As Chief Financial Officer of Hôpital de la Tour, Pierre-Antoine Binard brings 25 years of financial management experience to the role, including eight years in the healthcare sector. Responsible not only for traditional financial functions but also for managing partnerships with insurers and overseeing invoicing, he witnesses every day how growing administrative complexity impacts hospital resources.
As CFO of the hospital, how important is coding within your administrative department?
Medical coding is the beating heart of our administrative chain. In inpatient care, it is literally the “reactor” of invoicing. At our hospital, inpatient services account for about 50% of revenue, representing some 9’000 cases. This illustrates both the volume and the stakes. The recognition of case complexity and the accuracy of invoicing depend directly on medical coding.
Hôpital de la Tour has chosen to keep medical coding in-house. What are the advantages and challenges of this decision?
Keeping coding in-house is a strategic choice. It is vital for invoicing, for daily liaison with physicians, and for calculating their fees. It safeguards records, limits misunderstandings, and reduces rejections. But this choice comes at a cost: coders are scarce and in high demand, their training is lengthy and expensive, and their skills must be updated regularly because medicine evolves rapidly. Our teams are calibrated for a specific workload, which makes this a constant challenge – a single departure or absence has an immediate impact on productivity. On top of this, ongoing tariff reforms (Tardoc, outpatient flat rates, new invoicing models) add to the burden. In this environment, every resource counts, and the balance remains fragile.
How do you communicate with doctors about medical coding issues?
Communication with doctors is not always straightforward. We are dealing with highly specialised professionals who may not be eager to be challenged on an operative or discharge report. That is why discussions need to take place at a scientific level, using terminology that resonates with them. It is not always comfortable, but the shared interest is clear: a perfectly coded case benefits both the institution and the physician.
How do you perceive the growing administrative requirements, which consume ever more resources and even involve physicians in areas outside their core expertise?
We are seeing a real surge in administrative requirements, especially from insurers and sometimes from cantonal authorities, who demand ever more documentation to validate invoiced amounts: medical reports, use of materials, length of stay, and so on. This inevitably increases the number of rejected invoices. Added to this are the constant tariff changes – Tarmed, the future Tardoc, outpatient packages, private fees, each of which requires major adjustments. The example of Asteriks illustrates this well: integrating this new system slowed us down considerably.
This intensification of administration is, in my view, quite extraordinary, and I am not convinced that medicine benefits from it. Hospitals are forced to expand their administrative teams to meet control requirements, diverting resources that can no longer be invested elsewhere. It is a spiral that weighs on the system and restricts institutions’ investment capacity.
What strikes me most is the absence of any discussion on quality. The debates are purely administrative, neglecting what I see as the true strength and core of the healthcare system. In his book Livre blanc pour une Santé dans le rouge, Dr Thierry Glauser writes: “Private medicine is currently being systematically weakened by a combination of tariff reforms, structural imbalances between the public and private sectors, financial opacity, administrative overload and loss of clinical sovereignty.” Sometimes finance and medicine do see eye to eye!
“This intensification of administration is, in my view, quite extraordinary, and I am not convinced that medicine benefits from it. Hospitals are forced to expand their administrative teams to meet control requirements, diverting resources that can no longer be invested elsewhere. It is a spiral that weighs on the system and restricts institutions’ investment capacity.”
Pierre-Antoine Binard, CFO at Hôpital de La Tour, Geneva
How does the current financial situation of hospitals affect their ability to invest and maintain quality of care?
The financial situation of hospitals is tight and directly constrains their ability to invest. Margins are shrinking, even as the need to train staff, renew equipment and integrate new technologies continues to grow. I often cite a German chancellor who said: “Today’s profits are tomorrow’s investments and the jobs of the day after tomorrow.” Yet according to PwC, two-thirds to three-quarters of hospitals fail to reach the 10% EBITDA break-even threshold, and many have an equity deficit. Reports from ZKB also show the chronic inability of hospitals to finance investments from operating cash flow.
At the same time, administrative requirements and tariff cuts further intensify the pressure. Private hospitals, without access to public subsidies, must shoulder this burden alone, while public institutions are supported by tax revenues, often in ways that remain invisible to taxpayers. In this context, every franc invested in administration, in controls or in responses to insurers, is one franc less for improving care quality, training staff, and maintaining medical excellence. If nothing changes, we risk cutting off the very branch we sit on.
In your view, to what extent could new technologies and smart tools transform coding and ease the invoicing process?
Without a doubt, they will enable the coding profession to evolve. With tools capable of reading and interpreting medical documents with very low error rates, many simple cases can already be coded automatically. This will improve quality in the long run and, above all, free coders to focus on complex cases that require real dialogue with surgeons and specific medical expertise. AI will not replace humans, but it will absorb volume so that expertise can be applied where it delivers the greatest value.
Furthermore, such technologies could thoroughly modernise the administrative process from pre-authorization to payment. Today, we are still in the “stone age”: approval of coverage, insurance class, and services must be confirmed with multiple parties – the canton, physician, insurer, patient, institution. Even once care has been delivered, additional checks are carried out to confirm that the act was performed. This is a major drain of time and energy on non-medical tasks. Technological solutions could simplify this dramatically: once a service is accepted and delivered, payment should occur automatically. Tools like blockchain could provide the necessary traceability and significantly reduce administrative costs tied to pre- and post-service checks.
Better cooperation between stakeholders would be required. Do you think this is realistic?
Yes, I believe it is possible. At some point, a canton and an insurer will see the value of launching a pilot project, and we would be very eager to participate. If it helps reduce administrative costs for both sides, there should be no hesitation.
Would an external actor be necessary to bring stakeholders together or initiate this dialogue?
I don’t believe that is strictly necessary. What matters is bringing the right people to the table: a physician, a patient, a cantonal representative, an insurer, and a healthcare institution. The key is simply to try. It should not be complicated to implement, and it could finally allow us to digitise the entire administrative process surrounding hospitalisation.
There is a lot of discussion about Swisscoding in the inpatient setting, but we should not forget that outpatient volumes are a hundred times greater. While the potential for efficiency gains in inpatient care is clear, given its administrative complexity, outpatient care would also be an ideal ground for innovation. This could involve actors such as the Caisse des médecins (Medical Fund), invoicing organisations like Asteriks or VVG+, Medicalculis, or even external providers such as PwC or ELCA, who could spearhead a new concept. There is no shortage of ideas or partners – what is needed is the collective will to take the step forward.
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