Your Room is Ready: How to Recapture Health System Revenue by Solving “The Motel Problem”

Your Room is Ready: How to Recapture Health System Revenue by Solving “The Motel Problem”
Rich Miller, Chief Strategy Officer of QGenda

Healthcare leaders attempting to regain some of the revenue lost during the COVID-19 shutdowns now face a formidable challenge. The American Hospital Association estimates that U.S. hospitals and health systems lost $202.6 billion in just the four months from March 1 through June 30—roughly $50.7 billion per month.

Many variables feed into the overall financial impact for individual healthcare organizations, of course—including geographic location, local ordinances, specialty designations, and speed of service resumption. Regardless, every health system has experienced revenue shortfalls caused by disruptions to their service pipeline. The question now is how to generate enough additional revenue to cover some of those losses without incurring additional operating expenses. 

We may be able to take practical inspiration from an unlikely source: the hospitality industry. By solving for something one healthcare organization calls “the motel problem,” health systems can increase workflow efficiency, staff satisfaction, clinic volume, and revenue. 

The Motel Problem

Accurately assigning exam rooms with enough flexibility to accommodate continuously changing provider and patient schedules remains a perennial challenge for health systems. In fact, during a recent Porter Research study of 100 executive leaders, roughly two-thirds indicated their health systems lack visibility into exam room utilization. 

The leaders of one academic medical center’s 65-physician neurology clinic began referring to this capacity challenge as “the motel problem.” How do motels consistently keep their rooms full of paying customers?. In contrast, their own exam rooms often appeared full on the scheduling spreadsheet but actually sat empty. Staff afraid of accidentally double-booking the space would then let those rooms sit idle. 

Despite increasing the administrative time devoted to room management, underutilization in the neurology clinic caused rising patient wait times, lowered physician satisfaction, and decreased revenue. If the Porter Research survey is any indication, this situation is not unique. Approximately 72 percent of the survey’s respondents felt their room utilization rates were significantly subpar. Most said their organizations ran at about 20 points below the 80-89 percent utilization level they deemed optimal.

As the neurology department leadership mused about “the motel problem,” they looked at the similarities between motel and healthcare room management needs. Motels must match each guest to a room with the right accommodations (e.g., two doubles versus one king-sized bed) on the right dates. Health systems must take that same workflow one step further by matching the right patient and the right provider to a properly equipped exam room at the right time. In both cases, empty rooms mean lost revenue. Utilization is key.

Consequently, they came to believe that they needed a system that optimized room capacity with much of the same visibility and flexibility as a hotel or motel reservation system. That would require bringing together data about room availability, room attributes, provider schedules and patient needs—and making the resulting intelligence accessible through real-time displays. 

A meaningful solution

When it comes to capacity management within a health system, the real complexity lies with provider and patient schedules. The physical space is always there; it’s the “people” part of the equation that’s fluid. What happens when Dr. Johnson suddenly falls ill, for example? Or Dr. Smith needs to attend a last-minute meeting? Or when patient Mrs. Brown reschedules her appointment? 

Clinics typically rely on relatively static spreadsheets or siloed software to track room utilization. But these tools aren’t designed to make such real-time adjustments, especially at the enterprise level—which means the exam rooms assigned to an absent Dr. Johnson or Dr. Smith likely remain empty even as patients wait to be seen by other providers. 

On the other hand, an organization’s scheduling system is aware when a provider calls in sick, heads to a meeting, or arrives at the clinic early. With a cloud-based scheduling platform, organizations can achieve near real-time visibility into provider availability across the enterprise. 

Consider, then, what can happen when room management software is layered on top of an enterprise scheduling platform. Providers’ movements are then connected to exam room status. The entire organization gains transparency into how providers’ availability affects room availability. That allows staff to quickly and easily move providers into unused rooms and call patients in for appointments faster. Plus, by “tagging” various room attributes—like whether it’s equipped with oxygen or an ENT chair, for instance—such platforms ensure that the proper clinical accommodations are available when providers and patients need them. 

Bottom-line results

Such real-time visualization of room availability can have a substantial impact on health system revenue. One regional health system, for example, calculated that underutilization in its orthopedic clinic costs at least $2,000 per provider per day in lost revenue. 

Another large health system quantified the effect from a different perspective. It contemplated how maximizing capacity would enable increased patient throughput without investing in additional space or staff. With that in mind, the organization determined that every one percent increase in utilization results in an annual operational savings of $140,000. 

