General Archives • Pathstone Partners Healthcare Consulting Chicago

Rural Healthcare at Risk: Navigating the One Big Beautiful Bill

Key Takeaways

The One Big Beautiful Bill Act (OBBBA), a $1 trillion federal spending and tax package signed into law on July 4, 2025, includes major healthcare provisions alongside broader budget measures.
The One Big Beautiful Bill includes the Rural Health Transformation Fund, providing $50 billion over five years to support rural hospitals, though unjust fund distribution and competition for rural designations may skew the financial benefit away from the intended hospital recipients.
Medicaid work requirements could create administrative challenges and potential coverage gaps, particularly in rural communities, impacting patient access and therefore hospital financial stability.
Rural hospitals face ongoing financial pressures, and Pathstone Partners is uniquely positioned to support rural hospitals in optimizing operations, managing costs, and improving resilience without impacting the quality of care.

Unpacking the OBBBA: How the Law Shapes Healthcare

H.R. 1, the One Big Beautiful Bill Act (OBBBA), a spending and tax law passed through the reconciliation process and signed into law on July 4, 2025, has prompted widespread discussion regarding potential impacts on healthcare programs, with the bill representing an overall $1.4 trillion reduction in federal spending. States are now required to implement health-related provisions, including changes to Medicaid coverage and rural healthcare funding.

The Congressional Budget Office (CBO) anticipates that 11.8 million people will lose health insurance over the next decade as a result of the OBBB, creating serious consequences for community health and straining healthcare providers. Uninsured individuals already face steep challenges: nearly half of uninsured adults go without provider visits, one in five skip needed treatment due to cost (vs 5-7% of insured adults), receive less preventative care, and are consequently more often hospitalized for avoidable conditions. These projected coverage losses highlight the urgent need for solutions to safeguard access and strengthen care delivery in underserved areas. One such solution authorized by the OBBBA is the Rural Health Transformation (RHT) Program to invest in rural healthcare delivery.

Facing Closure: The Growing Crisis in Rural Healthcare

Rural facilities have faced an alarming rate of closures, with over 100 closing in the last decade. Southern states are at particularly high risk; in Alabama, 23 rural hospitals – half of the state’s total – are at immediate risk of closure. Rural hospitals carry high fixed costs, including 24/7 staffing, facility maintenance, and fully equipped departments, yet service smaller populations, generating less revenue to offset expenses than their urban hospital counterparts. Without sufficient federal support, these hospitals must negotiate with private insurers from a weaker position, often accepting lower reimbursement rates due to smaller patient volumes and limited market leverage.

Number of At-Risk Rural Hospitals Across the US

Number of At-Risk Rural Hospitals across the US based upon hospitals classified in the top 10% Medicaid payer mix of rural hospitals across the country and experiencing three years or more of negative total margin.

Source: Cecil G. Sheps Center for Health Services Research, University of North Carolina

Funding the Future of Rural Hospitals: Lifeline or Limited Relief

While the OBBB seeks to reduce overall federal Medicaid spending by $1 trillion over the next decade, it establishes the $50 billion Rural Health Transformation Fund – a five-year program to support rural healthcare and mitigate disproportionate impacts on rural hospitals. Analysts caution that this temporary lifeline is insufficient to offset massive financial losses from Medicaid cuts, straining hospitals (particularly those with high Medicaid populations), and limiting investment in care coordination and critical resources. However, broad discretion by the Centers for Medicare and Medicaid Services (CMS) and individual states in allocating funds raises concerns that resources may not reach hospitals most in need.

Johns Hopkins and Brown University research shows 400 urban hospitals now claim “rural” status; over a quarter are for-profit, and at least five generate more than $4 billion in annual net patient revenue. These are so-called dual-classified hospitals (those designated as both rural and urban) are uniquely positioned to take advantage of the new Health Transformation program, potentially diverting funds away from smaller hospitals facing genuine financial distress, as outlined in the graphic below.

Source: Wang et al., 2025; Sharp Rise in urban hospitals with rural status in Medicare, 2017-23. Raw data retrieved from RAND Hospital Data, Medicare Cost Reports. Note the number of geographically urban hospitals remains stable between 2013 and 2023 (2,543 – 2,258 respectively).

Medicaid Reform: Consequences for Patient and Providers

The OBBBA also introduces Medicaid work requirements, intended to encourage able-bodied adults to contribute to their healthcare coverage. While designed to promote employment and reduce reliance on public programs, evidence suggests these requirements often cause coverage loss due to administrative and technological challenges rather than unwillingness to work. For example, in Arkansas, over 18,000 people lost coverage within five months of a work requirement pilot, with little measurable increase in employment. Many beneficiaries already had jobs, caregiving responsibilities, or health limitations that made obtaining documentation difficult, and for rural communities, these requirements are especially burdensome. Eligibility checks every six months, technology demands, and verification for seasonal or self-employed work, such as farming, create challenges for both patients and county offices.

Rural hospitals are expected to be further negatively impacted by the new Medicaid work requirements. Coverage loss even among working populations could increase gaps in care and increase uncompensated care for rural hospitals. This decline in Medicaid coverage may reduce reimbursement streams, strain hospital finances, and heighten the risk of service cutbacks and closures, particularly in already vulnerable rural areas. In 40 Medicaid expansion states, federal funding cuts could lead to an average of 19% decline in operating margins, and safety-net facilities could see an average reduction of 56%. Together, these pressures underscore how Medicaid work requirements, while intended to encourage employment, may ultimately destabilize rural healthcare systems and weaken community access to essential medical services.

Looking Forward: Operational and Patient Impacts of the OBBBA on Rural Hospitals

Operational Strain on Rural Hospitals: High fixed costs, limited patient volumes, and reliance on Medicaid make rural hospitals financially vulnerable to the new bill
Coverage Loss and Access Gaps: Medicaid work requirements may cause individuals, even those employed, to lose coverage, increasing gaps in care and uncompensated services
Funding Allocation Challenges: Broad discretion in Rural Health Transformation Fund and urban hospitals claiming rural status may divert resources away from truly at-risk facilities
Impact on Care Coordination and Resources: Reduced funding and coverage instability can limit hospitals’ ability to invest in technology, supply chain efficiency, and coordinated care programs
Patient & System Impacts: Loss of insurance and resulting delays or forgone care can lead to preventable negative health outcomes, increased emergency department use, and more intensive interventions, while ongoing financial and operational pressures may erode staff morale and weaken the stability of rural healthcare delivery

To navigate the evolving healthcare landscape, medical providers must take proactive steps to improve operational efficiency and financial stability. Hospitals are facing the challenge of doing more with less, as high pharmaceutical, labor, and administrative costs, coupled with looming Medicaid cuts, strain finances. In response, providers are adopting targeted strategies such as better controlling drug utilization, implementing new technologies, minimizing waste, and optimizing supply chain and procurement processes. With the urgency to reduce costs and operate more efficiently at an all-time high, these measures are critical for maintaining both quality of care and organizational resilience, while preparing for anticipated reimbursement reductions and declines in Medicaid enrollment.

