Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

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After EHR Adoption, Revenue Cycle Technology Modernization Begins

With most providers now using an EHR system, healthcare organizations are starting to turn to the process of modernizing their revenue cycle technology in an effort to support value-based care.

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Electronic health records (EHRs) revolutionized the way healthcare organizations collect, analyze, and report patient and practice data. And now that nearly 97 percent of hospitals and almost three-quarters of providers are using certified EHR technology, many organizations are angling to adopt revenue cycle management solutions to complete their conversions to a digital environment. 

Healthcare organizations often faced an uphill battle with EHR implementation under the EHR Incentive Programs. The switch from paper to electronic medical records consumed the time, energy, and capital of most healthcare organizations.

Revenue cycle management was an unintentional casualty of that difficult and frustrating process.  While providers were busy with EHR adoption projects, other aspects of the healthcare organization remained manual or became outdated. A recent survey found that 78 percent of hospitals still use a manual healthcare supply chain management process.

Another 31 percent of providers told HIMSS Analytics in 2016 that their facility still has a manual claims denial management strategy.

"Everybody’s been focused on the EHRs, but revenue is getting tighter and tighter."

Now that the dust is settling on EHR implementation, many providers are seeking other technologies to bring all departments into the electronic era as they strive for integrated, end-to-end technology suites to support their entire business process.

“That’s what we’re seeing as the next wave,” Mark Weber, Infor’s Senior Vice President of Healthcare Development, explained to RevCycleIntelligence.com.

“Everybody’s been focused on the EHRs, but revenue is getting tighter and tighter. Now the questions are becoming, ‘how do I improve operational efficiency and how do I better get to understanding cost per physician, cost per patient, and costs across all my service lines?”

Healthcare revenue cycle management vendors are up against EHR industry heavy-hitters

Developing a comprehensive and efficient healthcare revenue cycle management strategy is not a simple task, especially as payers edge closer to full value-based purchasing implementation. But healthcare leaders do not have to take on the monumental responsibility of optimizing their revenue cycle alone.

Providers can turn to vendors to help them implement healthcare revenue cycle management and business operations solutions. Vendors offer a wide range of health IT products, from automated patient collection systems, dashboards that link clinical and financial data, to advanced predictive analytics and business intelligence tools.

Unfortunately, healthcare revenue cycle management adoption can be even more complex than an EHR implementation. Providers not only have more vendor options, but there are fewer guidelines for purchasing and many more modules to choose from.

Just a simple Google search for the top healthcare revenue cycle management vendors brings up lists comprising 100 or more companies.

In contrast, the top EHR vendors are easier to identify. Even though eligible professionals and hospitals used over 650 health IT vendors to attest to meaningful use through 2016, hospitals primarily used three vendors for attestation.

Out of 4,545 eligible hospitals, just about half of those organizations used either MEDITECH, Cerner, or Epic Systems. Epic and Cerner also topped the list for most meaningful use attestations by eligible professionals.

In addition to a more fragmented RCM vendor landscape, revenue cycle companies tend to develop a wider range of products that target different revenue cycle components, such as patient collections, claims management, supply chain management, and payer contract development. Products can also focus on enabling workflows for staff members in specific roles. 

Read More: Top Revenue Cycle Management Vendors and How to Select One

While healthcare revenue cycle management and EHR adoption are significantly different undertakings, an organization’s EHR vendor selection may still be an important factor in the revenue cycle management vendor decision-making process.

With health IT tools costing practices up to $32,500 per physician, many providers are unwilling to adopt healthcare revenue cycle management solutions that do not integrate with existing EHR systems.

A 2016 KLAS survey found that 59 percent of provider organizations considering a revenue cycle management system replacement said they made that decision because they wanted more EHR and revenue cycle management integration.

“If you’re an Epic shop and Epic’s offering you revenue cycle management that is totally tied in and integrated with the clinical workflow, why would somebody buy anything else?” asked Weber.

Additionally, variations between separate EHR and healthcare revenue cycle management systems may jeopardize clinical and financial success. As payers adopt value-based purchasing, provider revenue depends on integrating clinical and financial data to improve care quality while reducing costs. Separating the two systems does not support value-based purchasing goals.

Leveraging EHR data is also key to revenue cycle management success in a value-based purchasing world.

Providers need to prove that services furnished improved patient and cost outcomes. EHR documentation through ICD-10 codes and patient status descriptions are crucial to demonstrating value for reimbursement.

However, almost 75 percent of practices anticipated a profitability decline because of billing and recordkeeping issues in the EHR, a Black Book survey found.

As a result, 97 percent of healthcare business managers stated that the implementation of an “all-in-one EHR/practice management system” would result in less financial dependence and more revenue capture.

Future-proofing the revenue cycle in a changing environment

Despite the fact that Medicare has met its first goal of tying 30 percent of its fee-for-service payments to value-based purchasing models, healthcare organizations still seem to still have one foot planted in fee-for-service with the other in value-based care.

A 2016 AMGA survey revealed that healthcare organization leaders only anticipate about one-half of their revenues to come from value-based purchasing models by 2018.

