Timely access to individual and collective revenue cycle data streams is making the difference for hospital lobbyists petitioning Washington for more favorable healthcare policy, say representatives from the American Hospital Association (AHA) and the Federation for American Hospitals (FAH).
Addressing to an audience of provider revenue cycle heads at vendor Kodiak Solutions’ annual client networking event this past week, the groups’ policy experts said they had “made no progress for years” on long-standing pain points like care denials by Medicare Advantage plans.
However, tapping partners like Kodiak—whose platform ingests data from nearly 2,000 hospitals—to quantify the issue in industry reports has given the AHA’s arguments new legs, AHA Vice President of Policy, Research, Analytics and Strategy Ben Finder told attendees.
“It didn’t matter which [administration], it was year after year we’d go in and we’d complain about the MA plans denying care and not doing things,” he said. “It wasn’t until we started to see data from either OIG, the Kodiak data, large survey data, that we could actually start to affect change. There’s actually a shift in Washington.”
A more concrete data-driven victory for hospital lobbyists came earlier this year with the Change Healthcare cyberattack, added FAH Senior Vice President of Policy Don May.
Whereas the associations traditionally relied on cost reports where the data “tend to be old,” a more immediate snapshot of providers’ widespread revenue cycle disruptions was a key weapon in countering parent company UnitedHealth Group’s effort to downplay the outage’s impact.
“United was out there trying to tell their story [that] things were pretty peachy and rosy and things were okay,” May told the attendees. “On the other hand, hospitals were telling us that the claims process had stopped and that you were not getting payments [and] that impacts our ability to take care of our patients.”
Having access to the aggregate, national-level data “was instrumental … so that we could take it to the Hill and bring more eyes, tell those stories that folks on the Hill could understand what the impact was, who this was hurting and how large it was,” he said.
Finder and May said their organizations are taking a similar approach to reframe hospital industry sore spots like the country’s rising quantity of medical debt, a sticky issue for providers that are positioned to simultaneously advocate for patients' care while collecting their payments.
They contend that patients’ increasing inability to pay stems from insurers’ efforts to dodge reimbursements or limit beneficiaries’ coverage rather than hospitals’ service pricing. The proof, they said, can be found in hospitals’ uncompensated care ledgers and claims denials—especially when multiple hospitals’ data come together to show the influence of “bad players” on an entire community or market.
“Holding those insurers accountable is a key part of what we’re trying to accomplish,” Finder said. “That we have more data to shed light on this subject really helps us tell the hospital story—which is we’re in there providing care to these patients and in a lot of cases the insurers are the ones who are standing in the way or creating problems with affordability. The data has been really critical in helping us advance that story.”
“I often wonder,” May mused, “if the health plans were required to collect the copays … and the deductibles, if they would have the structures that they have. I bet they wouldn’t. They’re going to want to make it easier.”
There are still gaps in the data being aggregated by analytics platforms that could bolster hospitals’ narratives for policymakers, the lobbyists said. A reliance on submitted claims doesn’t give insight into events that did not occur due to payer policies—for instance, a potential discharge to a skilled nursing facility or inpatient rehab facility.
Also flying under the radar are concurrent denials, or those that occur between the case management team and the payer while the patient is still receiving care in a hospital.
“If we had a data source that could track … what’s happening in that prior authorization process—how many contacts, how many times are you having to do concurrent review, how many times you are being asked to do a request for additional information—that would be tremendous,” Finder said. “If we can show that kind of burden and add some quantitative data to that regulatory cost, that would be huge for us.”
Each of these data-driven efforts is still tied to the more traditional tactics of telling stories that affect change, the lobbyists added.
The Change Healthcare hack “was a perfect example” of that combination, May said, as lawmakers “heard the physicians practice stories where they’re selling off their 401k or their pension to pay their employees to continue to provide care.
“Those stories are powerful, but if it’s only that one doctor, if it’s only the one hospital—it doesn’t matter. You need broad-based data to support that claim and, together, it’s a really powerful combination.”
This is where individual organizations can best support their national or state associations, the pair added.
From a strategy perspective, industry groups need to hear from hospitals and health systems to know whether any policy changes or trends spotted in the data are occurring “on the ground,” May said.
More directly, hospitals can extend their firsthand experience with a policy issue to lawmakers themselves to help the story-driven heart follow the data-driven mind, they noted.
“Bringing the member of Congress to you is really critical,” May said. “Talking about the finances of healthcare—you can sometimes get a little jaded. What always helped me get through … is to go visit a hospital where you can actually see what this financial apparatus is actively funding and what happens from a patient care angle. Those member visits are critical.”