Transforming Care Through Financial Transparency

Summary

Becker’s Healthcare Podcast: Transforming Care Through Financial Transparency
Release Date: June 23, 2025

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Introduction

In the episode titled "Transforming Care Through Financial Transparency" of the Becker’s Healthcare Podcast, host Lucas Voss engages in a comprehensive discussion with Kathy McDowell, President and CEO of Kearns UPCO Associates. The conversation delves into the evolving landscape of financial transparency in healthcare, particularly within orthopedic practices, and explores how it serves as both a patient benefit and a competitive advantage for healthcare providers.

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Defining Financial Transparency in Healthcare

Lucas Voss opens the discussion by emphasizing the growing importance of financial transparency in enhancing the patient and practice experience. He poses a critical question to Kathy McDowell: “What does true financial transparency look like in practice and how can it become not just something that the patient benefits from, but also a competitive advantage?” [02:10].

Kathy McDowell responds by expanding the definition beyond merely posting fee schedules. She states, “True financial transparency means more than just posting fee schedules... it's about helping patients understand their financial responsibility, whether it's co-pays, deductibles, out-of-pocket limits before services are rendered” [02:10]. Kathy underscores that practices which proactively communicate cost estimates and payment options experience fewer billing complaints and more timely collections. She emphasizes that financial transparency isn't just a compliance requirement but a strategic tool that builds trust with patients, thereby fostering stronger patient-practice relationships.

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Practical Examples of Financial Transparency

Lucas Voss seeks to ground the discussion with real-world examples, asking Kathy how financial transparency manifests in daily operations. [02:54].

Kathy McDowell highlights the importance of training front office and billing staff to engage empathetically with patients regarding financial matters. “Having an empathetic and clear process with the front office... role-playing in real-world scenarios so that the tone should be supportive and not transactional for patients” [03:04]. She explains that when patients feel respected and informed, they are more likely to return for follow-up care, pay their bills on time, and recommend the practice to others. Kathy notes, “Transparency builds credibility in our world and that is a learned behavior” [04:20], highlighting trust as a valuable currency in the era of healthcare consumerism.

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Current Trends and Shifts in Orthopedic Healthcare

Shifting the focus to broader industry trends, Lucas Voss asks Kathy about significant shifts in the orthopedic space that industry leaders should monitor. [04:39].

Kathy McDowell identifies several key trends:

1. Value-Based Care: She mentions the increasing emphasis on value-based care, a term frequently heard in the industry, which focuses on patient outcomes relative to costs.

2. Outpatient Migration: There is a notable move of procedures like joint and spine surgeries from inpatient to outpatient settings, driven by advances in anesthesia, pain management, and surgical techniques. “Orthopedics is increasingly central to outpatient care models” [05:55].

3. Heightened Payer Scrutiny: Kathy observes increased prior authorization requirements, denials tied to service modifiers, and more post-payment audits. She notes, “Leaders have to focus on aligning documentation and coding precision with clinical intent” [05:41].

4. Care Coordination and Data Analytics: Investing in care coordination and data analytics has become essential for optimizing efficiency and ensuring seamless patient flow through the healthcare system.

Kathy emphasizes that orthopedic leaders must navigate these trends by enhancing documentation accuracy and embracing strategic investments in technology and care coordination.

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The Evolving Role of Orthopedics in Healthcare

Lucas Voss probes further into how orthopedics is adapting within the broader healthcare ecosystem. [05:55].

Kathy McDowell explains that orthopedics is becoming pivotal in outpatient care models, thanks to surgical advancements allowing procedures to be safely performed outside traditional hospital settings. “Orthopedic leaders now have an opportunity and a responsibility to drive the location of care to the appropriate location” [05:55]. She highlights the necessity for collaboration among hospitals, payers, and practices to determine the optimal settings for various procedures. The rapid pace of innovation in ambulatory care delivery is outpacing processes like authorization, underscoring the critical role of technology in bridging this gap.

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Technological Innovations Enhancing Financial Transparency

Returning to the theme of financial transparency, Lucas Voss inquires about promising technological innovations in the space. [07:44].

Kathy McDowell identifies several key technologies that are transforming financial transparency and care coordination:

1. AI-Assisted Coding Tools: She highlights the significant impact of artificial intelligence in streamlining coding processes.

2. Real-Time Eligibility and Benefit Estimators: These tools help reduce claim denials by providing accurate cost estimates and verifying patient coverage in real-time. “AI assisted coding tools and real time eligibility benefit estimators showing real promise in reducing denials and improving the patient's financial communication” [07:48].

3. Embedded Education and Training: Integrating short-form video training and coding prompts directly into Electronic Health Record (EHR) workflows enhances physician efficiency and accuracy.