With providers engaging in both payment structures at the same time, healthcare revenue cycle management vendors face the challenge of developing products that cater to both sides.

"Make sure your system is future-proof because regulations will change and you can’t afford to go buy new systems every day or week or month."

The slow value-based purchasing transition caused some healthcare revenue cycle management vendors to limit their product offerings to US customers.

“There’s a lot of uncertainty about where revenue management is going in the US,” said Weber. “There’s one foot on the dock and one foot on the boat. It’s too uncertain.”

The unpredictable atmosphere affects vendors as much as providers, he added.

“You don’t want to spend a lot of money putting your foot on the boat if it’s going to sink,” he said. “But you don’t want to be standing on the dock if you should really be on the boat. If you do get to more value-based care, that totally changes all that functionality.”

The time, money, and energy needed to develop a fee-for-service revenue cycle management option is not currently worth the risk for Infor. Weber explained that by the time his company develops a comprehensive revenue cycle management system for US customers, the payment landscape may already be different.

Read More: Best Practices for Value-Based Purchasing Implementation

Providers need to think along the same lines, pointed out Neal Singh, President and CEO at Caradigm.

“Make sure your system is future-proof because regulations will change and you can’t afford to go buy new systems every day or week or month,” he said. “You want a system that’s configurable and able to change rapidly.”

Different value-based purchasing models and regulations require providers to monitor different population health, care quality, and financial measures. Value-based purchasing models may also modify their measure sets or payment methodologies as the models mature.

Singh recommended that providers seek healthcare revenue cycle management technology that is not hard-coded. Instead, the systems should be configurable - preferably without a consumer having to ask for the configuration.

Healthcare revenue cycle management technologies should respond to changing value-based purchasing regulations in real-time to ensure provider workflows and claims reimbursement are not disrupted by system updates.

Avoiding the usability mistakes of the EHR transition

The switch to EHRs from paper records represented a significant change for healthcare, but it hasn’t always been a positive one.  EHR usability and functionality shortfalls have produced a constant litany of complaints from unhappy providers since the start of the EHR Incentive Programs.

A 2015 peer60 survey revealed that 54 percent of hospitals were unhappy with their EHR system’s usability. Chief complaints included limited functionalities, inadequate interoperability, and misaligned strategic objectives.

EHR vendors also don’t always know how to alleviate usability concerns. Only four out of eleven surveyed vendors said they had a strong understanding of what it should take to develop and implement a user-centered software design, a 2015 JAMA study revealed.

Fortunately for healthcare revenue cycle management vendors, EHR companies have thus far absorbed the brunt of health IT usability complaints. Healthcare revenue cycle management vendors and EHR companies expanding into the market took the lessons learned and have started to focus more on user-friendly healthcare revenue cycle management and business operations systems.

To combat limited vendor knowledge, many healthcare revenue cycle management vendors are establishing consumer-focused workflow and usability departments.

User experience teams should be able to respond to customer concerns and redesign systems accordingly, said Ric Sinclair, ZirMed’s Vice President of Product.  The teams should include “people who are not only well-versed in design but also fields like behavior economics and why people do what they do,” he said.

Usability experts should do more than make superficial changes, added Weber. 

Oftentimes a system update ends up as little more than changing square text boxes to a rounded design, he stated. Instead, vendors should concentrate on restructuring systems to ensure users can access data they need to complete their responsibilities.

"We’re not going to compare it to a health IT vendor."

Vendors are now focusing on making their products more intuitive and better aligned with the consumer-friendly platforms available on smartphones and tablets. 

“How you flow through the application has completely changed based on how people do their work,” Weber said. “There’s an expectation now, with iPhones and other smart technologies, that it should be intuitive to use. It’s not like people want to open the 500-page manual.”

Sinclair agreed that common consumer tools, like Netflix and Facebook, can positively influence the design of health IT products

“You want to provide a good experience,” he said. “We have made a big investment in intuitive design. We think of ourselves as a software company, so when we try to replicate designs that we think are designed well, we are going to compare that to the Netflix app on Apple TV and LinkedIn’s mobile app.”

“We’re not going to compare it to a health IT vendor,” he continued. “There’s nothing wrong with a lot of the experiences there, but we’re shooting for products that people love to use. We want to try and replicate that to the best of our ability. People are in our software seven to eight hours a day, we should provide a really fast experience that doesn’t crash and does work for them.”

Looking forward, as more providers engage with value-based purchasing on a larger scale, vendor solutions for healthcare revenue cycle management technology may integrate more with popular EHR systems.

“For large providers with multiple facilities and dynamic physician practice models looking to stay competitive in today’s rapidly evolving healthcare environment, it is critical to standardize operations across the enterprise and utilize a single vendor EHR/RCM system to more efficiently manage the enterprise revenue cycle,” PwC stated.

The organization added that the provider demand for integrated systems may spur more providers to adopt their EHR vendor’s healthcare revenue cycle management products.

Best-of-breed revenue cycle management vendors also may not be able to survive the competitive market if they do not develop methods for combining EHR and financial data.

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