3 Revenue Cycle Hurdles for Resuming Elective Procedures

Cash-strapped providers will be eager to get the ball rolling on revenue-generating elective procedures again when it's safe to do so, but rescheduling hundreds of deferred patient procedures won't be easy.

This article appears in the May/June 2020 edition of HealthLeaders magazine.

Although the decision about when to resume elective surgeries that have been postponed or delayed because of COVID-19 will largely be a clinical one, it will fall to the revenue cycle to actually reschedule and financially clear patients whose procedures have been postponed.

There's been a 32% - 60% decline in visit volumes between the weeks of March 1 and March 29, compared against pre-COVID-19 volumes, according to a TransUnion Healthcare analysis of more than 500 U.S. hospitals.

Moreover, more than 27% of patients in a new TransUnion Healthcare survey said they had an elective surgery, appointment, or procedure delayed or cancelled due to the COVID-19 pandemic.

Naturally, cash-strapped providers will be eager to get the ball rolling on revenue-generating elective procedures again when it's safe to do so.

However, rescheduling hundreds of patient procedures won't be as easy as picking up the phone and entering a new date into the calendar. There are several hurdles that revenue cycle leaders need to be ready to navigate when the time is right, from rerunning financial clearances to reassuring patients about COVID-19 safety measures.

"It's going to take time for providers to bring back those patients that they deferred," says Jonathan Wiik, principal of healthcare strategy at TransUnion Healthcare.

Here are three hurdles that revenue cycles will have to overcome and strategies for doing so when the time is right.

Hurdle one: Skyrocketing unemployment

Unemployment claims are through the roof as employers move forward with layoffs and furloughs—more than 4.4 million people filed for unemployment benefits during the week ending April 18, according the Labor Department data.

Since nearly half of Americans carry insurance through their employers, patients who were privately insured when their procedure was originally scheduled may have become self-pay patients in the past few weeks.  

Success requires: Going back to basics

Even if a patient had already been financially cleared for their postponed procedure, the process should begin anew when they're rescheduled.

"A lot of these patients are going to have the be financially cleared again," Wiik says. "Many, many people's incomes were affected by this, so their ability to pay a bill may have been fundamentally changed."

To succeed, revenue cycles should use a "back to basics" approach that includes re-running financial clearance processes, including verifying a patient's insurance eligibility and personal information, and conducting a financial assistance assessment. If a patient has lost their job, inquiring about COBRA benefits should also be part of this process.

In addition, postponing a procedure may have led to a patient becoming sicker in the meantime, which means the procedure itself may cost more than previously expected.

"Lots of weird things have happened in this wild mess of COVID-19," Wiik says. "It would behoove [revenue cycles] to…re-financially clear every patient."

If revenue cycles don't have the bandwidth to re-clear every patient, they should prioritize ones undergoing high-risk, high-cost procedures.

Finally, revenue cycles should be ready to offer robust financial assistance programs, including flexible, interest-free payment plans, as well as consider raising their financial assistance cap.

Hurdle 2: A backlog of cases

More than one in four patients surveyed (27%) by TransUnion said they had an elective surgery, appointment, or procedure delayed or cancelled due to the COVID-19 pandemic.

But trying to reschedule every patient who had a procedure deferred while also caring for current patients means that facilities will be bursting at the seams.

Plus, scheduling departments—which are already stretched thin—will be dealing with much heavier workloads. As Wiik notes, scheduling and registration departments "are typically staffed to keep the lights on. There's not a lot of capacity or flexibility there."

Success requires: Being prepared with cross-training and prioritizing patients

Scheduling complex surgical procedures isn't something that employees can be thrown into immediately. These schedulers must consider everything from room and equipment availability to the schedules of specialists like anesthesiologist and radiologists.

"Scheduling is a very, very complicated process; especially OR procedural scheduling," Wiik says. "It's not something you train someone to do next week, it takes time."

That means revenue cycles should consider reallocating and cross-training other employees, such as billers or registrars in clinics where patient flow has slowed down, to ensure that when surgical rescheduling is needed, there are expert staffers ready to do the work.

A backlog might also mean that patients get frustrated and shop around if they aren't able to reschedule their procedures, so revenue cycles should be ready with a plan to prioritize patients whose procedures were postponed first.

Hurdle 3: Patients don't want to come back

Even if facilities carefully follow the American College of Surgeons' recommendations for resuming elective surgeries, it doesn't mean that patients will be eager to come back right away.

Of the patients who had an elective procedure deferred, nearly 50% indicate they will only reschedule once they no longer believe there is a high risk of COVID-19 infection or once guidelines advise it is safe, according to TransUnion's survey.

The response: Careful safety messaging

It will be necessary for hospitals train schedulers on how to reassure nervous patients.

"'Is it safe to come back,' is a question that they're going to have to navigate," Wiik says. Patients may also ask whether COVID-19 patients have been in that hospital.

"That kind of thing absolutely is going to come up," he says.

If patients are not satisfied with the answers they receive to these questions, they may continue to defer their care or take their healthcare business elsewhere.

That's why schedulers should be prepared with talking points to cover things like how their facility decided to resume elective procedures and describing advanced infection control protocols.