What’s Top-of-Mind for Revenue Cycle Leaders in 2022
August 8, 2022
There is no doubt healthcare revenue cycle leaders have faced unprecedented challenges these past few years. As they navigate the lingering impact of the pandemic and the ever-changing regulatory and payer landscape, they are also attempting to prepare for whatever may come next.
With trade shows picking back up this year, healthcare and revenue cycle leaders have begun meeting in person again to discuss and collaborate on their ideas, innovations, and most pressing challenges. After attending the most popular healthcare and Revenue Cycle Management (RCM) conferences of the year, including HIMSS, Becker’s, and HFMA, we have gleaned several key insights.
Here’s a quick mid-year recap of the five most talked about issues.
1. Removing Unnecessary Barriers
Some hospital leaders are saying enough is enough. The industry continues to pressure caregivers to do “just one more thing” in meeting state and federal regulations, putting more obstacles and distance between themselves and their patients. There was even a roar of applause at one conference where a hospital executive suggested that she and her colleagues work together to push back on the ever-mounting regulations putting undo pressures on caregivers who are already on the brink of burnout. As workforce shortages persist across healthcare, the goal should be to help all caregivers remove unnecessary work and barriers to better focus on the work that matters most – treating patients and improving care quality. This call to action should invigorate all of us to ask ourselves daily what we are doing to help in these efforts.
2. Financial Challenges Fueled by Growing Expenses and Inflation
Since the pandemic began, the country’s hospitals and health systems have been up against the wall caring for patients and trying to protect their communities. While much progress has been made, they are now facing significant financial and operational challenges, including major revenue losses and ballooning expenses. Inflation, the rising cost of supplies, and continued workforce shortages pose severe detrimental impacts to hospital finances, leading to billions in losses and over 33% of hospitals operating on negative margins.
A recent AHA report highlights the significant growth in expenses across labor, drugs, and supplies and explores the impact of rising inflation on hospital prices.
“The median Kaufman Hall Year-To-Date (YTD) Operating Margin Index reflecting actual margins was -0.09% through June. The median change in Operating Margin was up 30.8% from last month but down 49.3% from June 2021. The median change in Operating EBITDA Margin was up 23.5% month-over-month, but down 35.0% from June 2021. While there has been some month-to-month improvement over the summer, there’s still a long road ahead to meeting pre-pandemic levels.” (Kaufman Hall, National Hospital Flash Report, July 2022)
3. Talent Acquisition
Most healthcare leaders agree that workforce shortages are at an all-time high with no relief in sight. With many staff quitting or retiring due to burnout during the pandemic, hospital leaders have been scrambling to recruit, hire, and maintain a high-performance workforce. The competitive landscape for recruiting top talent has increased significantly due to the wide availability of virtual positions and overall general availability of job openings in nearly every sector. Healthcare leaders are competing not only for local talent but also on a national level. Coupled with fewer clinical staff, many just aren’t finding the talent they need at a price they can afford.
So, how are leaders navigating these uncharted waters? Many hospital executives, especially those from rural and community hospitals, expressed the importance of culture in this environment. If they can’t compete on salary and benefits, culture has to play an ever more vital role. Candidates have to buy into the organization’s overall mission as well, and if hospitals can get them on board with these factors, they can often win them over.
In addition, healthcare leaders have found innovative means by which to continue to operate in this new normal. The workforce shortage for RCM leaders, for example, has given rise to artificial intelligence (AI) and robotic process automation (RPA) technologies, all in an effort to find ways to create efficiencies and streamline workflows with fewer team members. They’re looking for technology partners who understand the depth and breadth of their challenges and will lead with a consultative approach.
4. Cost Estimation & Transparency
Another hospital executive shared her dream of seeing accurate patient costs delivered upfront so that patients never have to deal with a bill post-service and can instead focus on healing. Unfortunately, the reality is often quite different. Despite cost transparency regulations, patient cost estimations often fall short of the desired future state. With so many insurance providers and plans, what a patient will ultimately owe post-encounter is impossible to predict perfectly. And while cost estimations might have initially promised reduced call volumes, many hospitals are experiencing the exact opposite.
Then there are the concerns that estimates cause undo anxiety and fear, resulting in patients electing not to come for treatment or fill their prescriptions. This has and will continue to bring about a new change in how we approach patient payments. Cash voucher programs, for example, have started to gain traction in some hospitals, eliminating the payer and delivering a set price for a particular procedure or treatment. We’ve also seen Walmart take a stand against complex payer contracts to provide a flat fee for vaccinations, prescriptions, and other services – no insurance needed.
Across the board, revenue cycle management leaders want to be paid timely for their services, including making the cost of treatment easy for their patients to understand. Collectively, they expressed ongoing concerns over payers’ willingness and ability to help them achieve the desired outcome.
5. Delivering Care When and Where the Patient Is
Hospitals continue to invest in innovative care models looking for new ways to improve access to care and make it more equitable for all. As technology and remote capabilities advance, some healthcare leaders envision a future where only the sickest or those with chronic and complex conditions will require a visit to the traditional hospital setting. They see a future state where the vast majority of patients can be cared for remotely or within their communities at locations they shop and frequent the most.
Large retail and pharmacy chains that have long offered essential services are rapidly increasing their offerings, installing more expansive “minute clinics,” and even building facilities for full-fledged healthcare providers with a wide range of services. Retailers such as Walmart have recognized how valuable their shopper’s data is and how it can play a valuable role in future disease prevention. Ultimately, everyone in healthcare understands that when you remove barriers to care, such as location and access, the community’s health improves.
These topics and others are impacting our healthcare and RCM ecosystem, causing shifts in how we operate and creating a new normal. As we in the healthcare industry continue to innovate with new ideas and solutions, the use of technology can often be a force multiplier when done right. However, we shouldn’t forget it all starts with people.
At The SSI Group, LLC (SSI), we lead with a high-touch human-first approach and empower with technology second. We believe in the continuous pursuit of streamlining and improving the RCM process to reduce barriers that impede the speed of care and time to payment, and we’ve been doing it for thirty-four years.
With a steady pulse on the industry and adaptability to market shifts, SSI helps you address and even capitalize on your biggest challenges. From patient access to medical claims denial prevention to reporting and analytics, our revenue cycle solutions empower your RCM workforce, allowing providers to maximize their efforts—and returns—at every stage.
Contact SSI if you’re interested in talking with a vendor with a proven solution and a solid reputation for helping RCM leaders improve operations for over thirty years.