Policy & Regulation News

How Revenue Cycle Management will Evolve in 2015

By Ryan Mcaskill

With the healthcare market in flux, 2015 will follow the path that is being created by current trends and regulations.

- The last year has been filled with trends and regulations that have shaped the healthcare industry. Value-based care and improved quality are pushing change throughout the market and creating a new age of healthcare. However, this creates the question of what happens from here and what path will be followed in 2015.

A recent report from Navigant’s Center for Healthcare Research and Policy Analysis examined the key areas that healthcare practitioners and payers need to be on top of going into the new year. Unsurprisingly, revenue cycle management is well represented in these trends that cover value, cost, patient empowerment and the right care at the right time.

“2015 is a watershed year for the healthcare industry. The uncertainty surrounding the ongoing implementation of the Affordable Care Act, shifting payment models, accelerated national and regional consolidation of large hospital and health systems and increasing emphasis on evidenced-based necessary care will have profound implications for payers, providers and patients,” said Paul Keckley, Managing Director of the Navigant Center for Healthcare Research and Policy Analysis.

The biggest focus going forward will be on the continued adoption and alteration of the Affordable Care Act. Since being implemented, there have been 38 changes to the law made through administrative actions and amendments with more to follow. With Medicaid expansion along with a growing number of individuals signing up, continued tweaking to the ACA is needed to ensure it remains as effective as possible.

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  • This will also be impacted following the pilots of new payment platforms, pieces of legislation and care programs like accountable care organizations or the Sunshine Act. With a demand for transparency and improved cost of care, the reaction to these programs after some time will have an impact on future regulations.

    This will also be affected by the growing shift from the fee-for-service and volume care platforms to a value-based solution. Many industry insiders see this shift as the key to reducing costs while enhancing safety and quality. It also puts emphasis Clearer incentives have been laid out that make switching to these platforms easier and harder to ignore.

    “Bundled payments, value-based purchasing, penalties for avoidable readmissions and unnecessary care, and other programs have a single aim: to replace fee-for-service incentives with results,” the report reads.

    These programs and many of the legislative moves focus on costs. The Center for Medicare and Medicaid Services Office of the Actuary predicts an increase in healthcare costs of six percent annually for the next decade. This increase will impact consumers and make getting health insurance through work and other means more complicated. This could also increase the bed debt and collection issues that many practices face.