Adjusting to the new normal: accelerating operating pressures and 70” of snow

Andrew Slotnick

Flash back to early January in New England – winter had barely shown its face, the football playoffs were underway and I was walking into Gillette Stadium for the HFMA MA RI regional revenue cycle event. As I write this blog post a few short weeks later, that scene could not be more different. Ok, yes, the obvious point to make here is that the New England Patriots won the Super Bowl, but unlike the Pats winning the big game, which as the odds makers had it at the time should not have been a huge surprise, the changes to the greater Boston landscape are downright shocking. In less than three weeks the region has been crushed with over 70+” of snow, and as of this morning it’s still falling. Roads are narrowing, resources such as public transportation and utility services are extremely limited by the snow and cold and everyday life has changed for the time being.

What I heard at the HFMA event back in snowless January, was that just like the impact this historic snowfall has had on Bostonians, everyday life for provider organizations is changing too. The most noticeable similarity in my opinion, between the challenges discussed at HFMA and the waves of snow storms that hit the Boston area is access to vital resources. While the streets of Boston are literally disappearing more and more with each snow fall and public transportation delays are becoming more prevalent and longer, cost and reimbursement pressures are having the same effect on hospital and health systems. Whether its cash flow, bond rating, or days cash on hand, declining profitability across the board is limiting the availability of financial resources that are vital funding the clinical mission. The hospitals and health systems attending the HFMA event however recognize that the time to address these prevailing trends is now. Facing rising out of pocket payments with front-end improvements to improve collections or scrutinizing workflow efficiencies to reduce costs are just two examples of the level of detail that high performers are taking to maintain or improve financial performance in the face to change.

Boston will recover from snowmagedon, and life will return to normal, minus some water and ice damage… However, that is where the parallel between Boston’s snowy story and the financial challenges of provider organizations ends. Life for provider organizations will not return to normal, in fact, even if you want to consider maintaining financial performance as ‘normal,’ doing so requires a new approach.  Weather it is flipping the revenue cycle upside down, investing in front-end vs. back end capabilities, or re-training staff to address uncomfortable financial discussions with patients prior to service or taking advantage of innovative technologies such as predictive analytics, it was very clear that maintaining the status quo will not return like results. In fact the ability to adapt to the new normal will dictate who tackles it shoulder-to-shoulder and who thrives, those who cannot will quickly identify themselves as ripening targets for acquisition.


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