At the neurology clinic, solving “the motel problem” by implementing a solution to standardize capacity generated both revenue growth and increased provider satisfaction. The organization has captured revenue previously missed through underutilization and has recognized that revenue scales directly proportional to volume.

To that end, gaining visibility into capacity has helped the clinic achieve a 7.4 percent increase in patient visits and a 4.7 percent increase in-clinic session volume. As important, providers now trust that the right exam rooms will be ready for them when needed—just like a reservation at a high-end hotel. 


About Rich Miller

Rich Miller is the Chief Strategy Officer of QGenda, a healthcare workforce management provider, enabling organizations to optimize capacity across the enterprise. Leading physician groups, hospitals, academic medical centers, and enterprise health systems use QGenda to optimize their workforce which allows them to provide the best possible patient care.


Hospital Sustainability Demands that Revenue Integrity Move Front and Center

Hospital Sustainability Demands that Revenue Integrity Move Front and Center
Vasilios Nassiopoulos, VP of Platform Strategy and Innovation, Hayes

Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020. 

The reality is that an increase in COVID-19 cases will not overcome the pandemic’s devasting financial impact. An internal analysis found that, in the first half of 2020, client organizations documented more than 1.2 million COVID-19 related cases. At least one study suggests that $2,500 will be lost per case–despite a 20% Medicare payment increase. And notably, a positive test result is now required for the increased inpatient payment.

The healthcare industry must face its own “new normal” as the current path is unsustainable, and the future stability of hospitals in communities across the nations is uncertain. If financial leaders do not act now to implement systems and embrace sound revenue integrity practices, they will face unavoidable revenue cycle bottlenecks and limit their ability to capitalize on all appropriate reimbursement opportunities. 

The COVID-19 Effect: A Bird’s Eye View

The financial impact of COVID-19 is far-reaching, impacting multiple angles of operations from supply chain costs to lost billing opportunities and compliance issues. Findings from a Physician’s Foundation report released in August suggest that U.S. healthcare spending dropped by 18% during the first quarter of 2020, the steepest decline since 1959.

Already vulnerable 2020 Q1 budgets were met with substantial losses when elective procedures—a sizeable part of income for most health systems—were halted for more than a month in many cases. Many hospitals continue to lose notable revenue associated with emergency care and ancillary testing as patients choose to avoid public settings amid ongoing public safety efforts. 

Outpatient visits also dropped a whopping 60% in the wake of the pandemic. While a recent Harvard report suggests that numbers are back on track, the reality is that a resurgence of cases could make consumers wary of both doctor visits and elective procedures again.

In addition, the supply chain quickly became a cost risk for health systems by Q2 2020 as the ability to acquire drugs and medical supplies came at a premium. Meeting cost-containment goals flew out the window as did the ability to create value in purchasing power.

Further exacerbating the situation is an expected increase in denials as healthcare organizations navigate a fluid regulatory environment and learn how to interpret new guidance around coding and billing for COVID-19 related care. For example, while telehealth has proved a game-changer for care continuity across the U.S., reimbursement for these visits remains largely untested. History confirms that in times of rapid change, billing errors increase—and so do claims denials.

While there is little that can be done to minimize the impact of revenue losses and supply chain challenges, healthcare organizations can take proactive steps to identify all revenue opportunities and minimize compliance issues that will undoubtedly surface when auditors come knocking to ensure the appropriate use of COVID-19 stimulus dollars. 

Holistically Addressing Revenue

Getting ahead of the current and evolving revenue storm will require healthcare organizations to elevate revenue integrity strategies. Hospitals and health systems should take four steps to get their billing and compliance house in order by addressing:

1. People: Build a cross-functional steering committee that will drive revenue integrity goals through better collaboration between billing and compliance teams.

2. Processes: Strategies that combine the strengths of both retrospective and prospective auditing will identify the root cause of errors and educate stakeholders to ensure clean, timely filed claims from the start. 

3. Metrics: Best practice key performance indexes are available and should be used. Clean claim submission, denial rate, bad debt reduction and days in AR are a few to consider.

4. Technology: The role of emerging technologies that use artificial intelligence cannot be understated. Their ability to speed identification of risks, perform targeted audits, identify and address root causes and most importantly, monitor the impact of process improvements is changing current dynamics. For one large pediatric health system in the Southwest, technology-enabled coding and compliance processes resulted in $230 million in reduced COVID-related denials and a financial impact of $2.3 million. 

