcare finance management agencies, conducted focus groups webinar and websites that includes health policies, healthcare management costs, finance and factors such as departmental cost management in hospitals. The results were clubbed into two parts i.e. one was healthcare revenue challenge and second was strategies for regenerate revenue during and after COVID-19. COVID-19 has shown a significant impact on the healthcare revenue cycle, financial operations, supply chain management, hospital operations and even for those who provide finances. Hospitals and healthcare systems needs to do the work on war footing in supply chain, clinical services, diagnostics services and operations management by ensuring that the management drives the strategies, transform process, create cost-reduction goals and identify possible sources of savings based on the organizations capital and liquid shortfall, using internal and external benchmarking.

MP76-15 PATIENT FOCUSED EDUCATION VIA SMARTPHONE: IS IT EFFECTIVE IN DECREASING SAME DAY SURGERY CANCELLATION RATE?

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-15 PATIENT FOCUSED EDUCATION VIA SMARTPHONE: IS IT EFFECTIVE IN DECREASING SAME DAY SURGERY CANCELLATION RATE? Esther Kim, Karina Canadas, Christine Geistkemper, Kathleen Chen, Rahul Baijal, and Abishek Seth Esther KimEsther Kim More articles by this author , Karina CanadasKarina Canadas More articles by this author , Christine GeistkemperChristine Geistkemper More articles by this author , Kathleen ChenKathleen Chen More articles by this author , Rahul BaijalRahul Baijal More articles by this author , and Abishek SethAbishek Seth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2583AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Same-day surgery cancellations cause a loss of health care revenue, wasted resources, and a delay of care for patients overall. Many cancellations are due to preventable reasons such as no-shows, incorrect time of surgery, and failure to adhere to preoperative guidelines. Health literacy, or the ability to interpret health information, is a target for improvement since studies have shown that the average American adults read below a 6th grade level. For this reason, we tested the impact of simplified videos delivered to patients' smartphones on the same-day surgery cancellation rate for the urology department at an urban pediatric tertiary care center. METHODS After IRB approval, texts containing an appointment reminder and a short-animated video of preoperative instructions were sent to the patients who agreed to participate. Data was collected prospectively to evaluate if those receiving texts clicked the link to watch the video. The study was conducted for five consecutive months, and a retrospective chart review was done to compare the frequency of same day surgery cancellations during the post-intervention period (June – October, 2017) and pre-intervention period (January- May, 2017). RESULTS A total number of 1306 patients out of 1433 patients (91.1%) participated in this study and were sent a text with video education. Of these participants, 45% clicked on the link and watched the video. The same-day surgery cancellation rate was 7.47% (70/937) in pre-intervention group and 3.29% (43/1306) in post-intervention group (p< 0.0001). Of the 3.29% cancellations in the intervention group, 44.2% (19/43) clicked on the video link. Overall, the rate of cancellations due to patients' failure to adhere to the nil-per-os guidelines or no-show also decreased from 2.24% (21/937) to 1.00% (13/1306) (p= 0.0219). Moreover, the cancellation rates were dramatically lower for the patients who agreed to the intervention compared to those who refused (43/1306 vs. 26/127) (p=0.0001). Whether the patient clicked on the video link or not made no difference in cancellation rates (19/587 vs. 24/719) (p=1.000). CONCLUSIONS Patient focused education sent to patients' smartphones shows a positive impact for adherence to preoperative guidelines and a decrease in same day surgery cancellation rate. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1024 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Esther Kim More articles by this author Karina Canadas More articles by this author Christine Geistkemper More articles by this author Kathleen Chen More articles by this author Rahul Baijal More articles by this author Abishek Seth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Big Five Health Insurers' Membership And Revenue Trends: Implications For Public Policy.

The five largest US commercial health insurance companies together enroll 125million members, or 43percent of the country's insured population. Over the past decade these insurers have become increasingly dependent for growth and profitability on public programs, according to an analysis of corporate reports. In 2016 Medicare and Medicaid accounted for nearly 60percent of the companies' health care revenues and 20percent of their comprehensive plan membership. Although headlines have focused on losses in the state Marketplaces created by the Affordable Care Act (ACA), the Marketplaces represent only a small fraction of insurers' members. Overall, the five largest insurers have remained profitable since passage of the ACA as a result of profits in other market segments. Notably, companies with significant Medicare or Medicaid enrollment have continued to insure beneficiaries in states where the insurers do not participate in Marketplaces. Given the insurers' dependence on public programs, there is potential to improve access if federal or state governments, or both, required insurers that participate in Medicare or Medicaid to also participate in the Marketplaces in the same geographic area. Such requirements could ensure more viable and less volatile insurance, benefiting people insured within each market as well as those who cycle on and off public and private insurance.

