Keeping Hospital Billing Systems Healthy In A Pandemic

April 10, 2020

On a good day, healthcare providers do a difficult job. In the last several weeks, that difficult job has become a heroic labor nationwide as workers on the front lines battle back the coronavirus pandemic.

And the front lines aren’t the only areas of the provider system stepping up above and beyond the call of duty these days, Flywire Executive Vice President and General Manager of Healthcare John Talaga told Karen Webster in a recent conversation. The side of the business Flywire mostly works with, he noted, are the administrators and business offices holding down the fort on the back end, a job that became Herculean in scope lately.

While critically ill patients are streaming in the front door, he said, the back office is responsible for making sure the doors are open, the lights are on, the staff is getting paid, and the supplies they need are on hand so that sick people can be given their absolute best chance of recovery.

The scale of the COVID-19 health crisis alone would make that incredibly hard all on its own, Talaga said, but the situation is compounded by the fact that despite how busy hospitals are at present, business is actually bad in terms of revenue collection and likely to stay that way for some time to come.

“Elective procedures have been postponed and account for almost 75 percent of [providers’] profitability,” Talaga said. “That is immediately having an impact on their cash flow, and as I have talked to several of our customers, they’re expecting an impact of at least 30 percent on revenue overall for the year. So, they are getting very creative with different ways that they can prepare for not only the immediate loss but also the long term because this is not just going to fix itself as soon as this is over.”

And that creativity, he noted, is becoming an across-the-board effort as a vertical that has been historically resistant to change is finding that it can no longer do things simply because they’ve always been done a certain way.

Rewriting Revenue Collection

Talaga said a healthcare crisis that sets off an economic depression in its wake creates a uniquely sticky situation in that healthcare providers desperately need to collect funds for provider services at the exact moment that consumers are less able to pay those bills because they’ve recently become unemployed or are concerned that they will not be employed for much longer.

Billing becomes a delicate issue — one where digital enablement and flexibility can make a big difference. Back-end systems able to put customers on payment plans — and then custom adjust them to consumers’ economic services in real time — have gone into this pandemic with a critical advantage, Talaga said. Every participant in the system already knows that collecting payment from the wave of coronavirus healthcare related costs is going to be a complicated three-way play between insurance companies, consumers and the federal government. Organizations with nimble payments systems already in place can reach out to their patients directly and work with them to tailor payments plans for their specific circumstances.

Systems lacking those kinds of options, Talaga told Webster, have been forced in many cases to shut down their billing operations wholesale in response to the coronavirus crisis because they don’t want to be hitting customers with collection letters during a difficult time. The truly heroic part of what is going on that is often overlooked during the crisis, he said, is the great lengths providers are going to provide the care and find a way to make the bill work to keep that care flowing.

“It’s just amazing to me when you look at how they’re dealing with this,” he said. “They’re working with patients, and they’re putting patients first. I see that across the board where they’re tweaking systems to be more flexible and adaptable to this. Some already have those systems, some don’t, and it’s not easy to quickly adapt.”

Adapting And Changing The Landscape

But they are adapting nonetheless, as fast as humanly imaginable. They’re building easier, faster onboarding processes to help automate care and make customers better able to self-manage their care.

They are suspending customer payments plans or reducing them down to 10 percent of their former levels to give patients a chance to physically and economically recover before facing bills.

They’ve relocated large swaths of their workforce to telework arrangements despite being not ideally situated for it before the current situation. In parallel, they are investing in telehealth practices — and more importantly making sure insurance companies pay for that telehealth care to meet what is now a rising tide of demand that in a post-coronavirus world will turn into a sea of consumer expectations.

“I think telehealth is going to be an explosion,” Talaga said. “Obviously you can’t replace things like surgery digitally; that still has to happen in person. But I think in the actual day-to-day care of patients, you are going to see a mix emerging because physicians are going to get more comfortable with it and consumers are going to demand it.”

In short, the healthcare system that existed before early March 2020 in the United States won’t be the same one that comes back to life in the aftermath of COVID-19, he said. When “normal” emerges, it will likely look very different than it used to.

And, he noted, the world of healthcare may be a long way from seeing normal — new or otherwise — return. The walk back, he said, is going to be long. Even after the all-clear is given for elective surgeries in a few weeks or months, there is no guarantee that patients hit hard economically by the events of the last several weeks and legitimately concerned about their health will go rushing into operating rooms unless they absolutely have to. Most of Flywire’s partners in healthcare, Talaga told Webster, said they believe they will still be feeling the economic effects of the pandemic into early 2021 and perhaps beyond.

But the light at the end of this twisting tunnel for providers, he noted, is that on the other side of this inflection point, the healthcare industry that emerges will likely be a smarter, safer and more flexible one than the one we know today.

“I think this may well end up being the catalyst to a lot of things that are possible that they will be willing to do now that they may not have previously been willing to do,” he said.