As one year fades into the next, we found a number of trends for hospital revenue cycle management (RCM) as we head into 2018.
Learn from the past: First, we took a look at 65 RCM tips for 2017 published in Becker’s Hospital Review and found a great collection of advice and tips all by different industry insiders. Here are the top 5 condensed… go the full article for a treasure trove of more tips:
- “Engaging clinical staff during the pre-authorization process decreases risk of rework related to incorrect or insufficient documentation in support of authorization.” — Theresa Brandon, managing director of Novia Strategies
- “Healthcare organizations should constantly measure their performance against their competitors to identify areas for improvement. To do this, organizations need to invest in an analytics platform that translates competitor data into meaningful insights.” — Destiny Schroeder, information systems director at Atwood, Kan.-based Rawlins County Health Center
- “Quality care is increasingly tied to healthy revenue through accurate documentation.” — Dexter D’Costa, MD, senior director of clinical documentation improvement at Conifer Health Solutions
- “Every patient accounting system and every hospital defines metrics in slightly different ways. Don’t assume the figure means what you expect it to mean. Understand what goes into the number and what it means in context.” — Peter Angerhofer, a principal at Colburn Hill Group
- “Hospitals need to track deposits that are split by the various patient accounting systems and general ledger accounts where the cash actually belongs. This quickly highlights any unposted or unreconciled amounts, allowing staff to resolve those exceptions quickly.” — Tyler Kurasek, a principal with Colburn Hill Group
Onward to 2018: Meanwhile, an article at RevSpring, lists five trends for hospital revenue cycle management to watch in 2018. Here’s a brief overview:
- Patient Responsibility and User Experience. One piece of advice for this trend offered is to “provide clear payment options, including clarification on what insurance will pay and what is owed by the patient.”
- 360 Patient Communications. You should help patients “schedule a follow-up visit or an annual exam with automated outreach reminders, tailored and specific to their needs.”
- Patients as Consumers. For this trend, RevSpring asks, “Do patients find your system easy to navigate? Is your website clear? Are your hold times reasonable? Are instructions and policies easy to find and available online?”
- Visibility. The article makes the case for smart use of analytics, advising you to “learn from your data to make the best decisions for your patients and organization.”
- The Path to Success. Noting that “many hospitals are making big investments in HIS systems; however, such investments do not cover all areas of a patient experience,” the advice is to focus on “well-designed statements, effective appointment reminders, follow-up surveys, and responsive design, and bill-pay options are valuable components required to make your engagement strategy a success.”
The Payer Consideration: HealthcareDIVE offers up some advice for what to expect from payers in 2018. This detailed article offers a lot of expansion on each point. Here we look at a top-level overview:
- Payers will continue to ramp up ways to cut costs — “Insurance companies have created policies, designed plans and narrowed provider networks to bring down healthcare costs.”
- There will be “greater emphasis on value-based care and contracting”.
- The article quotes Michael Abrams, co-founder and managing partner at Numerof & Associates, predicting that “more outpatient and virtual care utilization. Payers have been pushing more patients to outpatient facilities as a way to cut costs. Care delivery is moving out of the acute care setting and into the community. Such a trend is responsive to consumer demands for fast, convenient access, and it offers the potential for higher volume and lower costs in specialized clinic settings. “
- Consumers want cost, and quality transparency.
- More payer/provider partnerships may emerge with an eye on variations. These “partnerships vary in type, size, location, and model. There are 50/50 joint ventures with co-branding, and less intensive partnerships like pay for performance, accountable care organizations, patient-centered medical homes, and bundled payments.”
As usual, it should be a busy year for hospital RCM teams. Automation, patient satisfaction and pricing transparency, cooperation with payers, and smart use of analytics continue to be top of the list in trends for hospital revenue cycle management this year. We’ll keep an eye on smart revenue cycle management throughout the year.