The Brazilian Unified National Health System: Proposal of a Cost-effectiveness Evaluation Model

The Brazilian Unified National Health System (Sistema Unico de Saude [SUS]) is in a prominent position compared to the existing social policies. One of the new tools used by SUS is known as Performance Index of the Unified Health System (Indice de Desempenho do Sistema Unico de Saude [IDSUS]), which is intended to measure the performance of each municipality. Therefore, the aim of this study was to propose a model of cost-effectiveness to compare IDSUS performance against total revenues achieved in Homogeneous Group 2, consisting of 94 municipalities and analysed using data from IDSUS and the System Information of the Public Budget for Health Care (Sistema de Informacao do Orcamento Publico em Saude [SIOPS]) for the year 2011. After structuring this data, we carried out descriptive statistical and cluster analysis in order to group similar municipalities in accordance with established variables: IDSUS performance, population and total revenue in health per capita. Even with the division of municipalities into homogeneous groups and after using variables such as population and revenue to regroup them, the results showed there are municipalities with heterogeneous characteristics. Another finding is in the use and intersection of two distinct databases (IDSUS and SIOPS), which allowed for visualizing the impact of health care revenue on the municipalities performance.

Provision of Personal Healthcare Services by Local Health Departments: 2008-2013.

The scope of local health department (LHD) involvement in providing personal healthcare services versus population-based services has been debated for decades. A 2012 IOM report suggests that LHDs should gradually withdraw from providing personal healthcare services. The purpose of this study is to assess the level of LHD involvement in provision of personal healthcare services during 2008-2013 and examine the association between provision of personal healthcare services and per capita public health expenditures. Data are from the 2013 survey of LHDs and Area Health Resource Files. The number, ratio, and share of revenue from personal healthcare services were estimated. Both linear and panel fixed effects models were used to examine the association between provision of personal healthcare services and per capita public health expenditures. Data were analyzed in 2014. The mean number of personal healthcare services provided by LHDs did not change significantly in 2008-2013. Overall, personal services constituted 28% of total service items. The share of revenue from personal services increased from 16.8% in 2008 to 20.3% in 2013. Results from the fixed effect panel models show a positive association between personal healthcare services' share of revenue and per capita expenditures (b=0.57, p<0.001). A lower share of revenue from personal healthcare services is associated with lower per capita expenditures. LHDs, especially those serving <25,000 people, are highly dependent on personal healthcare revenue to sustain per capita expenditures. LHDs may need to consider strategies to replace lost revenue from discontinuing provision of personal healthcare services.

Commentary on “Total Joint Arthroplasty of the Distal Radioulnar Joint for Rheumatoid Arthritis”

Despite extraordinary advances in medical therapy, many patients with rheumatoid arthritis experience degeneration of the distal radioulnar joint (DRUJ), and the concept of a total joint arthroplasty for the DRUJ is appealing. This study reported impressive short-term results at an average follow-up of a little over 3 years. It is clear from this study that painwas improved in themajority of patients and that some elements of function were markedly improved. The question becomes, What is the advantage of this device? Pain relief from this procedure is exemplary, but so is pain relief and functional improvements from other DRUJ procedures, such as the Darrach distal ulnar resection and the SuaveKapandji procedure. There was no progression of ulnocarpal translocation in this arthroplasty group, but others have shown that ulnocarpal translation may be more related to disease progression andmay have less to do with biomechanical alterations following distal ulnar resection. Where will these arthroplasty patients be at 5 years, 10 years, and beyond, as their average age was 57 years? What will the pain scores and complication rate be at those junctures? Will this device be durable, and will the results surpass the results of alternative nonarthroplasty procedures? Moody’s Investor Services has reported that the cost of providing patient care in 2013 increased 5%, while health care revenue grew 4%. This is not sustainable long term. We must continue to ask

Dramatic increase of Cesarean deliveries in the midst of health reforms in rural China

Cesarean delivery (CD) rates were until recently low in rural China where the population lacked health insurance. In July 2003 the New Cooperative Medical Scheme (NCMS) was introduced. We report findings from a health systems study carried out in the EC-funded project "Structural hinders to and promoters of good maternal care in rural China" in central and western China. The purpose was to analyze how CD rates changed with the increased level of funding of the NCMS. The research design was a natural experiment. Quantitative demographic, administrative and accounts data for 2001-2007 were collected in five counties from the county public health bureaux, the county NCMS offices, the county statistical offices and the Maternal and Child Health (MCH) hospitals, using a structured data collection form. We found that the CD rates increased in four of the five counties in the period 2004-2007 by 36%, 53%, 61% and 131% respectively. In the fifth county the CD rate remained high at 60%. The revenue from CD made up 72-85% of total delivery fee revenue. CD fee revenue increased by 97%, 239% and 408% in the three counties with available data; a higher increase than in general health care revenue. Our conclusion is that the design of NCMS, the provider payment systems, and the revenue-related bonus systems for doctors need to be studied to rein in the unhealthy increases in rural CD rates.