Unlocking Savings and Resilience with Pathstone Partners

Pathstone offers rural hospitals cost-effective, hands-on support – bringing deep niche expertise, the agility to respond quickly to shifting challenges, and a partnership approach that tailors solutions to each hospital’s unique community and financial realities. Our boutique size and flexibility allow us to design customized strategies rather than using one-size-fits-all models, drawing on years of direct experience helping rural hospitals navigate financial pressures.

Reach out to Pathstone Partners today to request a no-cost spend assessment and understand how we can help drive financial efficiency for your organization.

Recognized on the 2025 Inc. 5000 List of Fastest-Growing Private Companies

Pathstone Partners, a Chicago-based healthcare consulting firm, has been honored with a spot on the 2025 Inc. 5000 list of Fastest Growing Private Companies in America, marking its second consecutive year on this prestigious ranking of America’s fastest-growing private companies. This recognition underscores Pathstone’s unwavering commitment to delivering impactful, operational solutions for healthcare organizations nationwide.

Strategic Growth Aligned with Changing Healthcare Needs

Pathstone Partners has achieved an impressive 92% revenue growth over the past 3-years, reflecting its success in partnering with healthcare providers to optimize costs while maintaining high-quality patient care. This milestone highlights the firm’s ability to adapt and thrive in a rapidly changing healthcare environment, where rising costs, staffing challenges, and evolving regulations are reshaping how hospitals and health systems operate.

Comprehensive Solutions for Healthcare Organizations

Pathstone Partners specializes in offering a range of services designed to enhance operational efficiency and financial performance:

Non-Labor Solutions: Streamlining laboratory and clinical supplies, purchased services, IT systems, and pharmaceuticals.
Labor Solutions: Optimizing workforce structures, reducing contract labor costs, managing overtime, and enhancing productivity.

By focusing on sustainable, data-driven strategies, Pathstone has continued to be a trusted partner for healthcare organizations navigating an increasingly complex and competitive landscape.

Proven Impact Across the Healthcare Sector

Pathstone Partners has collaborated with over 250 hospitals across the United States, generating more than $500 million in margin improvements. By leveraging a data-driven approach, the firm empowers healthcare leaders to make strategic, informed decisions that enhance operational performance while maintaining high-quality patient care.

Looking Ahead

As Pathstone Partners expands its impact amid a rapidly evolving healthcare landscape, the firm remains committed to transforming healthcare operations through innovative, data-driven solutions. Recognition on the 2025 Inc. 5000 list, along with 92% three-year revenue growth, underscores the dedication of the entire Pathstone team and reinforces its position as a trusted partner and leader in healthcare consulting.

Unlocking Hidden Value in Healthcare Supply Chain: Insights from AHRMM 2025 Spring Summit

Key Takeaways:

Move Beyond Price-Centric Thinking: Joseph Jang challenges the overreliance on price negotiation as the primary strategy for supply chain strategy.
The Multi-Lever Strategy Unlocks Greater Value: Pathstone’s framework enables organizations to apply multiple value levers (standardization, utilization, make vs buy, revenue, and strategic alliance) based on their specific market conditions, operational realities, and strategic priorities.
Dartboard Analogy Reframes Strategy: Rather than aiming for a single “bullseye” solution, organizations can coordinate multiple levers like darts on a board, with each targeting a different opportunity, to create a more resilient, financially optimized supply chain.
Strategy Starts with Context: Unlocking supply chain value begins with context-driven analysis to select the right combination of value levers, each with its own trade-offs, aligned to the organization’s goals, capabilities, and readiness for change.

Unlocking Opportunity at AHRMM: Rethinking Supply Chain Strategy

At the AHRMM 2025 Spring Summit, one of healthcare’s most influential forums for supply chain leaders, Pathstone Partner’s Joseph Jang delivered a powerful session titled Beyond the Surface: Unlocking Hidden Value with a Multi-Lever Strategy. His talk addressed a central challenge many healthcare organizations face: how to drive sustainable financial value without relying solely on pricing tactics.

Joseph challenged the historical approach of leaning on price negotiations as the go-to lever for reducing supply chain costs; in a healthcare environment shaped by constant change and margin pressures, organizations can do more than yield short-term gains without addressing root causes of system inefficiencies. Pathstone’s structured, multi-lever strategy empowers supply chain leaders to drive sustainable value and increase operational performance by using multiple tactics in tandem—not just price.

Going Beyond the Surface: The Dartboard Approach

The traditional view of cost reduction assumes that there is a singular “bullseye” solution—an ideal scenario where the lowest possible price is achieved through brute force negotiation. However, in reality, supply chains are far more dynamic. Joseph reframed this traditional thinking using the dartboard analogy: instead of chasing a single perfect shot, imagine evaluating the entire board—the full landscape of a category. When a multi-value lever strategy is employed, the more levers you have, the more darts you can throw. The goal shifts from hitting the bullseye once to scoring as many points as possible across the board. This approach allows supply chain teams to layer strategies, diversify efforts, and generate a greater cumulative impact—not from one perfect move, but from a well-executed series of targeted actions. In doing so, organizations “score higher” and build not just cost efficiency, but a more resilient and adaptable supply chain.

Why Value Levers Matter: A Framework for Action

Each organization faces unique constraints like budget, capacity, and stakeholder buy-in, and therefore requires flexibility in how it pursues cost savings and efficiency gains. Instead of a one-size-fits-all solution, the multi-lever framework allows teams to take a holistic view of their organization and match specific levers to their context, determine the most viable path forward, and recognize that multiple options may increase the likelihood of success.

To do so, organizations must begin with a thorough analysis of the external market environment by evaluating trends, supplier landscape and competition, pricing and volume history, and contractual shifts. Equally important is engaging with clinical and operational stakeholders through transparent conversations to validate how market data aligns with real-world utilization, pain points, and evolving needs. Then with this combined insight, organizations can identify and quantify opportunities across relevant levers by considering the appropriate market conditions. Strategy selection should reflect the organization’s financial goals, operational constraints, and internal capacity. Ultimately, success depends on structured analysis, stakeholder alignment, and a prioritized path to value that makes sense for your organization.

