Simply put, most current revenue cycle management systems are not well positioned for a future in which healthcare is rewarded for quality not for volume – but change is coming.
Right now, the RCM market is focused on clinicals, said John Hoyt, executive vice president of HIMSS Analytics, a division of HIMSS, Healthcare Finance News’ parent company.
"… the CFOs today have their eye on getting checks in the mail for meaningful use," he said. "Once that's over, I've got to believe they're going to start ripping out old systems to get ready for a new one."
Most of systems in use today are getting pretty long in the tooth, and the trend toward hospital consolidation means more and more of them will soon be getting yanked.
"We've got these nice little seven-hospital systems," he said. "But the real savings is (potentially) these 20, 30, 50, 200 hospital systems with one business office."
Banks do it all the time, after all, he said. "Go to North Dakota and look at how much processing is done there for credit cards. You've got to centralize this business back office stuff and rip out costs. We know 23 percent of our cost is administrative. If you can automate that and consolidate it into one function, yes, there's savings to be had."
While the RCM market isn’t likely to see any significant change until the mid- to late teens of this new decade, Hoyt said, HIMSS Analytics data does show where the market is moving: functionalities such as analytics, claims attachment tools, billers and dashboards are on the rise.
"It's the analytics," said Hoyt. "Or replacing with a revenue cycle that delivers analytics – or has better analytics – for managing the old revenue cycle.”
For most healthcare organizations, though, business intelligence, working in service of the revenue cycle, will be key in the coming years, says James Gaston, senior director of clinical and business intelligence at HIMSS Analytics.
"Analytics maturity enables the healthcare organizations to transition from fee-for-service to these new reimbursement models in an effective way," said Gaston. "As we see a shift from fee-for-service, there are revenue gains because you're not chasing every little claim for every reimbursement."
Because the revenue cycle for new types of reimbursement is very different than the traditional revenue cycle, analytics is key.
"Analytics allows you to look at how you're making your money, where your money is coming from and going, whether your clinical care is delivering the value it needs to deliver – but at the same time it also helps you understand where your expenses are, where your revenue is, and how to balance and optimize that."
This story is based on a report appearing on Healthcare IT News.