Pharmaceutical reimbursement: An overview

The Medicare program authority, structure, and current and proposed rules for and rates of pharmaceutical reimbursement; billing issues; proposed expansion of accepted compendia and off-label drug uses; problems with the cost basis for reimbursement; concerns of and need for collaboration among various participants in the health care revenue stream; and implications for pharmacists are described. Pharmaceutical reimbursement rates have decreased over the past several years as the Centers for Medicare and Medicaid Services (CMS) has striven to maintain neutrality in the federal budget. Now, health systems that fail to report quality indicators can incur financial penalties. Also, smaller payments for cases involving medical errors have been proposed. Efforts by pharmacists to improve the billing process can increase revenue. It is anticipated that rules proposed for 2008 will result in CMS acceptance of a greater number of compendia and off-label uses. Receiving reimbursement for drug handling costs is an important issue for pharmacists. Collaboration among pharmacists and other participants in the health care revenue stream is needed to improve the health care delivery system and ensure that money is wisely spent. An understanding of the complexities of Medicare pharmaceutical reimbursement can help pharmacists improve the financial viability of their institutions.

Rapid achievement of the child survival millennium development goal: evidence from the Navrongo experiment in Northern Ghana

To determine the impact of deploying nurses and volunteers to village locations on demographic and health outcomes. We implemented an experimental design that emphasizes the value of aligning community health services with traditional social institutions that organize village life. Data for this analysis come from the Navrongo demographic surveillance system, a longitudinal database that tracks fertility, mortality, and migration events over time. The experiment uses conventional demographic methods for estimating mortality rates from longitudinal demographic surveillance registers. Posting nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated attainment of the childhood-survival millennium development goal (MDG) in the study areas relative to trends observed in comparison areas. Results from the Navrongo experiment demonstrate that community health and family planning programmes can have an impact on childhood mortality. Posting nurses to communities can dramatically accelerate the pace of progress in achieving the childhood-survival MDGs. Community-volunteer approaches, however, have no additional impact, a finding that challenges the child survival value of international investment in volunteer-based health programmes. The total cost of the intensive arm of the project is less than $10 per capita per year. Navrongo research thus demonstrates affordable means of attaining the child survival MDG agenda with existing technologies.

Cost structure of osteopathic hospitals and their local counterparts in the USA: Are they any different?

Due to the emphasis on preventive care and less invasive solutions to medical problems, osteopathic hospitals may deliver cost efficient and cost effective care. This study examines the cost structure of osteopathic hospitals and compares their performance to a local control group selected from allopathic hospitals. Osteopathic hospitals are identified in the 1999 American Hospital Association (AHA) data and matched to local allopathic hospitals with respect to location, bed size, system, for-profit and teaching status. Cost functions are estimated for both groups of hospitals, and significant differences in input, output and costs are highlighted. Results show that osteopathic hospitals are more costly and less productive in comparison to their counterparts. Inefficient production of outpatient services and high cost of medical education are two reasons for the poor performance. The study has important policy implications on two fronts: first, osteopathic hospitals are more costly to operate than their counterparts, and subsequently this requires further analysis of the osteopathic treatments and techniques. In an environment where health care revenues are shrinking and costs are rising, this is probably much needed information for osteopathic hospitals. Secondly, there is an emerging concern among osteopathic medical schools and osteopathic physicians due to the declining number of osteopathic hospitals, which translates to a smaller number of residency positions for osteopathic medical school graduates. Analyzing cost, input and output variables reveal some of the contributing factors to the decline of osteopathic hospitals and help preserve this rich tradition.

Tantalus and the Tyranny of Territory: Pursuing the dream of parity in rural and metropolitan population health outcomes through primary health care programs

Many health professionals and rural health academics are motivated by the challenge of achieving equitable access to health care in rural communities with the implicit vision that fairer access to services might ultimately lead to more equitable health outcomes for people living in rural and remote settings. The purpose of this paper is to put the issue of rural and urban health outcome parity into perspective and assess recent progress towards achieving the ultimate goal of improving rural health status. I will also explore ways in which rural communities might increase their access to and use of primary health care revenue in the future to improve community health outcomes. While some improvements have been achieved across the rural health system in recent times, the fundamental problem of maintaining infrastructure to service community needs in rural areas remains as daunting as ever. Extensive evidence has now been assembled to show that rural people generally enjoy a much lower standard of health care, health outcomes and life expectancy than their urban cousins. The question underlying all of this evidence, however, is... must this always be so? Is it possible to redress the current inequities between rural and urban populations and could new primary health care initiatives, such as the Enhanced Primary Care (EPC) program, be vehicles for achieving more equitable health care arrangements and health outcomes for people living in rural communities?

Equity in the finance of health care: Some international comparisons

This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues.