Health care in America is in trouble. It’s in trouble for many reasons, but I tend to believe it’s all related to money. Although people outside the industry tend to believe that hospitals are making money hand over fist, the reality is that the majority of hospitals in this country are either losing money or are barely breaking even.

Because of all the changes that have occurred and changes that will be occurring, most hospitals only think about one thing; cutting stuff. It’s a pattern that both state and federal governments do when they start talking about reimbursements, and it’s the same thing many regular insurance companies do as well.

The thing is that hospitals really can only cut so much. They’ll start laying off nurses when there’s actually a nursing shortage and that creates a major backlog of work for those remaining, which is bad for patient care. They’ll lay off people in the billing office when those are the people who bring the money in that pays all the bills and payroll. They’ll lay off maintenance people who keep the equipment running because they can’t afford to buy new, and they’ll lay off cleaning people and take chances that they’ll fail OSHA regulations because there aren’t enough people to keep things sanitary.

At a certain point hospitals need to start thinking more about their revenue. The old models of believing that only budgeting based on traditional inpatient stays is failing; it’s been failing for a long time now. I actually understand why they do it; collection agencies follow the same principles of working with the “biggest bang for your buck”.

But things are much different. I can’t tell you how many former inpatient services there are that now are outpatient services. No one seemed prepared for that at the time, and years later I see hospitals doing those services, yet not concentrating on making sure they’re capturing all of the procedures properly, let alone making sure those procedures are coded properly.

What needs to happen is the same thing that governments need to figure out. When you’ve cut as much as you possibly can it means you have to find a way to generate new revenue. It means you have to find something that’s a need in your community and exploit it. You don’t need to add the same thing the hospital down the street has added; you need to have something different, something you can hang your hat on, something that will bring in sustainable new revenue to offset all the costs.

What do I propose? Truthfully I’m not sure. Each community will have something that’s lacking, that they can create and generate new revenue from, so it’s not a universal thing. But it can’t be something that ends up costing more to do than the community will support. We don’t need every hospital buying things such as MRI because there’s not enough use of them to warrant it. We could probably use more physical therapy sites and outpatient surgery centers, possibly even getting more into elective surgeries. The money is there, and so are the clients.

And of course make sure your CDMs are up to date, and that your staff understands the charge capture process. Without that you’re just lost, no matter how many initiatives are put into place. Oh yeah, did you know I provide CDM services? 😉

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