From One Lever to Many

Each value lever in Pathstone’s framework comes with trade-offs. Some levers are quick wins, while others require more time, alignment, or investment. Below is a simplified breakdown of how these levers work, when to use them, and what organizations should expect:

Value Lever	Typical % Impact	Typical Savings %	Appropriate Market Conditions	Advantages	Disadvantages
Price	50%	5-20%	Non-concentrated markets, Cost shifts, Misaligned pricing, New entrants to market	Fast results, Low disruption, Minimal resistance	Most supplier leverage, Short term impact
Standardization	20%	10-25%	Fragmented use of suppliers, Multiple similar suppliers/products, Expiring patents	Higher leverage, Operational efficiency	Customer pushback, Service disruption risk
Utilization	15%	10-30%	High or under-utilization, Cost tied to usage, Leadership buy-in to reduce utilization	High value, Resilient to supplier price hikes	Difficult to sustain, Behavior change required
Make vs Buy	15%	15-35%	Poor service quality, Internal capability growth, Service model shift	Transformative impact, Aligns with core strengths	High risk and high effort, Requires strong leadership
Revenue	5%	5-15%	Margin decline, Low visibility into revenue collection	Hidden opportunity, Possibility for quick wins	Requires financial alignment, Customers may be sensitive to changes
Strategic Alliance	5%	20-23%	Long-term partners, New services, High investment potential	Shared risk, Long-term value	High effort, Mutual commitment, Disruption risk

Pathstone works with clients to match these levers to their current state, determine which levers are most likely to deliver impact, and prioritize a path forward that reflects their financial goals, internal capabilities, and appetite for change.

Ready to Unlock More Value?

If you’re interested in how a multi-lever strategy could help your organization navigate uncertainty, improve supply chain resilience, and unlock hidden value, Pathstone can help. We offer a tailored evaluation to determine which levers are most appropriate for your organization, whether you need quick wins or are planning a multi-year transformation.

Joseph’s full AHRMM talk, Beyond the Surface: Unlocking Hidden Value with a Multi-Lever Strategy, is available for purchase through the AHRMM 2025 Spring Summit Site.

Watch Full Talk Here.

Why Healthcare Consultants are Valuable for Hospitals

In the intricate world of healthcare, hospitals face the constant challenge of balancing providing exceptional quality patient care, mitigating financial pressures, and matching the pace of medical innovation. Healthcare consultants offer vital support, providing expertise and strategies to navigate financial complexities. Let’s explore why the contributions of a healthcare consulting firm are so valuable to healthcare organizations.

Navigating the Complex Healthcare Landscape

The healthcare industry is dynamic and multifaceted, requiring a deep understanding of regulatory requirements and hospital financial structures. Healthcare consultants bring this specialized knowledge to help navigate these unique challenges. They offer expertise in areas such as:

Financial Management: They help hospitals manage costs effectively, freeing up funds to invest in enhanced patient care and innovation. A consultant might also identify an opportunity to increase revenue on a given service line through more appropriate billing and coding, or may point out an alternate supplier with reduced pricing for existing services.
Operational Efficiency: Consultants assess current clinical and non-clinical workflows and processes, identifying bottlenecks and inefficiencies that hinder productivity.
Technology Integration: Consultants can help hospitals integrate new technologies and optimize use of software modules already owned. They may identify areas to rationalize and eliminate duplicative technology purchases across campuses and departments.

The Imperative of Financial Oversight

Maintaining financial stability is crucial for hospital systems. Healthcare consultants play a key role in ensuring hospitals prevent runaway spend growth. To manage overall system finances, healthcare consultants can work to:

Improve Margins: Consultants work to enhance revenue and reduce expenses across categories, leading to improved financial margins. Margins can be improved through negotiating more favorable supplier contracts. Pathstone Partners has improved margins by over $500 million across the combined client portfolio.
Reduce Operational Costs: By streamlining processes and optimizing resource allocation, consultants identify areas where internal costs can be reduced. Pathstone Partners, for example, focuses on streamlining operations and lowering operational costs for healthcare providers.
Non-Labor Cost Reduction: Consultants also focus on the optimization of non-labor costs through negotiated price reductions with suppliers and reduced utilization of goods and services. Typical target areas for non-labor cost reduction include laboratory supplies, clinical supplies, clinical purchased services, information technology, and pharmacy.
Labor Cost Reduction: Consultants provide labor solutions that help with structure optimization, contract labor, premium pay reduction, and overtime reduction.
Data-Driven Insights: Consultants use data analysis to track spending, identify cost drivers, and provide actionable insights for financial improvement.

Fostering Innovation in Healthcare

Innovation is essential for healthcare to evolve and adapt to changing needs. Healthcare consultants play a role in driving innovation in the following ways:

Implementing New Technologies: Consultants help hospitals identify, select, and implement innovative technology solutions. Target new technologies may automate existing manual tasks and enhance data collection / revenue cycle management. These innovations can enable staff to focus on higher-level responsibilities and ensure clinicians practice at the top of their licensure.
Improving Processes: By redesigning workflows and implementing best practices, consultants enable healthcare providers to embrace innovative approaches to patient care and operational management.
Introducing New Models of Care: Consultants support the adoption of new models of care delivery that can lead to improved patient outcomes and efficiency.

Areas of Focus Consultants work with a variety of healthcare facilities including:

Acute Care Facilities
Academic Health Systems
Regional Health Systems
Pediatric Health Systems
Non-Acute Care Facilities
Community Health Systems

The Value of an Objective Perspective

Healthcare consultants offer an objective perspective that can be invaluable to executives making critical decisions. They can offer an unbiased opinion on:

- Process Analysis: They analyze workflows, identifying areas of improvement that might be overlooked by internal staff.

Supplier Relationships: Consultants can help hospitals challenge long-standing supplier partnerships and ensure they are receiving maximum value from current supplier contracts.
Strategy Development: Consultants work with hospital leadership to develop strategic plans that align with an organization’s goals and values. Their impartial strategic review can set an organization up for the best chance of success.

Learn How Pathstone Partners Can Make an Impact

Healthcare consultants are essential partners for hospital systems, helping them navigate the complexities of healthcare with expertise, objectivity, and a commitment to reducing costs while maintaining quality patient care. By partnering with a healthcare consultant like Pathstone Partners, hospitals can achieve operational excellence and financial stability, and position themselves for a successful future.

Pathstone Partners: Giving Back to Make a Difference in 2024

Our Giving Back Ideology

At Pathstone Partners, the commitment to improving lives goes beyond healthcare consulting. In 2024, the team embraced its Giving Back ideology through meaningful initiatives that supported vulnerable populations and made a positive impact in the community.

