REVENUE CYCLE MANAGEMENT
MEETING CHALLENGES – OLD AND NEW
cycles to support the move to value-based care. Unfortunately, many organizations are struggling to handle this transition. A survey of 117 hospital financial executives, conducted by the Healthcare Financial Management Association (HFMA), shows that respondents do not view their organizations as highly capable in most areas that support value-based payment.
“Many healthcare organizations do not currently have the infrastructure that is needed to be successful under the various value-based payment and care delivery models. Investments in building the infrastructure such as technology and personnel is critical, in addition to organizational alignment and clinical redesign. Strong partnerships with health plans and physician buy-in is key,” said Susan Horras, director, Healthcare Finance Policy, Health Plan and Population Health, HFMA. “Healthcare organizations need to analyze, identify and manage the trends impacting the quality and total cost of care. Some organizations are still faced with the challenges of having timely, actionable information that impact cost and quality outcomes.”
One of the most difficult – and pressing – challenges for healthcare organization is to implement the integrated information systems that are needed to support value-based models. Indeed, according to the HFMA study, 24% of respondents said their organizations are “not capable” of supporting external interoperability and 59% said their organizations are only somewhat capable of handling external interoperability while 2% said they are “not capable” of supporting interoperability and 57% said they are only “somewhat capable.”
“There are challenges with both internal and external interoperability. Internally, some organizations have disparate systems across the organization that presents challenges in exchanging meaningful clinical and financial data. For example, all physicians may not be on the same EHR and an interim solution may need to be implemented in order to exchange and share information across primary care, specialists, pharmacy, etc.,” Horras said. “Externally, the industry still lacks national data definitions and standards that ensure consistency across software functionality. Patient matching is a significant challenge with no room for error when exchanging medical record information. Information needs to be in a consistent meaningful format that can be used across the continuum to improve patient safety, manage cost and build efficiencies.”
While many organizations do not yet have this interoperability in place, healthcare leaders recognize its value – as more than 70% anticipate an extremely important need for capabilities around interoperability and 50% around external interoperability in the next three years (see Project Needs Chart).
With all of these projected needs, healthcare organizations are expected to invest more heavily in revenue cycle management systems. In fact, the healthcare revenue cycle management market is expected to hit $100 billion by 2024, according to a report from Global Market Insights Inc. This growth is expected to emanate from not only the government and private insurance shift from volume to value-based healthcare but also form the demand to reduce billing errors, the implementation of big data analytics, the need to address government compliance requirements such as ICD-10 and HIPAA v5010 and increased fraudulence screening, according to the report.
Healthcare Financial Management Association, HMFA’s Executive Survey Value Based Payment Readiness, Sponsored by Humana