Current manual processes used by many healthcare organizations to assess denials and manage revenue cycle will not provide the transparency needed to both get ahead of problems and identify areas for process improvement and corrective action in today’s complex environment. 

About Vasilios Nassiopoulos

Vasilios Nassiopoulosis the Vice President of Platform Strategy and Innovation at Hayes, a healthcare technology provider that partners with the nation’s premier healthcare organizations to improve revenue, mitigate risk and streamline operations to succeed in an evolving healthcare landscape. Vasilios has over 25 years of healthcare experience with extensive knowledge of EHR systems and PMS software from Epic, Cerner, GE Centricity and Meditech. Prior to joining Hayes, Vasilios served Associate Principal at The Chartis Group. 

CMS to penalize hospitals, labs that don’t report Covid-19 data

New rules by the Center for Medicare and Medicaid Services would penalize hospitals and laboratories that report Covid-19 data. Hospitals would be required to report the number of confirmed or suspected Covid-19 patient, occupied beds, and availability of ventilators and other critical supplies.

COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever

Medsphere CEO Talks Affordable Healthcare IT and Future of EHRs
Irv Lichtenwald, President & CEO of Medsphere Systems Corporation

In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need to provide healthcare for all in the event of calamity upending the basic functions of a civilized society. With that, the UK’s National Health Service (NHS) was born.

In 2020, all perspectives about quality and the time it takes to see a provider aside, the NHS remains quite popular among UK citizens and is an enduring source of national pride.

With the United States in the midst of its own upheaval, it’s for a related question: Might the current COVID-19 situation give rise to significant changes to the American healthcare system? 

Virtually no one thinks the correct answer is ‘No.’ Things will change. The question is how and to what extent. The healthcare system in place in the United States now is dramatically more complex than that in use by Britons after WW II. There are so many moving parts, so many things that can break. 

So, in which aspects of the current American healthcare system are we likely to see changes after COVID-19 is dealt with?

Telehealth: Someone always benefits in a catastrophe. In this case, that someone may be Zoom shareholders.

From 10 million daily users in December, Zoom rocketed to 200 million in March and nearly 300 million a month later. Much of that was healthcare related. 

Of course, Zoom is not the only direct beneficiary of coronavirus as venerable meeting platforms like WebEx and Skype, among others, have also experienced dramatic growth.

Hospitals and health systems were incrementally implementing telehealth services prior to the coronavirus outbreak, but there was no sense of urgency that accompanies a rapidly spreading virus. Since then, the federal government, states and insurance companies have allocated funds and rewritten regulation to expand the use of telehealth. 

But there are more telehealth related-issues to address, some of which have thorns. Service and payment parity across insurance companies is an issue. If telehealth is going to be a regular component of healthcare, technology gaps will have to be addressed, especially in rural areas. 

This is something the federal government recognizes. The White House recently drafted an executive order oriented around improving rural health by expanding technology access, developing new payment models and reducing regulatory burdens. The EO tasks the secretaries of health and human services and agriculture to work with the Federal Communications Commission to “develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans.” But until Congress gets involved and provides funding for something like this, it will probably never get out of the proposal phase. 

In fact, there are enough concerns—parity, technology gaps, added costs—associated with telehealth to wonder if it will endure after coronavirus is in the rear view. Enough about telehealth benefits both providers and patients for it to stick and proliferate, but that could also be said about any number of healthcare initiatives that seem to languish for lack of coordination and political will. 

Health Insurance: This is where the NHS analogy is the most relevant. Many millions of workers are furloughed or simply laid off with the impact of COVID-19 on frontline jobs like restaurant worker, massage therapist and barista. Those who had insurance through work may not have it anymore, leaving them doubly vulnerable—no coverage, no income—to illness or accident. 

Mass unemployment episodes reveal, each time, the weakness in the patchwork employment-based healthcare insurance system we’ve sort of made peace with for decades. Sure, Medicaid exists to fill the gaps, but it may make sense to render Medicaid unnecessary, especially since its value is questionable in particular states.

“You notice the number of band-aids that Congress is having to apply to help people who have lost their jobs,” said former CMS Administrator Don Berwick, MD. “What we have now is a whole series of band-aids and special measures. What if instead, we just had universal health insurance?”