Supporting Global Healthcare with Project CURE

This year, Pathstone held its biannual service event with Project CURE in Chicago. The team came together to sort through medical supplies, prepare shipments, and load containers. As the world’s largest distributor of donated medical relief, Project CURE ensures these supplies reach underserved communities in need of quality healthcare. Pathstone’s efforts directly contributed to this vital mission, helping bridge gaps in global healthcare access.

Spreading Holiday Cheer with Little Brothers Friends of the Elderly

Pathstone partnered with Little Brothers Friends of the Elderly, an organization dedicated to reducing loneliness among older adults. The Pathstone team embraced the holiday spirit, spending hours decorating festive paper bags. These beautifully crafted bags will hold goodie items, delivering joy and companionship to seniors during the holiday season.

A Commitment to Community

Through initiatives like these, Pathstone Partners exemplifies its commitment to making a difference, not just in the healthcare industry but also in the broader community. By giving time and effort to meaningful causes, the team demonstrates how collective action can uplift lives and create lasting impact.

Pathstone Partners is proud to partner with organizations like Project CURE and Little Brothers Friends of the Elderly. These collaborations reflect the company’s dedication to creating a better world, one initiative at a time. Stay tuned for more updates on Pathstone’s community involvement in the coming year!

Pathstone @ Preeminent Healthcare Conferences in 2024

A Year Of Industry Leadership

In 2024, Pathstone Partners actively participated in several high-profile conferences and events, sharing insights and connecting with industry leaders. These events reinforced Pathstone’s role as a thought leader in healthcare consulting and showcased the team’s innovative approaches to cost savings and operational efficiency.

AHRMM SME Podcast: Elevating Organizational Change

Managing Partner Joseph Jang joined the AHRMM Subject Matter Expert Podcast to discuss strategies for driving organizational change through cost savings. His expertise illuminated actionable ways healthcare organizations can tackle financial challenges while maintaining high standards of patient care.

Health Connect Partners (HCP): Supply Chain Leadership in Dallas

In May, Senior Directors Dan Ehle and Andy Poorman attended the HCP Hospital Supply Chain Conference in Dallas, Texas. The event provided an excellent platform to exchange ideas with supply chain healthcare professionals, exploring cutting-edge solutions for optimizing supply chain operations.

Becker’s Healthcare National Conference: Insights from Chicago

Pathstone Partners played a key role at the Becker’s Healthcare National Conference in Chicago, Illinois, in March. Joseph Jang and Senior Director Colin King connected with healthcare professionals, sharing expertise on tackling challenges in cost management and operational improvements.

IDN Summit: Sharing Expertise in Orlando

At the IDN Summit & Reverse Expo in April, Joseph Jang presented Pathstone’s groundbreaking knowledge on driving hospital cost savings and improving margins. The event, held in Orlando, Florida, emphasized collaborative strategies for overcoming financial pressures in the healthcare sector.

AHRMM Spring Summit: Insights on Transformation Excellence

In April, Joseph Jang represented Pathstone Partners at the AHRMM Spring Summit on Transformation Excellence. He shared valuable insights on how supply chain teams can elevate cost management efforts, driving impactful results for healthcare organizations.

HCP Hospital Supply Chain: Fall Conference in Las Vegas

Capping off the year, Dan Ehle and Andy Poorman attended the HCP Hospital Supply Chain Conference in Las Vegas. The event offered an incredible opportunity to engage with healthcare supply chain leaders, exploring innovative ideas to tackle the industry’s most pressing challenges.

Showing Innovation In A Growing Field

Pathstone Partners’ active presence at these events underscores their dedication to staying at the forefront of healthcare innovation. By participating in discussions with industry leaders, the Pathstone team continues to refine and expand its solutions to meet the evolving needs of healthcare providers.

As Pathstone Partners reflects on the knowledge and connections gained in 2024, the team looks forward to continued collaboration with industry peers and clients. These conferences not only strengthen Pathstone’s commitment to excellence but also inspire new strategies for reducing costs and optimizing operations in healthcare

One of Inc. Magazine’s Fastest-Growing Private Companies in 2024

Driving Growth Through Dedication

Pathstone Partners, a healthcare consulting firm based in Chicago, Illinois, is proud to announce its recognition by Inc. Magazine as one of the Fastest-Growing Private Companies in the United States for 2024. With an impressive 3-year revenue growth rate of 84%, Pathstone has joined an elite group of organizations celebrated for innovation, impact, and a steadfast commitment to excellence.

Pathstone’s milestone reflects the remarkable achievements of its talented team, which has grown to over 35 professionals dedicated to streamlining operational costs and optimizing healthcare services nationwide. Collaborating with over 250 hospitals across the U.S., Pathstone has achieved more than $500 million in margin improvements, delivering measurable value to healthcare providers of all sizes, from academic health systems to community health organizations.

Transforming Healthcare Operations

Pathstone Partners has built its reputation by offering tailored solutions for both non-labor and labor-related operational challenges, including:

Non-labor services: Streamlining laboratory and clinical supplies, purchased services, IT systems, and pharmaceuticals.
Labor solutions: Optimizing workforce structures, reducing contract labor costs, managing overtime, and enhancing productivity.

By focusing on creating sustainable cost-saving strategies, Pathstone has become a trusted partner for organizations navigating the complexities of the healthcare industry.

A Commitment to Excellence

Earning a spot among the fastest-growing companies is not just a reflection of financial success—it is a recognition of Pathstone’s ability to adapt, innovate, and create meaningful change for its clients. As Pathstone continues to expand its footprint across the United States, its commitment to empowering healthcare providers remains stronger than ever.

Looking Ahead

Being recognized by Inc. Magazine is a significant accomplishment, but for Pathstone Partners, it’s just the beginning. The firm remains dedicated to its mission of helping healthcare organizations reduce costs, optimize operations, and improve patient outcomes.

As Pathstone continues to grow, the company looks forward to building on this momentum, leveraging its expertise to create even greater value for clients and the healthcare industry as a whole. Together, we are building a brighter future for healthcare, one success story at a time.

Identifying Revenue Leakage in Healthcare

What Is Revenue Leakage in Healthcare?

Revenue leakage happens when a healthcare practice gives care but does not receive payment for the services it provided. Leakage can occur in a few ways, such as forgotten accounts receivable or missed appeals deadlines for denied claims. It impacts the revenue cycle, preventing businesses from becoming financially viable.

Revenue leakage often goes unnoticed, but its impact can be detrimental to healthcare practices seeking to grow their business and maintain a high standard of care for their patients. The longer providers take to address points of leakage, the less likely they will be to receive any reimbursement for their services.

What Is the Impact of Revenue Leakage?

