COVID-19 Is Changing Access to Care Permanently, What Hospitals Can Do

May 21, 2021 - Patient volumes have improved to 90 percent of pre-pandemic levels at Sharp HealthCare. But 90 percent is not 100 percent, says Gerilynn Sevenikar, vice president of revenue cycle of the San Diego, California-based, non-profit health system.

“Not only are we not at where we were, we actually have not realized those increases in volumes, we were hoping for either [when developing the FY20 budget],” Sevenikar said at Xtelligent Healthcare Media’s recent Revenue Cycle Management Virtual Summit.

Hospitals and health systems across the country are still on the road to recovery after the COVID-19 pandemic forced the healthcare industry to pivot operations. And that road is proving to be rocky, according to recent data predicting that over a third of hospitals will operate in the red this year despite widespread availability of vaccines.

The COVID-19 pandemic has permanently altered how patients access the healthcare system, shared Sevenikar who oversees all hospital access service and business office functions at the seven-hospital system.

“We believe that most of the delayed elective care in the hospital setting will be caught up probably by mid-2021. So, we're getting to a place where we hopefully will have a steady stream of those elective surgeries,” Sevenikar stated. “But as FY21 will bring us this new steady state of volume and potentially ED volume, it will permanently lower [volumes elsewhere] as people are more selective in what they get treatment for.”

The state of unemployment and its impact on health insurance coverage is also likely to influence access to care moving forward. Payers are also likely to be more aggressive with pricing because of this climate, seeking narrow networks and lower rates.

These factors are expected to particularly impact ambulatory care settings since patients are still delaying lower-acuity and long-term services out of fear of catching the virus or because of a change in coverage and/or employment. The slow “catch-up” could spell trouble for health systems like Sharp HealthCare, which has about a quarter of revenue in capitated contracts.

“Specific to the capitated population, this catch-up in volumes comes with no increased revenue, therefore, a negative financial result,” Sevenikar reported.

The financial outlook for hospitals and health systems over the next year is a mixed bag, with some positive financial impacts (e.g., lower-cost telehealth options, recapture of elective volume) offsetting negative impacts influenced by lingering trends like higher supply costs and new patient access behaviors.

To survive in this post-pandemic world, Sharp HealthCare is investing in “strategic initiatives to drive volume,” Sevenikar said.

The health system opened a new hospital tower with over 100 beds at its Chula Vista campus in January. A new medical office building is also slated to open this fall, along with an investment in a woman’s hospital at Sharp HealthCare’s Grossmont Hospital.

“We assume we’ll be able to successfully capture volume associated with these projects even in a post-COVID-19 environment and are prepared for the additional growth when our community is ready to seek care,” Sevenikar stated. “Inability to do so would result in less than anticipated financial performance.”

Sharp HealthCare is also restarting many of its initiatives put on pause during the pandemic, like implementation of robotic process automation (RPA) and predictive analytics.

“One of the best ways to save costs, particularly in a revenue cycle environment, is by automating some of these processes and making them more efficient and ideally more accurate, giving you a higher quality product,” Sevenikar explained. “We tried to identify access, charge integrity, and then financial services, and really lift out those functions that are performed in each of those areas and identify what type of automation may be applicable to those areas.”

Predictive analytics solutions are also now giving Sevenikar and other leaders at the health system more frequent, customizable access to data to improve clinical operations as well as revenue cycle management. For example, Sevenikar is leveraging the data to predict propensity to pay and developing dialer queues around that information.

Optimizing patient financial experience will be key moving forward in the post-pandemic world.

Patient financial responsibility continues to trend upward, with the latest figures from Kaiser Family Foundation showing a 111 percent increase in the burden of deductibles among covered workers. This is also all happening as healthcare organizations also face an influx of uninsured and Medicaid patients after the pandemic.

During the pandemic, Sharp HealthCare leaned into digital capabilities, such as patient self-service for bill payment and payment plan set-up. Within the first six months, the health system had over $1 million set up in automatic payment plans and over 80 percent of those consumers made their first payment.

Sharp HealthCare is also reengaging with consumer products to create an even more digital patient experience through virtual urgent care, online appointment scheduling, and enterprise proxy, which allows parents to schedule care for their children.

“We need to hit the play button now,” Sevenikar said. “We were on pause, we didn't do a lot of these things, and it's time to get back into play.”

To view the full keynote session, click here. To attend future events, visit Xtelligent Healthcare Media’s website.