News Feature | May 28, 2015

Providers Unprepared For Revenue Cycle Changes

Christine Kern

By Christine Kern, contributing writer


Task Force finds RCM ‘ill-equipped’ for the challenges of today’s healthcare marketplace.

A report from the HIMSS Revenue Cycle Improvement Task Force has found, “Revenue Cycle Management (RCM), as it exists today, is ill-equipped to handle the market forces impacting healthcare,” adding the current approach of “bolting on” new technologies and reworking existing processes will not suffice to address the current challenges of healthcare revenue management. “Rapid growth in consumer payments, reduced payer reimbursement rates, an ever changing regulatory environment, and shifting consumer expectations have all contributed to the challenges facing RCM,” write the report’s authors.

The task force gathered input from experts in order to provide an overview of the state of RCM in healthcare today as well as a blueprint for the consumer financial experience of the future and how it affects stakeholders. According to the report, members will focus on solutions in 2016.

Historically, healthcare providers have designed revenue cycle systems around business-to-business models that communicate with and collect payments from government and commercial healthcare insurance companies (payers). However, the healthcare marketplace is increasingly shifting to consumer-directed healthcare (CDH), and in the wake of the ACA, providers are now ill-equipped to efficiently handle the dramatic increase in consumer payments.

The Centers for Medicare and Medicaid Services estimates out-of-pocket expenditures for consumers will total $420 billion, up 68 percent since 2007. As more provider revenue comes from patients, providers must engage in industry-wide collaboration to create a new revenue cycle model that puts consumers and quality care at the center of the RCM process.

The report also recognizes payers are not immune to the new financial dangers, noting, “If providers are unable to find a way to improve their collection of consumer payments, the increase in consumer payments is expected to lead to an increase in bad debt rates, putting increased financial pressure on providers. This could translate to a demand for higher reimbursement rates from payers.”

The HIMSS Revenue Cycle Improvement Task Force created an infographic illustrating its vision for the Patient Financial Experience of the Future, focused on tools and processes that keep administrative cost containment, interoperability and consumer engagement front and center, regardless of the reimbursement methodology being applied.