When asked which revenue cycle capability their organization is most focused on for improvement over the next year, 79 percent of respondents suggested technology-related capabilities, including business intelligence analytics, electronic health record (EHR)-enabled workflow or reporting, revenue integrity, and coding and physician/clinician documentation.
Not surprisingly, nearly three out of four executives say their RCM technology budgets are increasing, with 32 percent suggesting an increase of 5 percent or more. Among them, 77 percent of small hospitals (less than 100 beds) and 78 percent of medium-sized hospitals (100 to 500 beds) are projected to increase spending, survey results suggest.
Budgets are on the upswing, but providers are struggling to leverage the power of technology — and EHRs in particular — to drive process improvement and long-term success:
51 percent said their organizations cannot keep up with EHR upgrades or fail to maximize functional, workflow, and reporting improvements.
41 percent do not have a method to track the effectiveness of their technology enhancements.
21 percent attempt to identify cost reductions through vendor consolidation.
“Healthcare providers are actively searching for technologies which advance the quality, efficiency, and fiscal viability of care delivery in order to respond to ongoing reimbursement and resource constraints,” said Mary Beth Briscoe, CFO of UAB Hospital and UAB Medicine Clinical Operations. “As new technologies are implemented, it is critical to understand and plan for linkages across clinical and financial activities to optimize workflow and reporting in both environments. By adopting a holistic approach to technology evaluation and design, providers should benefit from automation, scale, and process improvement, thus positively impacting quality and financial outcomes.”
Revenue Integrity Trends
Although revenue integrity was cited by 22 percent of respondents as the top RCM focus area for the coming year, just 44 percent say their organizations have established revenue integrity programs.
Revenue integrity is the internal process or function of ensuring that revenue is accurate in coding, appropriate in charge capture, contains reasonable pricing for services that are being provided, and complies with laws and regulations. A strong program should yield reliable financial reporting and effective and efficient operations.
Those providers with revenue integrity programs are achieving significant benefits, including increased net collections (68 percent) and charge capture (61 percent), and reduced compliance risks (61 percent).
“Revenue integrity should be the glue that binds clinical operations with coding and business office functions,” said Jake Morris, managing director at Navigant. “It’s clear that providers with established revenue integrity programs are benefiting from them, and expanding their scope will help yield long-term financial reporting reliability and operational efficiencies.”
Uncompensated Care and Patient Engagement Trends
Consumer responsibility for healthcare costs will continue to affect providers, and there are opportunities to more holistically educate patients and predict their propensity to pay.
More than 90 percent of respondents believe that the increase in consumer responsibility will continue to affect their organizations. Among them, almost twice as many rural executives (58 percent) believe that the impact will be significant, as compared with urban respondents.
Providers are starting to access more consumer-friendly means to enable patient payment, with 93 percent of respondents offering an online payment portal and 63 percent offering cost-of-care estimation tools. But leveraging innovative technology is again proving to be a challenge: just 14 percent of respondents use advanced modeling tools for segmenting and predicting propensity to pay, with fewer than one in four using a data source or external partner.
“It is essential for healthcare leaders to apply a discipline to patient financial communications. This should include when and where conversations may be conducted, who should be engaged, and guidance for discussing issues such as financial assistance and prior balances,” said Sandra J. Wolfskill, FHFMA, director of healthcare finance policy, revenue cycle MAP for HFMA.
Navigant Consulting, Inc. (NYSE: NCI) is a specialized, global professional services firm that helps clients take control of their future. Navigant’s professionals apply deep industry knowledge, substantive technical expertise, and an enterprising approach to help clients build, manage, and/or protect their business interests. With a focus on markets and clients facing transformational change and significant regulatory or legal pressures, the firm primarily serves clients in the health care, energy, and financial services industries. Across a range of advisory, consulting, outsourcing, and technology/analytics services, Navigant’s practitioners bring sharp insight that pinpoints opportunities and delivers powerful results.
With more than 40,000 members, the Healthcare Financial Management Association (HFMA) is the nation's premier membership organization for healthcare finance leaders. HFMA builds and supports coalitions with other healthcare associations and industry groups to achieve consensus on solutions for the challenges the U.S. healthcare system faces today. Working with a broad cross-section of stakeholders, HFMA identifies gaps throughout the healthcare delivery system and bridges them through the establishment and sharing of knowledge and best practices. We help healthcare stakeholders achieve optimal results by creating and providing education, analysis, and practical tools and solutions. Our mission is to lead the financial management of health care. Learn more at www.hfma.org.