What if, indeed. Will COVID-19 be the straw that burns the bridge of employer-based health insurance, to mangle a metaphor? That may depend on how long the pandemic lasts, who is president sometime after November 3 and how much damage is done to the national fabric before economy and society start a process of repair.

Payment Models: For years now, hospitals have been in the middle of slow shift from fee-for-service care to value-based care and alternative payment models. That transition didn’t happen quickly enough to prevent most hospitals from falling into a financial chasm. If elective procedures are a big part of revenue, it follows that revenue will fall if those procedures disappear. 

To be fair, the hit to hospital finances has been catastrophic enough—more than $200 billion in losses over four months, according to the American Hospital Association—that federal government support would have been necessary even if a full pay-for-quality model had been in place.  

But the pandemic spotlights the downside of treating essential services like healthcare as though they are mere services one selects or rejects. And it exposes the folly of not making sure everyone has insurance coverage (a payer) when the individual costs for COVID-19-related hospital admission can range from $20,000 to $88,000. 

End-of-Life Care: According to one analysis, 42 percent of COVID-19 deaths have occurred in nursing homes or assisted living facilities. The families of those unfortunate souls who’ve died while in a facility have generally endured the agony of saying goodbye outside a window or over a video link. It’s hard to believe, after COVID-19, that the assisted living industry will continue as before. 

“The crisis surely will lead nursing home administrators to reconsider the way patients are cared for,” says Modern Healthcare. “Among the ideas Harvard’s [Professor David] Grabowski believes will get a longer look in the wake of the pandemic are using telemedicine services, creating specialized Medicare Advantage plans for the homes and pursuing smaller settings.”

Perhaps. And perhaps a son or daughter that remembers coronavirus will simply choose not to risk everything by putting their parent in a home. Could enough of them make such a decision that the industry contracts? Is forced to take quality care more seriously? Attracts more serious federal regulation? 

As the deaths mount, it’s hard not to give every option serious consideration. 

Supply Chain: These days we’re bickering in public and on social media (looking at you, maskless Karen throwing food in Trader Joes) about whether or not masks should be mandated. Look back with me  to February, however, and you’ll fondly recall concerns about there being enough masks at all. 

Back then we learned that the United States had exactly one mask manufacturer, and that all other masks are sourced from overseas. That it takes longer to get stuff from China than from Amarillo creates obvious potential problems when a crisis hits, but it also pits hospitals and government entities against one another and guarantees that the winner will pay more for supplies than they would in less-critical times. 

It also creates weird, unnecessary scenarios that could be avoided using coordination and leadership. The governor of Maryland, for example, used his wife’s connections to South Korea (her country of birth) to secure 500,000 coronavirus tests, which he then put in an undisclosed location and protected using national guard troops. 

What’s the remedy? 

Modern Healthcare has called for a national supply chain czar, which in other times may have just been the head of FEMA. The suggestion, however, highlights the need for a coordinated central clearing house where supplies can be ordered, managed and dispersed based on need. 

Individual hospitals, clinics and health systems can also help themselves by using a robust supply chain software system that keeps track in real time of available supplies, covers all ordering systems and methodologies, and reacts swiftly to certain thresholds. 

The uniquely unfortunate aspect of the American political system among western democracies is that, for the most part, it responds to the demands of special interests. Think about your local representative. Chances are good the shouts of specific business interests are ringing in his or her hears so loudly that little else is audible. 

As such, there is a significant danger that the American healthcare system will return, post-COVID-19, to the same dynamic it had when the virus arrived, which will be unfortunate. What we need post-pandemic is not necessarily specific changes to hospitals, clinics, insurance companies, etc., though they could be part of an overall solution. What will be necessary is an examination of where every aspect of the healthcare system overall, inasmuch as there is one, didn’t do its job.   

Disasters are social sodium pentothal that, while active, force groups of people to take an honest look at their failures. Once the disaster is passed, however, there is a danger that Upton Sinclair’s maxim—“It is difficult to get a man to understand something when his salary depends upon his not understanding it”—will rule the day. 

No one hopes for more dramatic damage to the American economy and social fabric, but the irony is that necessary change sometimes only comes when reality is undeniable, as in a shellshocked Britain instituting the NHS. If COVID-19 doesn’t shock us sufficiently into making substantial changes to the healthcare system, it’s a pretty safe bet the same disaster will occur again.