Healthcare providers must keep up with expenses to secure customer satisfaction and keep their practice in business. Revenue leakage can lead to lower earnings, putting providers at a disadvantage to their competitors.

A lack of revenue will significantly impact a healthcare facility’s ability to maintain several aspects of its organization, including:

Staff: Healthcare practices require proper resources to maintain a team with all the talents necessary to meet patient needs, ensure smooth processes and promote detailed organization. Revenue leakage can make hiring and retaining a highly skilled workforce challenging.
Quality care: If a provider is experiencing revenue leakage, they may add more services to compensate for the missing revenue. Extra services may decrease a provider’s ability to maintain high-quality care by increasing the likelihood of burnout.
Growth: Steady revenue enables organizations to grow their services and meet the needs of an expanding community. Healthcare practices that experience inconsistent income due to leakage may need help to keep up with growth demands.
Innovation: Cash flow powers innovation, helping providers maintain a competitive edge. A decrease in revenue will prevent businesses from matching a competitor’s offer, leading to a decline in patients.
Business goals: Revenue leakage can inhibit healthcare providers’ ability to meet business goals and objectives. Proper funding is necessary to achieve high standards and goals that drive the business forward.

What Are the Top Causes of Revenue Leakage in Healthcare?

Many forms of leakage are accidental and easy to correct, but they first must be identified. Revenue leakage can come from numerous sources, from issues with a provider’s processes to how patients or payors handle payments.

Some common causes of revenue leakage include:

Inaccurate information: Insufficient or incorrect registration data may result in a denied claim or errors in billing. Any changes in a patient’s personal information may also lead to revenue leakage.
Unverified insurance coverage: Without a proper review of insurance eligibility or approval, procedures and services may be given without adequate coverage. Inconsistencies with insurance coverage may also come from errors in payor-provider agreements, halting the revenue cycle.
Pricing issues: Inadequate pricing may lead to missed revenue opportunities. Prices set too low may undermine services for what they are worth, while prices set too high may drive patients to seek care elsewhere.
Unpaid accounts receivable: Sometimes outstanding bills remain unpaid for too long, going unnoticed or becoming lost. The longer an accounts receivable goes unpaid, the less likely providers are to recover any reimbursement.
Claims denials and underpayments: Inaccurate information can lead to claim denials and underpayments, slowing the revenue cycle for a healthcare provider. Any delay in addressing these issues with insurance companies can lead to missed appeals deadlines and less revenue for services already given.
Unbilled claims: Without a dedicated team to manage claims, practices may experience a variety of problems leading to revenue leakage. Claims require accuracy and consistent follow up ensure all claims are correctly billed.
Scheduling issues: Revenue leakage can also result from missed opportunities to receive revenue. These instances include referred patients who have yet to make an appointment or gaps in scheduling that could have been filled to maximize available time and resources.
Lost patients: Previous patients who seek another provider for care instead of returning are another form of revenue leakage. Healthcare providers miss out on revenue opportunities when patients feel their needs will be met better elsewhere.
Billing errors: Manual input of data may lead to various types of billing errors, decreasing the amount of revenue providers could and should be receiving. Accidental discounts or other inaccuracies in billing will halt the revenue cycle.
Unaccounted costs: Administrative costs can sometimes be miscalculated, resulting in underpayment from patients or payors. Incomplete logs of materials and equipment used during treatment or medical procedures performed may also lead to inaccuracies in how much patients or payors are charged.

These forms of leakage are common and usually unintentional, making it challenging to track and manage potential revenue opportunities. Healthcare practices need to ensure careful follow-up to protect vital revenue streams and prevent any leakage.

Revenue management is essential in the healthcare industry. Consistent cash flow enables providers to establish themselves as trustworthy professionals that provide the high-quality care patients seek. Revenue also allows organizations to experience growth and innovation that helps them keep up with competitors and maintain a talented workforce.

Healthcare practices need to ensure they have the funds to support their services and maintain patient satisfaction. Providers have a thin margin of error to work with, making revenue leakage an essential situation to address and resolve if healthcare practices wish to enjoy the benefits of consistent revenue.

Guide to Different Types of Healthcare Contracts

Health Care Financial Consultant Contracts

Contracts are the glue holding every operation together within the healthcare industry.

They connect employees and employers, suppliers and buyers, ensuring each party remains protected. Whether dealing with hiring, your supply chain or equipment, contracts can be long and complex and require time and effort to ensure they’re structured in your best interest. Understanding the different types of contracts and how they work is the first step to an effective contract management operation.

Supply Chain Contracts

Healthcare organizations depend on countless materials and products to complete daily tasks. Some of the most common products used throughout healthcare centers and hospitals include syringes, defibrillators, sterilizers, gloves and masks.

You can create supply chain contracts to secure these raw materials, products and services from reliable suppliers. These written agreements guarantee the supplier will provide specified goods or services for a pre-determined period at a fixed cost. They also outline delivery schedules, consequences for failing to adequately buy or supply and termination conditions.

Types of Supply Chain Contracts in Healthcare Facilities

Healthcare professionals use expensive instruments daily, and they might have equipment lease contracts rather than buying items outright. This strategy provides additional flexibility and security to obtain the required tools at a more convenient price. However, there are other solutions healthcare providers might employ to get the resources they need. Common types of supply chain contracts found within healthcare facilities and organizations also include:

Purchase orders: A purchase order is a binding contract the buyer produces detailing what they want to purchase from a supplier. This document includes information like quantity, payment terms and delivery.
Service agreements: These contracts are lists of all the services a supplier agrees to provide. It also outlines pricing, timelines and the rights afforded to each party.
Distributor agreements: Distributor agreements are formed between suppliers and merchants. The seller, or distributor, agrees to market and sell specified providers’ products for a fixed fee.

Labor Contracts

Standard labor agreements are legal contracts outlining the terms and conditions of employment at an organization or company. These documents vary by company and position and provide explanations of employee responsibilities and duties, employment terms, compensation and benefits and conditions of termination.

Commonly used labor contracts in every industry include:

Union contracts: A single, written agreement between the employer and a group of employees agreed upon using collective bargaining. These documents detail wages, hours and scheduling, time off, working conditions, advancement and more.
Non-union contracts: Customized documents that employers and individual employees negotiate. Individual employment agreements state conditions of employment and are often subject to governmental regulations.
Independent contractor agreements: Contractors are not employees and agree to perform specific services for a company in return for payment. These contracts outline the scope of work, compensation, deadlines and partnership length.

Special Healthcare Labor Contracts

Labor contracts are required for every employee within your organization. Which one you use depends on their position and union status and must meet all state and federal employment laws. However, there are special circumstances in which you must utilize other contract types, such as hiring a physician.

