Are Your IT Clients Ready For The New World Of Revenue Cycle?
By Megan Williams, contributing writer
Your clients are working with revenue cycle tools built for a healthcare world centered around fee-for-service payment models, and according to this article from Healthcare IT News, they’re likely a generation behind the times.
You may want to consider starting conversations around budgeting for systems updates, as CMS (Centers for Medicare and Medicaid Services) pushes forward on payment reform in a direction that continues to move toward value-based initiatives.
While CMS is still not quite clear on a direction, it’s almost certain that the times of being reimbursed for volume are passing, meaning that the technologies based around these payment models are quickly becoming obsolete.
The Cost Of MU
Unfortunately, expensive efforts to meet Meaningful Use requirements have left many providers strapped for the cash that would be needed to bring financial tools up to date.
According to HIMSS Analytics senior director of research, Jennifer Horowitz, “The writing has been on the wall for a long time. Because we’ve had such an unnatural market with the clinical applications, and the amount of focus there, at some point (providers) are going to have to focus on the revenue side. They’re just not going to be able to accommodate what they need to do anymore.”
The Impact Of Consolidation
Budgets won’t be the only force at play as financial tech moves forward. Providers will be seeing more consolidation in the billing department, as the forces that have kept business office services localized dwindle. The article predicts that systems like Catholic Health Initiatives, with its 86 hospitals in 17 states, and outsourced revenue cycle operations, will become more and more common. An industry-wide consolidation will also mean the need for a standard around revenue cycle work.
A Similar Outlook For Payers
In turn, the insurance industry will have to adjust. John Hoyt, executive VP of HIMSS Analytics spells out why: “Of course the insurance industry is going to have to change a little bit too to accept that, but Medicare is leading that trumpet by forcing consolidated billing: ‘I’m gonna give you one payment and then you go figure out how much goes to the anesthesiologist.’ The number of people who qualified for Stage 2 stunned everybody, including the government. And the government is obviously embarrassed by it. If it’s not massively improved, I think you’re right: ‘I’m gonna take that money and invest it in revenue cycle as I continue to grow my IDN. Acquire hospitals, acquire physicians, acquire home care, nursing homes, and fix my whole revenue cycle. Or outsource it.’”
Don’t look for this to happen immediately though. According to a recent Black Book survey, 40 percent of hospital CFOs said that they had misjudged EHR, HIE, and patient portal expenses so badly, that they’re putting off revenue cycle software purchases until at least 2016.