Top concerns and opportunities for healthcare revenue cycle leaders: four themes

Top concerns and opportunities for healthcare revenue cycle leaders: four themes

November 01, 2019
Business Affairs Health IT
By Jessica Ziegler

Hospital and health system leaders from across the country shared their insights on how they’re preparing for the trends and market shifts impacting the revenue cycle at Navigant’s (a Guidehouse company) fourth Annual Forum of Revenue Cycle Experts (FORCE) in Chicago.

FORCE attendees discussed how revenue cycle operations fit in with broader changes across the healthcare industry and why their role is central to the function and reputation of their organizations — from the patient’s point of view in particular. As one executive put it, “We in the revenue cycle have just as much impact on a patient satisfaction survey as the nurses and doctors, so we need to take that responsibility seriously.”

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Navigant managing director Tim Kinney opened the conference by sharing the top concerns of the health systems he’s working with, including 1) the promises of scale, 2) effectively managing the EHR, 3) enhancing the patient experience, 4) ensuring revenue cycle/clinical collaboration, and 5) how best to harness automation and innovate.

The presentations and panels that followed touched on these concerns, arraying them around the following top themes, each of which describes an orientation to the future of the revenue cycle.

Realism: Hospitals are facing tighter margins due to a host of factors, including decreasing hospital admissions and evolving reimbursement models. If they don’t adapt to these new realities, they won’t last long.

According to healthcare futurist Nate Kaufman, the conference’s keynote speaker, hospitals, as they’re currently managed, are in dire circumstances: from pharmaceutical costs to physician contracts to declining inpatient demand, hospitals are facing new outlays while reimbursement is decreasing. In fact, Kaufman argued that current hospital margins are actually less than widely accepted industry figures.

To survive, said Kaufman, hospitals have to identify where their costs are and find better ways to manage them. Instead of starting with the revenue cycle, though, he argues that a clinical shift from general population management to selective population management is the first, most critical step. Today, 5% of patients account for 50% of overall healthcare costs. The key is to deeply manage the cost of that 5%, identify the people at risk of joining this group, and intervene before that happens.

While this targeted form of population management must be accomplished clinically, revenue cycle leaders still have a role to play and may be able to frame the problem to the hospital leadership in a more compelling way. Until hospitals can provide patients with truly integrated care delivery, the revenue cycle will need to optimize its approach to denials, self-pay, and other challenges, Kaufman suggested.

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