Hospitals Turn to Bolt-On, Outsourced Revenue Cycle Management

About 45 percent of large and community hospitals will use multiple core and bolt-on software solutions as part of their organization’s revenue cycle management strategy until 2019, according to a new Black Book survey.

On the other hand, most small hospitals (35 percent) plan to outsource their revenue cycle management functions end-to-end, the survey of 567 executives, providers, and other staff from over 4,000 hospitals and health systems revealed.

Large and community hospital staff were less likely to implement an outsourcing strategy between 2017 and 2019. Outsourcing revenue cycle management end-to-end was the least common strategy, with 14 percent of community staff and 15 percent of large hospital staff selecting this option.

In addition, few hospitals from across the size spectrum expect to use one core legacy vendor for a software solution. Only 23 percent of small hospital staff, 15 percent of community hospital staff, and 17 percent of large hospital staff stated that this was their organization’s current revenue cycle management strategy.

Hospitals and health systems may be turning to full or partial revenue cycle management outsourcing because of staffing concerns.

Roughly 93 percent of small hospital executives and business leaders agreed that their organization experienced trouble recruiting and training staff after a revenue cycle management software implementation.

About 75 percent and 56 percent of similar employees at community and large hospital, respectively, saw the same staffing challenges.

In the face of employment obstacles, 83 percent of small hospital finance leaders and 52 percent of those in large organizations agreed that outsourcing core or bolt-on services was a better short-term solution than a full software implementation.

However, only one-third of community hospital finance leaders thought staffing concerns warranted outsourcing over an implementation.

While finance leaders viewed partial or full outsourcing as a short-term solution, most hospital users across the size spectrum anticipate maintaining outsourcing services for 36 to 60 months. Approximately 72 percent of large hospital users expect to outsource for up to five years, followed by 55 percent of staff from community hospitals and 51 percent from small hospitals.

Additionally, the survey uncovered that almost one-third of hospitals that were planning to upgrade or replace their revenue cycle management system in 2012 have failed to start the replacement process by January 2017.

Rather than initiate a replacement or upgrade plan, hospital leaders prioritized myopic task forces on ICD-10 coding, EHR integration with physician practices, interoperability and EHR connectivity, and insurance verification and eligibility, according to 71 percent of hospital CFOs.

Almost 30 percent of hospitals with less than 200 beds also postponed revenue cycle management system transformation plans until after coding transitions finished and revenue from meaningful use came in.

Now that ICD-10 implementation is complete and hospitals are moving away from meaningful use to MACRA, over-three quarters of small hospitals are in the process of selecting a new revenue cycle management vendor.

Ninety-six of large hospitals that are considering a revenue cycle management system transformation also plan to execute the project before January 2018.

Revenue cycle management transformations should occur sooner rather than later, according to 95 percent of large hospital finance executives. They believe that neglected transformation projects by the first quarter of 2019 will be detrimental to the organization’s value-based reimbursement transition and revenue.

Consequently, 94 percent of hospital CFOs stated that revenue cycle management is now a top priority, especially as EHR implementation and clinical data analytics installations conclude.

As part of their transformation initiatives, hospitals are turning to their EHR vendors. Approximately 35 percent of CFOs in hospitals with fewer than 100 beds expect their vendor selection to be based on their EHR vendor relationship.

The majority hospital leaders and providers (93 percent) are also looking into revenue cycle management solutions that can address population health, coding, forecasting, budgeting, and alternative payment models.