Examining a Holistic Approach to Revenue Cycle Management
By - As healthcare continues to shift more of its focus on to the customer, a holistic approach to revenue cycle management requires addressing changing consumer behaviors.
Providers experiencing an increasing array of reimbursement challenges seek efficient cost reduction and enhanced revenue. Collecting from patients efficiently means improving the quality of patient and provider interaction and a stronger focus on upcoming initiatives.
Ben Colton, Senior Manager at ECG Management Consultants and Leader of ECG’s revenue cycle practice, spoke with RevCycleIntelligence.com about revenue cycle management’s evolving complexity and about how change within the healthcare system is becoming more standardized.
RevCycleIntelligence.com: As revenue cycle becomes more complex, what is the role of the independent physician practice focus?
Ben Colton: Historically, it was not uncommon for staff in a physician practice to wear many hats – the front desk person who would also do billing in their downtime or maybe it was the office manager sending the bills and making sure they were getting reimbursed. That said, most of the time it wasn’t an experienced revenue cycle person.
With the increased complexity of contract terms, doctors are nervous about the challenges we’re seeing with payers, shrinking reimbursement, the complexity of rules, and additional screws put forth by the OIG and others. They’re saying, “This is not my core competency. I need help doing this.” Doctors don’t want to run the risk of compliance issues or lost reimbursement.
RCI.com: How can the top revenue cycle talent be attracted to make things more efficient overall?
BC: There continues to be a focus on reducing the overall costs to collect. CFOs tend to focus on how much their revenue cycle costs. While it’s important, I think it’s somewhat short-sighted. Just because it’s cheap doesn’t make it good.
There is the need to appropriately invest in revenue cycle. And, subsequently, the need to invest in quality talent to push forward your revenue cycle because if you’re attracting good talent, you’re paying them enough, you’ve got a good incentive structure in place, that will have a downstream influence on the quality of your revenue cycle performance.
Unfortunately, revenue cycle management is often a thankless role with an unclear career path and therefore does not always attract top talent. You’re not typically getting a lot of young professionals who say, “Hey, I want to get into healthcare billing.” Subsequently, management positions are often staffed by individuals who were promoted from line level positions. To that end, organizations need to invest in ongoing training and development.
Also, we, as an industry, need to do a better job of articulating why it’s an interesting niche in the healthcare market so that we can continue to introduce top talent.
RCI.com: What about the value-based care movement and the ICD-10 transition?
BC: Organizations are struggling with keeping the ball rolling in terms of daily operations while thinking about different things on the horizon. I’m seeing clients make the assumption that it’s something they don’t need to be focusing on because the initiatives have been delayed.
It’s critical to assume the worst and hope for the best to be appropriately prepared. I think it’s critical for value-based reimbursement and for ICD-10 to be considering those as initiatives across the greater health system enterprise rather than saying this is a hospital initiative or this is a physician-based initiative. You need a holistic approach across the whole organization.
RCI.com: How will the much needed modernization of ICD-10 deepen our overall understanding of healthcare?
BC: This level of specificity will assist with population health management and trending of disease, as long as we’re using the data appropriately. It requires we use the tools in order to get good information out of it.
RCI.com: Where is the healthcare industry headed next financially?
BC: We will continue to see shrinking reimbursement or shifting reimbursement sources. There was a hope and expectation the exchanges are going to reduce our overall volumes of bad debt.
Unfortunately, what we’re finding is a lot of patients are still selecting high deductible plans which requires a significant amount of self-pay follow-up activity. I don’t know if that’s going to be the solution. We’re going to continue to see some pressure on reimbursement and subsequently continued effort on reducing overall cost.
Where organizations need to focus is not just looking at opportunities for cost reduction but how to do so efficiently in a way where you’re also increasing your margins. It’s not just looking for opportunities for cost reduction but also revenue enhancement.
