HealthWare Systems Blog

Healthcare Revenue Cycle Realities that Aren’t Going Away

Posted on Mon, Aug 31, 2015

The healthcare revenue cycle process is pretty tough to map these days, let alone manage. “Making progress in the face of uncertainty” has all but become the primary job description for professionals who oversee RCM activities—from hospital CFOs, to patient access directors, to IT managers. Some say the full scope of ACA and value-based reimbursement challenges are still unknown. Others realize the need for immediate help retooling RCM workflows and managing receivables.

Either way, if you’re looking for trends you can bank on, these three healthcare revenue cycle realities are clear:

The Share of Self-Pay Patients Will Continue to Rise

Along with high-deductible health plans and increased financial responsibility on patients’ shoulders, the challenge of collecting self-pay dollars looms large for health systems. According to data from a Deloitte University Press article, 18 percent of US employers have already implemented high-deductible plans, and 44 percent are currently considering such plans. Meanwhile, 19 million Americans now purchase health insurance entirely on their own.

Most hospitals and health systems are looking to address this reality with a stronger front-end collections strategy. That means tools and processes that deliver better patient registration accuracy and full-spectrum patient encounter management. As we’ve seen from our own RCM case studies, eliminating errors at the point of registration (and beyond) dramatically improves financial performance on the backend, while reducing bad debt by as much as 50 percent.

Patients Will Continue to Approach Healthcare from a Consumer Perspective

With patients paying more healthcare costs out of pocket, their expectations are growing, too. One 2014 survey shows how eagerly patients are borrowing on consumer habits to inform their healthcare buying decisions. Last year, 62 percent of patients reported using video, computers, or mobile device apps to learn more about or choose between different treatment options. Fifty-two percent say they would like access to tools or websites that enable them to review quality rankings, satisfaction rankings, and patient reviews for specific doctors and hospitals.

And although patient satisfaction is a complex science, some of its more obvious components—for example, patient wait times—still carry the most weight (pun intended). In 2015, consumers are conditioned to expect shipment tracking codes for online purchases and coasters that buzz and blink when their restaurant table is ready. They lose confidence in providers that can’t resolve, or at least communicate, wait time issues.

The proof? A 2014 study published in The American Journal of Managed Care confirms that longer wait times aren’t just negatively associated with clinical provider scores of patient satisfaction. In fact, study results indicated that every aspectof patient experience—including confidence in the care provider and the perceived quality of care—were also correlated negatively with longer patient wait times.

Health Systems Need Better Options from RCM Vendors

For many health systems and hospitals, solutions can’t come quickly enough. Stuart Hanson, chair of the HIMSS Revenue Cycle Improvement Task Force, was recently quoted in a Healthcare IT News blog saying, “on the IT front, one thing is really clear. [The] IT systems behind revenue cycle, most of them were built in the ’80s or ’90s—and that’s being generous to some of them… Those systems are not really capable of dealing with the revenue cycle shift that these organizations need to go through…”

Indeed, the majority of hospitals/health systems admit they need alternatives. A recent peer60 report on revenue cycle management technology suggests most providers are still scouting different RCM partners. Sixty-one percent say they’re undecided on whom their technology partner will be in the years ahead. Are you one of them?

We want to know more about your facility’s healthcare revenue cycle challenges. Share them below, or discuss them with our team directly.