Healthcare Revenue Cycle Realities that Aren’t Going Away

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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. 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.

Revenue Cycle Software: The Do’s and Dont’s of HIT Buying

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HealthWare Systems Blog

Revenue Cycle Software: The Do’s and Don’ts of HIT Buying

Posted on Tue, Aug 04, 2015

No one would argue that revenue cycle management (RCM) is a top priority among hospitals and health systems. But getting the tools in place to address core RCM functions can become a marathon effort. Thanks to the complexity and evolving nature of today’s healthcare landscape—from healthcare reform to the promise of next generation RCM solutions—many provider organizations are stuck in a holding pattern.

  • What does the ideal RCM solution look like?
  • Do we need to adapt our current workflows, our revenue cycle software, or both?
  • What’s coming on the horizon?

With questions like these, many hospital leaders don’t know where to start. And despite the unprecedented need for better processes, improved cash flow, and stellar patient experiences, RCM buying decisions drag on for months and months…

If you’re in the market for revenue cycle software, our latest guide can make comparison shopping a lot easier. This guide will help you develop a more streamlined buying process for RCM software—including patient trackingpatient encounter/registration, and physician order management solutions. Download it here:

Meanwhile, here are some important do’s and don’ts to keep in mind:

DO Start with a Requirements Document

A requirements document (RD) is a formal, written document, outlining how a proposed piece of software will respond to specific user actions and/or integrated system requests. The process of negotiating, drafting, and finalizing concrete requirements helps to align everyone’s expectations surrounding a new solution.

During the vendor demonstration process, your RD can also function as a script and evaluation tool, keeping vendors on point—for example, not referencing competitor weaknesses. Once a buying decision has been made, the details of your requirements doc can be used to assign project roles, establish an implementation timeline, and support user training plans.

DON’T Exclude Key Users

When nearly 4,000 licensed RNs were surveyed about their input in EHR decisions, a whopping 98 percent reported never being included in their hospitals’ IT decisions. As a result, some 85 percent of the nurses said they “grapple daily with flawed EHR systems.”

These figures are hardly a ringing endorsement for the thousands of digital health records systems put into place. But even more concerning, they suggest nurses’ jobs have become increasingly (unnecessarily) onerous simply because nurse representatives were excluded from important stages in HIT software buying.

How do you know which employees should be consulted before you invest in new technology? Again, our RCM software buying guide can help.

DON’T Prolong Purchase Decisions

Over the past several years, average timelines for enterprise IT purchases are getting longer and longer. This typical purchase process data is not confined to the healthcare sector, but it shows that other large organizations are struggling to shorten IT buy cycles (down to a preferred three months), despite pulling more people onto their buying teams, and consequently taking more than five months to complete a single purchase.

One way to truncate the process is to arm yourself, as the RCM software sponsor, with helpful content (product videos, revenue cycle management case studies or testimonials) from different vendors. Resources like these will help you narrow the field of possible solutions and educate your fellow decision makers in advance of any sales conversations.

What are the biggest questions you have for a healthcare software vendor?  And how efficient is your HIT buying committee?