4. Digital Health Partnerships: Collaborations with physical therapy and digital health platforms extend the episode of care and improve outcome tracking without increasing administrative burdens.

Kathy asserts, “This is where we're going to see in our opinion, a lot of shift forward” [07:44], expressing optimism about technological advancements enabling faster and more efficient financial transparency processes.

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Artificial Intelligence’s Impact on Financial Transparency

Lucas Voss emphasizes the inevitability of discussing AI in this context, to which Kathy McDowell agrees enthusiastically. [09:04].

Kathy McDowell elaborates on how AI is revolutionizing financial transparency:

• Benefit Estimators and Eligibility Tools: AI enhances these tools by providing more accurate and timely information, aiding both patients and staff in understanding financial obligations.

• Staff Training and Utilization: She notes that the successful implementation of AI tools depends on adequately training staff to utilize them effectively. “The slack on that would be staff understanding how to use those tools” [09:04].

• Patient Planning: AI tools empower patients by clearly outlining their financial responsibilities, enabling better financial planning and enhancing their overall experience with the practice.

Kathy concludes that while AI presents significant opportunities, its success hinges on proper education and integration within practice workflows. “If you're doing it correctly in a practice and a differentiator because a lot of people” [09:48].

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Conclusion

The episode concludes with Lucas Voss thanking Kathy McDowell for her insightful contributions. [10:05]. The discussion underscores the critical role of financial transparency in building patient trust, optimizing practice operations, and leveraging technological advancements to stay competitive in the evolving healthcare landscape.

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Key Takeaways

• Financial Transparency: Goes beyond fee schedules to include clear communication of costs, fostering patient trust and practice loyalty.

• Empathetic Communication: Training staff to handle financial discussions with empathy and clarity is essential for patient satisfaction and timely collections.

• Industry Trends: Value-based care, outpatient migration, and increased payer scrutiny are reshaping orthopedic practices.

• Technological Innovations: AI-assisted tools and real-time estimators are pivotal in enhancing financial transparency and reducing administrative burdens.

• Collaboration and Integration: Effective care coordination and integration of new technologies are fundamental to adapting to the rapidly changing healthcare environment.

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For more insights and discussions from the Becker’s Healthcare Podcast, visit becker'shospitalreview.com and explore the latest episodes on transforming healthcare through innovation and strategic practices.

Transcript

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[Lucas Voss]

Everyone, this is Lucas Voss with Becker's Healthcare. Thanks so much for tuning in to the Becker's Healthcare Podcast series. It's great to have you. Today we're going to talk about how financial transparency helps transform the patient and practice experience. Joining me for today's discussion, very excited to have her is Kathy McDowell, President and CEO of Kearns UPCO Associates. Kathy, thanks so much for being here today.

[Kathy McDowell]

Thank you for having me. I'm happy to be here.

[Lucas Voss]

Absolutely. Could you introduce yourself and share a little bit about yourself and your role?

[Kathy McDowell]

Sure. As you said, I'm Kathy McDowell, President and CEO of Karen Zepco Associates. We are a healthcare consulting firm that's been advising orthopedic practices and surgical specialties for now over 40 years. Our work centers primarily on revenue cycle optimization, coding and compliance education, practice management strategy. We we serve both private and hospital owned groups. We also serve industry and we've built a reputation for being very pragmatic, physician focused solutions that elevate both operations and outcomes for practices.

[Lucas Voss]

It's fantastic to have you. So glad to have you on. As our title suggested, we're talking about financial transparency and it's becoming more important, a more important prominent part of the patient experience. I'd like to know from your perspective, what does true financial transparency look like in practice and how can financial transparency also become not just something that the patient benefits from, but also a competitive advantage?

[Kathy McDowell]

Well, I think that it has transitioned over the years. I think true financial transparency means more than just posting fee schedules, which it did in the past. It's about helping patients understand their financial responsibility, whether it's co pays, deductions, deductibles out of pocket limits before services are rendered, practices that proactively communicate cost estimates, payment options are seeing fewer billing complaints and more timely collections. It's not just a compliance requirement, it's a strategic advantage. I think transparency leads to trust. It allows you to build a relationship with your patients that is stronger and Keeps them within your practice.

[Lucas Voss]

I'd love to hear about an example. How have you seen this in your day to day work? Either from a patient interaction or operational perspective? What does this look like?

[Kathy McDowell]

I'll start with our focus on scripting staff and how to discuss financial transactions and deductibles with patients. Having a empathetic and clear process with the front office. Billing staff should feel confident explaining the cost, verifying the coverage and knowing when to escalate. Complex questions. We do a lot of training that is role playing in real world scenarios so that the tone should be supportive and not transactional for patients. And what we are seeing is that patients are much more receptive when they feel respected and informed. I think that from the front office side that is very important. I think when patients trust you that you're being honest and helpful about costs, they're more likely to return for follow up care, pay their bills and recommend your practice. Transparency builds credibility in our world and that is a learned behavior. A lot of staff and offices or practices are anxious about those discussions. In this era of healthcare consumerism, trust can be currency for a practice.

