The pressures on revenue cycle executives have not eased since the Guidehouse roundtable discussion moderated by Molly Gamble, editor-in-chief of Becker's Hospital Review, at the Becker's 5th Annual CEO + CFO Roundtable conference in late 2016.
Patients still find it difficult to pay their high deductibles, payers and providers still struggle over denials management, and margins are still tight. As an industry, though, healthcare organizations are starting to shift their focus from integration — those mergers and acquisitions that have swept across the marketplace in past years — towards transformation. Especially in terms of electronic health record (EHR) and revenue cycle management systems, hospitals and health systems are actively pursuing gains with the systems they have, rather than seeking upgrades or new implementations.
Reaching an implementation plateau
The majority of healthcare organizations (and probably all of the top performers) in the U.S. have already invested in the clinical EHR they’re going to stick with, so we are seeing fewer massive clinical/revenue cycle implementations planned for 2018. One exception to the implementation “plateau” we’re seeing is where hospitals are extending their EHR to the post acute area (i.e., home health).
Hospitals have largely settled on the clinical system they’ll be using going forward. Having made this decision, hospitals are now looking to bolt on or go live with a revenue cycle module. Even the more narrow revenue cycle system implementations require pre-live planning and testing; solutions for problem-solving during go-live; and focus on concrete metrics in the post-live phase. That’s the story here in the U.S. Globally, however, it is likely that those large-scale clinical/revenue cycle implementations are still on the rise.
Growing focus on optimization
As hospitals and health systems are now competing with larger, consolidated organizations and dealing with less cash on hand, performance optimization becomes their best hope for sustainability and success. In 2018, most of our inquiries from organizations, both on the physician side and the hospital side, have been requests for performance optimization assessments. Those assessments most often turn up needed technical improvements across three themes:
Internal workflow optimization
Coding improvement (or outsourcing)
Clinical documentation improvement
Strategic outsourcing for technical operations that can be accomplished via a well-defined partnership rather than in-house
This last piece is partly a response to the pressures mentioned above. Most hospitals would, if given the chance, put more of their focus on the delivery of care than on aspects like coding or patient account balance follow-up. Improved options for outsourcing make possible this sharper focus on providing care. While coding leads the way in this regard, viable and effective options are also emerging in other aspects of revenue cycle management.