Many states prohibit medical facilities, like hospitals, from employing physicians directly. Detailed physician employment contracts or independent contractor agreements are often necessary.

They include schedule expectations, wages and benefits, on-call requirements and a restrictive covenant outlining non-compete conditions. If you are hiring for the role of medical director, a separate contract is also required and includes similar information.

Purchased Services Contracts

A lot goes into running and maintaining your healthcare facility. It takes time, effort and money to provide patients with the care and attention they deserve. Partnering with outside companies will ensure your operations are sustainable and run smoothly while saving you money. These partnerships are usually called purchased services and are part of your non-labor spending budget.

Purchased services agreements are the contracts between your organization and outside businesses. They include information regarding contract terms, scope of services, pricing structures and scheduling. Standard outside services many organizations choose to outsource include:

Laundry and linen
HVAC
Marketing
Rehabilitation services
Specialty equipment
Legal services

Types of Purchased Services Medical Contracts

Your healthcare business depends on the services you source from outside businesses and contractors. Outsourcing activities like coding, transcriptions and billing collections require managed services agreements (MSAs) and outsourcing agreements. These examples of healthcare contracts outline the promised service, payment structures, liability protections and timelines. They can also include penalties, fines and exit strategies.

Professional service agreements (PSAs) are another form of purchased services contract that aims to reduce company expenses. Facilities like hospitals often use PSAs to enlist the help of specialized physicians such as anesthesiologists, radiologists, hospitalists and many other professionals.

These professionals remain independent from the business while adhering to a contract tailored to fit the needs of your business or organization in return for payment. You can create them for a single service provider or a whole department, varying in term length, schedule type and responsibilities. These contracts tend to be more complicated, yet they can be extremely powerful when they are done right.

Informational Technology Contracts

As technology has continued to advance, it has become a staple of the healthcare world. Healthcare companies everywhere depend on cutting-edge technology and software to treat patients effectively and deliver reliable services.

Technology contracting is critical to these companies acquiring the resources they need. Most applications, software and information-based technology require licensing agreements detailing necessary fees, the duration of the agreement and prohibited activities.

Examples of Healthcare Informational Technology Contracts

The healthcare industry is extremely reliant on innovative technology to continue meaningful growth. With this, you may see various types of healthcare contracts, including:

Software licensing agreements: This is a legally binding contract between your healthcare organization and a technology company permitting the use of specific software. It defines where a purchaser can install the software, how to use it, how much it costs and how a party can terminate it.
Software development contracts: These agreements enlist the help of developers to design and implement custom programs and applications to expand business offerings and capabilities. A software development contract offers an overview of the project details and expectations, including the timeline, expectations, budget and other information.
Information technology outsourcing (ITO): ITO agreements are legal documents describing all the work to be handled by a third-party partner. You can establish relationships with vendors for infrastructure management, data center services and application development and maintenance.
Data use agreements (DUA): Providers use DUAs with patients when transferring protected health information, like limited data sets and identifiable data. This contract establishes both parties’ rights, responsibilities and obligations regarding permitted use, ownership and liability.
Application service provider (ASP) agreements: Healthcare companies can work with vendors to obtain the right to use their software or application. Instead of licensing and receiving a copy of the software, organizations rely on vendors to operate and manage the software on their behalf, often charging a usage fee or subscription.
Business process outsourcing: Organizations choose to streamline their technological supply chain by subcontracting specific jobs to third-party service providers. Popular online sectors that healthcare facilities create agreements for include finance and accounting, human resources and customer call centers.

Pharmacy Contracts

Drugs and medications are heavily regulated at the state and federal levels. Contractual agreements are used between healthcare organizations and pharmacies to protect each party’s rights and meet legal restrictions.

Pharmacy contracts are legal agreements between pharmacies and healthcare organizations. These detailed documents establish the terms and conditions regarding various operations, including purchasing, dispensing and paying for drugs and related services.

Types of Pharmacy Contracts

Pharmacy contracts will likely vary from pharmacy to pharmacy, and they are heavily dependent on provided services. Essential terms covered within these types of medical contracts include the scope of services, pricing, confidentiality, compliance and termination. Whether you run a pharmacy or work side by side with them, you should be aware of the following contracts you might encounter:

Manufacturer rebate agreements: Also known as vendor rebate agreements, these arrangements act as incentives to increase manufacturer sales while offering businesses reduced price points. This contract details the conditions a healthcare organization must meet before they receive a rebate check or future discount.
Group purchasing agreements: Specialty healthcare entities and pharmacies can enter into group purchasing organizations to secure supplier discount pricing. Organizations use these agreements to increase their buying power and negotiate with manufacturers, vendors and suppliers.
Pharmacy benefit management (PBM) contracts: These documents facilitate the relationship between pharmacy benefit managers and employers, health plans, labor unions, wholesalers and other organizations involved in healthcare. PBM contracts describe the manager’s role in processing and paying prescription drug claims and outline pricing areas and unique exclusions.

Choose Pathstone Partners to Handle Your Healthcare Contracts

Legal contracts come in all shapes and sizes within the healthcare industry, facilitating integral services that businesses and organizations rely on to succeed. Understanding how each operates and how to navigate through each situation accurately is crucial to your growth. It will ensure you’re capable of effectively helping and caring for customers and patients.

Pathstone Partners is devoted to providing your business with a broad spectrum of exceptional healthcare consulting services to manage all your medical contract needs. We have a long history of working with healthcare organizations of all sizes, identifying challenges and capitalizing on opportunities to enhance performance. Our healthcare consultants have unrivaled expertise to oversee contracts across all your business ventures. Get in touch with us to get started today.

10 Key Metrics in the Healthcare Industry

Health Care Financial Consultant Metrics

Measurements in the Healthcare Industry

Like any business, hospitals must collect and analyze data about their processes and procedures to streamline operations, improve patient care and avoid overspending. Healthcare performance metrics are essential data points that indicate how efficiently an institution is running and allow hospitals to monitor their quality of care and spending habits.

In this guide, you’ll discover the common healthcare metrics that hospitals and facilities should leverage to provide outstanding patient care and remain as efficient and profitable as possible.

Metric #1: Length of Stay

The average length of stay measures the duration of a patient’s hospital stay from their admittance to discharge. According to the Centers for Disease Control and Prevention (CDC), the average hospital stay in the United States lasts 5.4 days.

Hospitals can track and segment this metric by hours, days, weeks, months or quarters. If desired, they can further categorize length of stay metrics by diagnosis or department. However, most hospitals typically track their average stay length using months or annual quarters as units of measurement.

