CFO Roundtable lookback / trends for 2018

The pressures on revenue cycle executives have not eased since the Navigant 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 EMR 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.

New emphasis on outpatient space
Clinical documentation improvement used to emphasize the inpatient space, where the bills were higher and the reimbursement required substantial documentation. An expanding outpatient market stands to change that emphasis in 2018.

Because there is no single answer to the intricacies of outpatient revenue management (in terms of technology but also in terms of education), it is still a challenging area where hospitals can make great strides. Even though the ROI will not be as dramatic as it will be on the inpatient side, superb outpatient clinical documentation is still a differentiator for superior performing organizations, and it contributes directly to patient satisfaction. And finally, that ROI may rise as more and more of the high-cost services are taken out of the ED and inpatient spaces and being performed in standalone outpatient centers.

Front end enhancement
We predict that hospitals and health systems that have already spent time optimizing their revenue cycle management system and supporting structures will turn to one-touch call centers and other front end innovations to enhance patient access and get more things done virtually. Think about it: a one-touch call that would include scheduling an appointment but also securing the account or even relating what the patient liability will be. From text directions to scheduling blood draws to a clinician’s authorization for a procedure, everything can be done on that one phone call. In some ways, the call center could also act as the pre-service center we’ve been advocating.

Front end enhancement doesn’t end at the call center, though. Tapping the remaining potential in technologies like patient portals is one way hospitals can achieve greater efficiency and increase patient engagement. New applications of robotic processing (for auto-authorization approval, e.g.) remove the need for burdensome and delay-prone patient and insurance contact.

Revenue integrity
From a revenue cycle management or CFO perspective, revenue integrity units are just as vital in 2018 as they were in 2017 or 2016. There’s been widespread adoption of this multidisciplinary problem-solving entity, but the market conditions—where RCM systems are being added onto existing clinical EHRs—mean that revenue integrity must remain foremost in the minds of an organization’s financial leadership.

Revenue integrity becomes a pivotal point within an organization as that unit “owns” education, net revenue, gross revenue, metrics, denial management, etc. This unit is also the critical link to clinical departments that are now more engaged in resolving billing edits at the source. To shoulder these responsibilities and provide adequate education and oversight, the group will have to become more technology-driven. They may also need new expertise and experience—for instance in predictive modeling and analytics, or in business practices that can reduce variation across facilities. We will discuss some of these skills as well as broader trends in healthcare workforce management in a follow-up to this article.

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