The Role of RCM in Health Equity

The following is a guest article by Leigh Poland RHIA, CCS, VP of Coding Services at AGS Health. A strong business case exists for addressing the financial impacts of social determinants of health (SDoH) and new reimbursement models designed to emphasize health equity. Involving revenue cycle management (RCM) is necessary for any comprehensive SDoH/health equity strategy. This is because health disparities contribute more than $93 billion in unnecessary medical care costs and more than $42 billion annually in lost productivity. Additional economic losses are a result of premature deaths. Further, according to the W.K. Kellogg Foundation, eliminating these inequities by 2050 may erase more than $150 billion in unnecessary medical care. Reimbursement is also closely linked to quality because of the use of outcome measures by the Centers for Medicare and Medicaid Services (CMS) to determine a hospital’s overall quality, including: Mortality Safety of care Readmission rate Excess stay Patient experience Effectiveness of care SDoH Factors Impacting Patients and Revenue In particular, readmission rates, utilization, and excess inpatient stays all point back to SDoH. Additionally, low literacy is linked to poor health outcomes and less frequent receipt of wellness services — leading to more frequent extended hospital stays for these individuals. Lack of access to reliable transportation for essential health needs results in 41% more excess days in the hospital. In addi...
Source: EMR and HIPAA - Category: Information Technology Authors: Tags: Health IT Company Healthcare IT HIM Hospital - Health System Revenue Cycle Management AGS Health AHIMA Centers for Medicare and Medicaid Services CMS Health Equity ICD-10 ICD-10-CM Z Code Leigh Poland RCM SDOH Social Determin Source Type: blogs