Stakeholders can use this metric to measure efficiency and financial performance. The longer a patient stays in the hospital, the more their care costs, meaning shorter stays reduce a hospital’s cost per discharge. Post-acute care is also generally less expensive than inpatient care.

Metric #2: Readmission Rates

Patient readmission rate refers to the number of patients readmitted to the same hospital for the same condition after being discharged for less than 30 days. The most recent data from the Healthcare Cost and Utilization Project (HCUP) indicates the average 30-day hospital readmission rate for Medicare patients was 16.9% in 2018.

This metric fluctuates depending on the type of patient and condition. For example, the average 30-day readmission rate for Medicare patients with heart failure in 2018 was 22.9%.

Readmission rates demonstrate a hospital’s quality of care, as a higher hospital readmission rate indicates that care providers likely overlooked complications and prematurely discharged patients.

Hospitals also use readmission rates to measure financial performance, as hospitals with higher readmission rates might not receive full reimbursements from Medicare.

Metric #3: Bed Occupancy Rate

Bed occupancy or bed utilization rate measures the number of occupied hospital beds at any time. This healthcare performance metric helps providers to see the ratio of available beds to those awaiting care. Current data indicates the average national bed occupancy rate in the U.S. was 64.4% in 2019.

Much like a hospital’s readmission rates, bed occupancy rate helps hospitals evaluate their quality of care and financial performance. The higher the bed occupancy rate, the more staff is needed to care for patients. Adequate staffing is paramount, as quality of care could suffer if a hospital is understaffed.

Conversely, if a hospital’s bed occupancy rate is too low, the facility might lose money due to overstaffing and maintenance costs.

Metric #4: Incident Rate

A hospital’s incident rate measures the occurrence of care complications, including issues such as bed sores, infections, reactions or postoperative respiratory failure, hemorrhages, sepsis and pulmonary embolism.

According to a 2018 report by the U.S. Department of Health and Human Services Office of Inspector General (OIG), 25% of Medicare patients experienced harm during a hospital stay. These adverse events included pressure injuries, intraoperative hypotension and respiratory infections, resulting in the need for life-sustaining measures and prolonged hospital stays.

Having a lower incident rate indicates a hospital’s ability to provide high-quality curative care without adverse reactions. Better care also reduces a hospital’s financial losses because it minimizes the need for additional treatment, meaning that this specific performance metric has a substantial impact on other areas of operation.

Metric #5: Average Cost Per Discharge

The average cost per discharge is the median cost per hospital visit for each discharged patient. As with average length of stay, hospitals can segment the average cost per discharge based on diagnosis or department.

Current data indicates that the average cost per discharge for Veterans Affairs Hospitals was $40,763 in 2020. According to the HCUP, the average cost of a common hospital stay in the U.S. in 2017 was $12,100, compared to $11,700 in 2016. Septicemia, osteoarthritis and heart failure were among the most expensive inpatient conditions in the U.S. in 2017.

Hospitalization continues to be one of the most expensive aspects of medical treatment. Tracking the average cost per discharge helps hospitals measure inpatient costs to assess their spending efficiency and monitor areas of overspending. The average cost per discharge metric also showcases where hospitals routinely profit.

Metric #6: Operating Margin

A hospital’s operating margin is its net revenue minus its operating costs. Operating costs include but are not limited to staff salaries, medical equipment, supplies, utilities, liability insurance, treatments, medications, meals and marketing expenses.

According to the American Hospital Association, one report indicates the average operating margin for over 900 U.S. hospitals at the beginning of 2022 was -3.45%, meaning that many U.S. hospitals did not turn a profit early in 2022.

A hospital’s operating margin is an essential healthcare performance metric that demonstrates the institution’s financial health, as a higher operating margin translates to greater profit for the hospital. Higher operating margins also indicate excellent management revenue cycle and patient care.

Metric #7: Inpatient Mortality Rate

Inpatient mortality rate refers to the percentage of patients who die in a hospital’s care. Mortality rates differ based on patient demographics and diagnoses.

For example, a National Health Statistics Report from the CDC asserted that 35% of patients hospitalized for pneumonia in 2016 died during their hospital stay. Other serious conditions, such as congestive heart failure, will naturally involve a higher mortality rate, while more minor issues and illnesses are less likely to result in a patient’s death while under care.

This metric is especially important for informing stakeholders of an institution’s performance because it is an Inpatient Quality Indicator (IQI) demonstrating a hospital’s ability to stabilize and adequately care for patients. Though variation is expected based on patient demographics, higher overall patient mortality rates indicate care deficiencies.

Metric #8: Asset Utilization Rate

A hospital’s asset utilization rate refers to the percentage of time its hospital equipment is in use, with a higher asset utilization rate indicating better performance. That’s because the more a piece of equipment is in use — or the higher the utilization rate — the more the hospital generates revenue from that investment.

A lower utilization rate might mean a hospital has more equipment than is reasonably necessary, hinting at overspending. Without knowing how often a hospital’s staff uses its assets, it’s challenging to budget for or justify equipment expenditures, so this metric is vital for assessing a facility’s financial status.

Metric #9: Patient Satisfaction

Patient satisfaction refers to a patient’s satisfaction with the care and service provided during their hospital stay. Factors that might influence a patient’s satisfaction include staff temperaments, wait time, visit length, technology, facility condition and diagnosis.

According to a 2019 study by the Centers for Medicare and Medicaid Services, only 8% of U.S. hospitals received a 5-star rating on patient experience. In the same study, it was found that the majority of U.S. hospitals receive 3-star ratings.

Why is measuring patient satisfaction important? Patient satisfaction provides actionable feedback and data hospitals can use to improve care and optimize services.

Patient satisfaction also affects the likelihood of a patient recommending a hospital to their loved ones, contributing to its reputation. A positive reputation can bolster a hospital’s bottom line.

Metric #10: Time to Service

Time to service refers to the time it takes a patient to receive care at a hospital, from the first arrival to when they receive healthcare services. This metric also includes the time it takes for a patient to see a physician.

Hospitals can segment time to service based on diagnosis, discipline or department, such as in the case of emergency room (ER) visits. The current time to service for U.S. emergency departments differs by state, with North Dakota having the lowest wait time at 104 minutes as of 2022.

Time to service is an important metric for hospitals to track because it provides information about their ability to provide prompt patient care. Wait times also directly impact patient satisfaction, meaning hospitals can improve their patient satisfaction rates by focusing on improving service times.

