By Joey Cavanaugh, RN, chief operations officer, Zotec Partners.
The American healthcare system has long been burdened by interoperability issues preventing easy access to and sharing of important patient health data. Amid the ongoing COVID-19 pandemic, those issues have created additional challenges for physicians, administrators, and other industry partners. If these problems persist, they could impact provider business models negatively.
Increased consolidation among physician groups during the pandemic has resulted in a corresponding increase in coding operations for many practices. Given the gap between the demand for coders and the trained talent available to meet that demand, organizations have increasingly shifted toward outsourcing to fill critical technical roles. The process of outsourcing these skills, combined with a surge in the number of labor hours needed to meet organizational objectives, could increase the time to code or decrease the quality of output, ultimately creating revenue cycle issues.
If not careful, staffing issues can cause fluctuations in data quality. With less personnel available to ensure the correct information is entered into the correct fields, some organizations have found it difficult to fully harness the power of healthcare solutions to streamline revenue management and operations. Moreover, understaffed facilities may struggle to make the changes to technologies and internal processes that would equip them to take advantage of government programs providing reimbursements for COVID patient care. New CPT codes for COVID have also required insurance companies to update their processes during the pandemic, adding complexities for providers in how quickly they can exchange medical information.
From a clinical perspective, the pandemic’s far-reaching impact on the healthcare system has manifested in the form of lost productivity, resource deprivation, HIPAA breaches, and other, often severe, consequences. However, the strain it has put on payers and revenue cycle management systems has been somewhat less visible from the public eye. In the concerted effort to support clinicians and mitigate the pandemic’s effects on frontline workers, the focus for getting the right data into the right hands to ensure services could be paid for in a timely manner was temporarily deprioritized. Unless these interoperability challenges are addressed as an industry, the cost of healthcare will continue to rise, as will the clunky experiences for both providers and patients.