Healthcare Revenue Cycle Management Trends for the Last Half of 2019

Corporate business team and manager in a meeting
Healthcare revenue cycle management trends in the last half of 2019 will keep financial teams on their toes.

Healthcare revenue cycle management leaders are constantly looking for revenue integrity solutions. Pricing transparency, cyber security, and revenue cycle outsourcing are on the minds of CFOs and their teams in the last half of year.

Becker’s Hospital Review sums up the challenge like this:

“Shrinking reimbursement rates and increasing costs keep hospital and health system CFOs and revenue cycle leaders constantly seeking strategies to improve the financial health of their organizations. Boosting revenue cycle performance is a key imperative for hospital leaders, and they’re implementing new technology and partnering with vendors to navigate the ever-changing reimbursement landscape.”  — Becker’s Hospital Review article

The same article lists some emerging trends from recent studies, plus we found some other ideas to help with your revenue cycle strategies in the final half of 2019. Below we cover four such trends for healthcare revenue cycle management.

1. Healthcare Pricing Transparency

Led by consumer groups, federal and state policies, and the increasing patient-centric paradigm, more hospitals are seeking to boost speed to revenue by stating costs up front and asking for initial payments during patient access activities.

A study conducted by the Health Management Academy and Cedar in July 2019 found that, “Beyond evolving consumer expectations, legislative and regulatory requirements around price transparency and surprise billing have forced health systems to implement strategies to better manage the patient financial journey.” But the same report also dives to the underlying roadblock on the way to true transparency. “In response to increased demand for price transparency, health systems have worked to improve accessibility to pricing information prior to care, most commonly through publication of the chargemaster on the health system’s website (80%). However, as the chargemaster prices are not the prices charged to the patient, these resources are commonly confusing and hard to interpret for consumers and ultimately cannot provide accurate estimations of patient obligation.” The report also provides insight into current tools needed, like out of pocket pricing estimation and notes that, “as of June 2019, the Trump administration has signed an executive order that could mandate that health systems provide out-of-pocket cost estimations to patients upfront.”

2. Increasing demand for revenue cycle outsourcing

A Black Book revenue cycle management survey conducted in 2018 found that a lot of hospitals are winging it, or plan to seek consulting services soon, according to an article in RevCycle Intelligence. The article observes that, “Without a workable revenue cycle management system, 82 percent of the hospitals plan to go blind with value-based reimbursement and 85 percent may seek consulting services.”

We took a look at the official release from Black Book and note their historical outlook shows some progress, with a lot more needing to be done. They write, “In 2012, 35% of all hospitals failed to have an RCM strategy to optimize or replace their RCM systems. Six years later, 26% remain without a transition plan. On a positive note, this does indicate that there have been workable RCM IT plans adopted and new systems implemented by about 400 hospitals over the past six years.”

3. Cyber security concerns are growing

In April 2019, the government reported 44 data breaches — “the highest number of healthcare breaches reported in a single month since HHS’ Office for Civil Rights began maintaining its online database of healthcare breaches in 2010, surpassing the previous record—exactly one year ago, April 2018—when healthcare groups reported 42 breaches to the agency,” Modern Healthcare reports. These breaches can not only expose sensitive health data but also disrupt entire hospital systems and result in costs in the form of fines and in some cases “ransom” demanded by hackers.

HIPAA Journal gives more details on an incident in May of this year when Bayamón Medical Center discovered “that their computer systems had been infected with ransomware. The ransomware encrypted a wide range of files and prevented hospital staff from accessing patient information ‘for a short period of time.’ Approximately 522,000 current and former patients are being notified about the ransomware attack as a precautionary measure. The article continues, noting in general that, “Data from Malwarebytes indicates ransomware attacks increased by 195% in Q1, 2019 and a recently published report from Coveware shows ransomware attacks increased by 184% in Q2. Last month, Carbon Black released the findings of a survey which indicated 66% of healthcare organizations had experienced a ransomware attack in the past 12 months.”

4. CFO’s are getting more involved 

In an article from April of this year at Becker’s Hospital Review, Ben Spence, chief financial and business service officer of Fort Myers, Florida based Lee Health, recommends listening to employees. “Take time to really listen to the front line and to your managers, to listen to their ideas of how to improve. I firmly believe the change we need to facilitate in healthcare today is going to have to come from those who are doing the work.”

Healthcare IT Leaders Revenue Cycle Lead, Larry Todd, recommends that CFO’s go beyond listening to implementing. An article at their blog quotes him recommending that since, “any implementation will affect the revenue of the organization so it’s very important for CFOs to be involved in the implementation project and to be informed of key parts of the project that could put the organization and its revenue at risk.”

And, in a Healthcare Finance article “CFOs explain changing role, see collaboration key as healthcare changes,” Jeff Francis, CFO for Nebraska Methodist Health System, says that success for CFOs is not so tied to education as it is to the ability to create processes that support the business. A CFO must be able to make others successful, getting important information out timely and accurately so that operations people can have the right staffing level, supply spend info and, if a new project is the table, what it means from dollars and sense standpoint.

In the same article, Linda Hoff of Legacy Health sums up the role of today’s healthcare CFO like this: “You have a passion for what you’re doing within your facilities, how you’re interacting with patients. You have to be as interested in patient satisfaction and quality as you are in the financials. If you don’t have that passion for all those aspects, you’re really not going to land yourself in a CFO role especially today.”

Pricing transparency, CFO involvement, outsourcing, and cyber security are on the burners for the second half of 2019. During all of that activity, Revint believes hospitals and health systems should be paid in full for the services they provide. Our industry-leading Enterprise Revenue Integrity Solutions can get you closer to that goal. In this market full of point solutions that are either a pure technology or pure consulting play, we are an outlier. We offer solutions that combine leading edge technology with our highly skilled and trained workforce. We expect as much from our solutions as we do our people. Here’s to a good close of the year.

Discover top trends affecting the revenue cycle – and how to address them –  with the 2023 Revenue Intelligence™ Data and Insights Report.