Leverage Hospital Performance Metrics With Pathstone Partners

If you’re looking for ways to leverage healthcare performance metrics data to improve your hospital’s operations and finances, consult the experts at Pathstone Partners. We’re a leading healthcare management consulting firm that assists healthcare organizations with developing streamlined operational strategies. We’ll help you identify trends that can enhance your facility’s operations to improve your quality of care and boost your bottom line.

Contact us today to learn more about improving your healthcare organization’s efficiency by analyzing healthcare performance metrics.

Medical Billing in Healthcare: In-House vs Outsourced

Health Care Financial Consultant Medical Billing

Understanding Medical Billing in Healthcare Practices

One of the more complex components of running a medical practice is managing your organization’s medical billing process. With thousands of potential medical codes for different diagnoses and procedures, on top of the numerous payers in the market, having the ability to effectively manage billing is a key driver of success in today’s healthcare industry.

In-House vs Outsourced Billing: No One-Size-Fits-All Solution

There is no “one-size-fits-all” as it relates to medical billing solutions; however, the two primary options for a healthcare organization are in-house medical billing and outsourced billing. There are three overarching considerations when evaluating whether to implement in-house or outsourced billing:

The cost
An organization’s capacity to execute billing
Maintaining confidential health services while billing

Evaluating the Cost of Medical Billing

Evaluating the cost implications of your selected billing option is critical for revenue management. For small clinics, there may not be enough revenue generated to cover the fixed costs of billing and turn a return on investment (ROI). It is important to do a cost-benefit analysis to ensure that the clinic can expect a net income.

Essential Internal Billing Activities

Whether or not your organization elects to keep billing in-house or outsource billing, a handful of important billing activities must be maintained internally. As an organization, you are held accountable for submitting accurate and timely billing information to the outsourced billing agency or to individual third-party payers. The organization is also responsible for:

Insurance verification
Medical patient registration
Coding

Maintaining Confidentiality: Written Billing Policies

Finally, it is of utmost importance to have clear written healthcare billing policies on how to manage bills and balances to ensure private patient information is managed appropriately.

Exploring In-House Billing

In-house billing includes the staff of a clinic or healthcare organization being responsible for all aspects of revenue cycle management. They submit claims to a clearinghouse, directly to Medicaid, or to the insurance company for reimbursement. They also set charges, collect patient fees (copays and deductibles), and manage the accounts receivable.

In-housing billing comes with several advantages all of which include:

More visibility over the billing process
High flexibility
Increased control over patient accounts

Nevertheless, it’s essential to be mindful of the potential difficulties linked with in-house billing, which encompass:

High upfront expenses for labor and technology
Ongoing training needs
High dependency on your staff members

Outsourcing: A Common Solution to Medical Billing

Many healthcare organizations opt to outsource their medical billing to a third party. These third-party companies typically take a percentage of a healthcare organization’s collections as payment for managing many aspects of a revenue cycle, on top of recurring monthly fees.

Outsourced billing has countless benefits which may include:

Having more experienced parties managing your billing
Advanced software options
Saving on internal time and resources

However, outsourced billing requires your organization to:

Maintain and oversee contractual obligations to the selected third party
Outsourcing gives your organization less control over patient accounts

Weighing the Choices: Outsourced vs In-House Medical Billing

The decision in outsource medical billing versus billing in-house is very dependent on your organization’s needs and resources, and each option has its own benefits and disadvantages.

To learn how Pathstone Partners can help your organization with medical billing, contact our team of healthcare experts.

How to Stop Revenue Leakage In Healthcare

Identify and Evaluate Opportunities

Your organization can prevent revenue leakage by implementing a few best practices that ensure accuracy and efficiency and promote optimization. Addressing points of leakage will enable your organization to increase revenue while maintaining quality patient-provider relationships.

Consider your organization’s practices and determine what processes could be optimized to promote more efficiency. A few areas to evaluate include:

Patient scheduling and registration: How do patients schedule appointments? Do they need to fill out paperwork or an electronic form when registering? Where do data entry inaccuracies occur?
Recording of medical supplies, procedures and equipment used: Who records information during a patient’s visit? How are procedures documented? Are responsibilities established among staff members?
Insurance verification: When does verification take place? Who handles insurance? Where do errors happen in the process?
Claims management: Who is responsible for follow-up when claims are denied? Who is responsible for issuing claim submissions? What is the current timeline for claim processes?

Some solutions may be as simple as cleaning up common clerical errors, while others may be more complex, such as implementing digital transformation and integration. Reviewing your processes will reveal opportunities for improvement, expose inaccuracy or inefficiency and enable your team to resolve problems and create a smoother revenue cycle.

Ensure Accuracy

Revenue leakage often occurs from issues at the beginning of the revenue cycle when patients first register or schedule an appointment. Ensuring accuracy in the information collection process will drastically improve how practices capture revenue, enabling them to create claims with correct patient information.

One way to ensure accuracy is to utilize electronic capabilities. Requiring patients to register or schedule appointments online will decrease data entry errors from paperwork. Electronic referrals will help your practice keep track of potential patients and encourage them to schedule.

Verify Insurance

Checking insurance eligibility and approval is another way to prevent revenue leakage by ensuring your services will be covered. Maintaining accurate insurance information will enable your practice to submit claims with precise data.

Establish correct insurance information by reviewing it with patients at the beginning of their appointment. Update any changes to insurance carriers, coverage or contact information. Adjusting any changes will be easier to complete before the visit rather than tracking down patients after they leave.

Set Financial Responsibility Expectations

Keeping patients informed of their responsibilities will improve your revenue cycle and increase patient satisfaction. Providing estimated costs to patients before their appointment will keep patients informed and prepared to complete their payments.

Collect copays and coinsurance during check-in or after an appointment to ensure accurate and timely payments and decreased revenue leakage.

Organize Claim Management

Commitment to timely claim submission and appeals will enable your practice to improve your revenue cycle. Accurate patient data will decrease the number of claims denials you receive, and a dedicated management team will be able to appeal denied claims quickly and efficiently. Taking the time to evaluate, revise and resubmit denied claims will greatly decrease revenue leakage.

Simplify Payment Processes

Creating an easy payment process for your patients will improve revenue and boost patient satisfaction. Make bill pay convenient by offering an online payment option or a payment plan to give patients the flexibility to meet their bills.

Prevent Revenue Leakage With Help From Pathstone Partners

Revenue management and leakage prevention can be complex, but you can find understanding and empowerment when you work with Pathstone Partners. Our consultants will help you tackle financial and operational processes to identify opportunities, implement solutions and sustain beneficial practices for the success of your healthcare practice.

Our variety of services will enable your organization to manage revenue cycles easily, provide quality patient care, exceed business goals and ensure success. Contact us today to learn how Pathstone Partners can drive value for your healthcare practice.