[Lucas Voss]

Yeah. And that's certainly something that practices providers should pay attention to. I'd love to tap into your knowledge of the space as well here. What are some of the trends and shifts that you're seeing right now in the orthopedic space that you think are most important for industry leaders to pay attention to?

[Kathy McDowell]

There's so much. There's a growing emphasis on value based care. We all hear that term. And outpatient migration. We all read a lot about that, particularly for procedures like joints and spine surgeries. At the same time we're seeing heightened scrutiny from payers. Right. So simultaneously more prior authorization requirements on both side, denials being tied to certain modifiers like location of service and increased post payment audits. Leaders have to focus differently. They have to focus on aligning documentation and coding precision with clinical intent. And while they optimize efficiency. That's an easy sentence to say, not very easy to do. Investing in care coordination in data analytics is no longer an option. You have to have a clear process to move the patients through. And so much of the work to get the patients approved is done on the front end. And during the documentation phase.

[Lucas Voss]

Yeah, you've touched on sort of the coordination part, which I think is very key because there's so many moving parts to this as well. How do you see the. The role of orthopedics evolve within this broader healthcare ecosystem as well?

[Kathy McDowell]

Orthopedics is increasingly central to outpatient care models. Right. It's, it's been moving in that direction for a number of years. While with advances though in anesthesia, pain management, surgical technique, many of the orthopedic procedures are safely migrating to these settings. The shift is transforming how hospitals, payers and practices collaborate. Collaboration is a must. What procedures do you do inpatient? What procedures procedures do you move to the outpatient Orthopedic leaders now have an opportunity and a responsibility to drive the location of care to the appropriate location. But keeping quality efficiency inside and at the top of your list. Innovation in ambulatory care delivery is only going to continue. It is moving faster than some of our processes around authorization are moving, for example, and that's where technology will come in to help us with speeding, speeding that up there there are many oars in the water, if you will. And, and it's a much tougher job now to determine where and how, how fast each of those or should be moving. And they all have to move simultaneously to get anywhere.

[Lucas Voss]

Yeah. Coming back to the care coordination piece, we, we started our conversation on financial transparency and certainly sort of the efficient nature of it all and having to create more efficiencies for teams across the system. You just touched on technology and the importance of it. I'd love to know what you're excited about when it comes to technology. What are some of the innovations that you're looking towards when you see the space that you're really excited about and what's promising to you?

[Kathy McDowell]

You know, the answer is AI assisted coding tools.

[Lucas Voss]

We have to talk about it.

[Kathy McDowell]

Yes, we have to talk about AI. So AI assisted coding tools and real time eligibility benefit estimators showing real promise in reducing denials and improving the patient's financial communication. We're also seeing success in embedded education or integrating short form video training and coding prompts directly into EHR workflows, which can be an amazing tool for physicians. And finally, partnerships with different departments such as physical therapy and digital health platforms can extend the episode of care and improve outcomes tracking without adding administrative burden. All of this done within that wonderful EHR platform and visual to all providers that are taking part in that, whether they be therapy, whether they be physicians or advanced practice providers. I think that that's where we're going to see in our opinion, a lot of shift forward. There's still going to be need for all of this. I think it's just going to allow us to move to faster.

[Lucas Voss]

Yeah. Are you seeing AI making a significant impact on the conversation around financial transparency.

[Kathy McDowell]

As well in the estimators, benefit estimators or eligibility? Yes, absolutely. And I think that that will continue to grow. I think that we are seeing that it is where we're seeing that the slack on that would be staff understanding how to use those tools. And oftentimes we purchase, you know, innovation or different tools and we don't put in the time and effort to educate the the team that's actually utilizing them. That's where companies like ours come in. However, I do think that for patience, knowing what they have to pay so that they can better plan for that. It's a real strength if you're doing it correctly in a practice and a differentiator because a lot of people.

[Lucas Voss]

Yeah, yeah, absolutely.

[Kathy McDowell]

To do it.

[Lucas Voss]

If you think that this conversation was going to end without AI, I don't know where you were. We have to talk about it.

[Kathy McDowell]

Yes, exactly.

[Lucas Voss]

Yes. Kathy, thank you so much for being on today. Thank you for your time and insights. This is a fantastic conversation.

[Kathy McDowell]

I appreciate you you having me and I look forward to talking to you again.

[Lucas Voss]

Absolutely. We also want to thank our podcast sponsor, CareCredit. You can tune into more podcasts from Becker's Healthcare by visiting our podcast page @becker's hospital review.com.