The pressure on hospitals to trim operating costs coupled with diminishing inpatient revenues continues. The Partnership in Operational Excellence and Transparency (POET), a collaborative between HASC and Blue Shield of California (BSCA) launched eight years ago, deploys to contracted BSCA network hospitals a performance dashboard addressing the processes and complexities of claim adjudication and payments. It has been widely accepted and subsequently spread statewide.

Over this time period, hospitals have been able to receive faster payments, have experienced a steep decline in claim denials, and have developed a restored sense of trust in the partnership relationships that continue today. The collaborative demonstrates that provider/plan collaborations coupled with the latest technology can drive improved operational performance, strategic decision-making and on-site process management.

While this good work reflects enormous progress, not all hospitals are moving the needle at the same pace, and not all hospitals have the skill sets working with a unified purpose and accountability. Some remain silos, while others have attained higher productivity through redesigned workspaces. Others are examining the growing trend of revenue cycle outsourcing, because obtaining the analytics software and/or recruiting or retaining qualified staff are beyond the institution’s short-term financial capacity.

A recent article in Becker’s Hospital CFO (January 8, 2015) reported that nationally, 21 percent of CFOs who outsourced these functions were facing bankruptcy within four years had they not chosen outsourcing. This trend is expected to accelerate as environmental factors in dense urban managed care markets and new ACO partnerships evolve at a quickening pace.

California hospitals now struggle in determining their future competitive service line strategies and potential partnerships. POET offers an opportunity to see where your hospital stands in revenue cycle performance effectiveness comparative metrics, as well as new options to assess market positioning strengths and weaknesses with the payer community.

Contact: George Mack

(213) 538-0717, gmack@hasc.org