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

Practice Management News

How to Boost Ambulatory Revenue Cycle Management Performance

Ambulatory revenue cycle management demands greater focus on the financing and delivery of comprehensive, coordinated patient care.

By Jacqueline DiChiara

- Ambulatory revenue cycle management is driven by a variety of factors, such as the market growth of Electronic Health Records (EHRs), the meaningful use program, and technological trends.

ambulatory revenue cycle management

Operating as outpatient healthcare facilities, ambulatory surgical centers (ASCs) include physician offices, medical laboratories, and home healthcare.

Since they are not tied to the type of inpatient care delivered by hospitals, nursing facilities, and the like, they must consider a very different revenue cycle approach than their larger hospital counterparts to survive.

ASCs are growing in volume nationwide. In 2013, over 5,300 ASCs treated 3.4 million fee-for-service Medicare beneficiaries, according to a report from the Medicare Payment Advisory Commission.

ASC services were reportedly tied to $3.7 billion in spending.

READ MORE: Key Ways to Start A Hospital Revenue Cycle Turnaround Process

Physician offices make up almost half of ambulatory healthcare services receipts, according to the U.S. Census Bureau.

Care has consistently transitioned to the outpatient realm over the past two decades, according to a whitepaper from Melissa McCain, Principal at the Chartis Group.

From 1988 to 2008, the percentage of total hospital gross revenue tied to outpatient activity jumped from 21 percent to over 39 percent, McCain explains.

By 2019, this number is expected to increase by another 20 percent, she says.

Reimbursement among ambulatory practices has allegedly improved because of EHR implementation, according to research from the Journal of the American Medical Informatics Association.

READ MORE: Making a Business Case for the Patient-Centered Medical Home

Ambulatory practices, slow to adapt EHR technology, remain focused on how to achieve high levels of reimbursement performance. Hospitals have reportedly generated more revenue from outpatient services within the past several years.

According to 2012 data from HIMSS, nearly 6 percent of ambulatory practices utilized online portals and personal health records.

In 2014, over a quarter of ambulatory practices were reportedly on board to replace their EHR systems. But nearly half confirmed they lacked the financial ability to do so.

“There are different reasons for this shift,” stated Jared Dowland, author of Ambulatory EMR Perception 2014: New Leaders Emerging as Market Shifts, within a public statement.

“Larger practices are seeking to consolidate from multiple EMRs and tighten their relationships with nearby hospitals, while smaller practices are seeking to resolve functionality, support, and cost concerns.”

READ MORE: Tenet Starts Chicago Market Exit with Sale of MacNeal Hospital

Revenue growth expected to spike in coming years

Healthcare providers are nonetheless focused on incorporating ambulatory systems as they experience greater levels of revenue cycle growth in coming years.

According to recent research from Frost & Sullivan about the future of the ambulatory EHR market, ambulatory practices will likely be more accepting of costlier, integrated EHRs.

“Overall, winners in the U.S. ambulatory EHR market will include disruptive, provider-oriented, specialty-specific, cost-competitive technology companies capable of juggling this industry’s unique combination of risks and rewards,” say researchers.

“Additionally, companies providing products and services supporting clinical decisions and better streamline delivery of care will have an edge.”

Revenue growth will reach an apex of sorts from 2019 to 2020, predicts Koustav Chatterjee, Transformational Health Senior Research Analyst at Frost & Sullivan.

“With healthcare providers’ desire to benchmark outcomes at a network, practice and patient level, their need for integrated EHRs will only grow.”

Key focuses for the ambulatory revenue cycle future include a greater knowledge base regarding overall cost experience and the implementation of systems that effectively inform care delivery, says McCain.

 “Although many organizations have mastered measurement of some core operational processes, such as revenue management and productivity, most have not evolved systems of measurement to include a closer scrutiny of experience and health outcomes, access to care and cost across the continuum or episode of care.”

Ambulatory care can prevent hospitalization and help generate positive outcomes with patients receiving care for the management of chronic conditions, she says.

“Managing ambulatory care has become critically important from numerous perspectives, including the financing and delivery of comprehensive, coordinated patient care.”

But hospitals fare a bit differently. A 4 percent rise in hospital admissions for the Hospital Corporation of America (HCA) Holdings, resulted in a revenue spike.

Yet a conflicting report from the Healthcare Cost Institute confirmed a decline in the utilization of healthcare services. Acute inpatient hospital admissions reportedly went down by over 2 percent. Outpatient visits allegedly dropped by 0.8 percent.

“As market forces continue to evolve, with incentives and rewards increasingly tied to outcomes across the continuum of care, progressive provider organizations are searching for a comprehensive approach to improving ambulatory patient service and access,” McCain explains.

“In markets dominated by fee-for-service reimbursement, outpatient services provide the majority of operating margin for most health systems. In more advanced managed care markets, successful ambulatory operations are essential to effective patient care and population health management.”

“Outpatient care continues to expand as increasing numbers of procedures and treatments transition to the ambulatory setting. For these and other reasons, improving ambulatory performance has become a top strategic priority for health systems nationwide.”

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