Hospital revenue cycles, and the professionals who manage them, are under immense pressure heading into 2024. Early last year, Fitch Ratings called 2022 “the worst operating year ever,” for healthcare, and declared 2023 a “make-or-break year.” [1] Moody’s Investor Services in November offered some measure of hope for the year ahead when it revised its 2024 outlook from negative to stable for not-for-profit and public healthcare. [2]
Moody’s predicts that single-digit growth in reimbursement rates and modest patient volume increases will be key factors driving operating revenue 4-6% upward [3] – meaning it will be more important than ever for revenue cycle management teams to optimize reimbursement, avoid missing revenue opportunities, and master charge capture.
Yet, an Ingenious Med report published in 2023, and based on research conducted independently by healthcare consultancy Sage Growth Partners, found that 79% of the 95 survey respondents say denials and underpayments are the top revenue cycle management (RCM) pain points, only 35% are satisfied with their current RCM solution, and their organizations are leaving 15% of revenue on the table.[4]
To inform hospitals, health systems, and medical groups developing RCM plans for 2024, here are seven trends to take into account:
- Surviving workforce shortages
- Transforming the patient financial experience
- Unleashing the power of MIPS
- Safeguarding against cybersecurity threats
- Leveraging AI early and often
- Unlocking value-based reimbursement
- Keeping pace with regulatory changes
1. Surviving workforce shortages
In February of 2023, the American College of Healthcare Executives stated that in a survey of CEOs, workforce was the top issue confronting hospitals [5] for the second year in a row.[6] Also, KLAS noted that healthcare providers “are feeling heightened reimbursement pressure due to continually changing payer claims requirements, shrinking allowable charges, and increased patient financial responsibilities. On top of those external challenges, organizations are also seeing stricter staffing budgets and difficulties recruiting qualified employees.”[7] While burnout is particularly troublesome among clinicians and nurses [8] , healthcare leaders will also need to focus on fortifying revenue cycle management teams to maximize reimbursement.
2. Transforming the patient financial experience
The need to improve the patient financial experience has been discussed for some time now, but a number of statistics demonstrate that it remains a challenge – and an opportunity for health systems, hospitals, and medical practices. More than 50% of consumers believe their hospital prioritizes profits over affordable quality care, almost half (46%) of young people won’t access care because of the cost, and nearly one-third of consumers cited financial concerns as a reason for delaying needed care.[9] Further, 93% of consumers say a bad billing experience could impact whether they return to a specific provider or seek care elsewhere.[10] Healthcare organizations have important opportunities to attract and retain patients by delivering a positive financial experience.
3. Unleashing the power of MIPS
The U.S. Centers for Medicare and Medicaid Services revamped and consolidated its quality reporting programs into the Merit-based Incentive Payment System (MIPS) with a focus on quality, cost, interoperability and improvement activities.[11] MIPS also brings benefits and consequences. The benefits include: incentives for quality care, financial rewards, performance transparency, alignment with value-based care, and overall improved data utilization.[12] And the consequences of not participating in MIPS: negative payment adjustments, missed opportunities for improvement, loss of competitive advantage, and limited resource allocation. [13] Healthcare leaders that embrace MIPS will position their organizations to enhance both health outcomes and financial performance.
4. Safeguarding against ransomware in the revenue cycle and other persistent cyberthreats
Medical practices, hospitals, and health systems are heavily dependent on IT systems for delivering patient care that drives revenue, and any information security event that takes those systems offline has a very negative impact.[14] That’s particularly important because the healthcare sector is the top target for cyberattacks,[15] of which 1,463 were launched globally every week in 2022 – a 75% increase over 2021.[16] Also worse in 2022 is the 24-day average downtime resulting from cyberattacks, compared to 15 days in 2021. [17] Healthcare providers essentially have three options: taking out a cybersecurity insurance policy, deploying back-up systems to protect the data from being encrypted, and implementing tools such as Ingenious Med Continuum, a cloud-based service for continuous workflow that enables secure remote access to vital patient data and billing operations during a downtime event.
5. Leveraging AI early and often
Artificial intelligence and machine learning are showing early promise reducing administrative burden, including documentation at the point of care, and automating routine tasks.[18] But even though 82% of executives participating in our aforementioned research say AI and automation will be important moving forward, only 16% currently use AI for RCM, and only 27% plan to adopt it within three years.[19] Survey respondents say AI’s greatest potential value is in coding (60%), eligibility/insurance verification (60%), and denials prevention and management (58%).[20] In 2024, however, it is clear that hospitals, health systems and medical groups have an urgent opportunity to move more quickly than other organizations in harnessing AI to create a competitive advantage.[21]
6. Unlocking value-based care and payment models
While 93% of the more than 200 executives participating in an Advisory Board survey related to the ongoing transition toward value-based care are optimistic about VBC, the firm also explains that value-based care is both a clinical transformation and a financial transformation.[22] To effectively leverage alternative payment models, health systems, hospitals, and practices need data analytics to accurately measure their performance and address the top revenue cycle management pain points of inefficiency, missing charges, charge lag, and coding errors.[23] In fact, our research found that 84% of survey respondents want smart analytics to identify under-coding, and 68% say the same for over-coding.[24]
7. Keeping pace with regulatory changes
Revenue cycle management teams are already challenged by a number of regulations: the No Surprises Act, price transparency mandates, reimbursement changes to telehealth and behavioral health, even the voluntary Making Care Primary model can all impact payment models and the revenue cycle. As, of course, can provisions in the older HITECH and HIPAA regulations that remain important to comply with or risk financial penalties.
How healthy is your organization’s revenue cycle? Conduct a self-assessment using the Ingenious Med RCM Scorecard to both determine where your organization is meeting key revenue cycle metrics and identify areas in need of urgent improvement.
Sources:
[1] Hospitals face “make-or-break year” after bleak 2022, Fitch says, Bloomberg
[2] Moody’s upgrades healthcare outlook from negative to stable in 2024, Healthcare Finance
[3] Moody’s upgrades healthcare outlook from negative to stable in 2024, Healthcare Finance
[4] Where does it hurt? The many sources of pain in RCM and the potential of AI, Ingenious Med
[5] Survey: Workforce challenges cited by CEOs as top issue confronting hospitals in 2022, American College of Healthcare Executives
[6] Survey: Personnel shortages cited above financial challenges as top issue confronting hospitals in 2021, American College of Healthcare Executives
[7] Ambulatory Revenue Cycle Management Services 2023, KLAS
[8] Nearly two-thirds of doctors are burned out, poll shows, HealthDay
[9] National Consumer Survey 2023: Money matters: the rising standard for healthcare, Jarrard, Inc.
[10] Key ways to boost collection of patient financial responsibility, RevCycleIntelligence
[11] Understanding Medicare’s Merit-based Incentive Payment System, American Medical Association
[12] The power of MIPS: Benefits, consequences, and financial impact, Ingenious Med
[13] The power of MIPS: Benefits, consequences, and financial impact, Ingenious Med
[14] Region 8 HFMA: Under Attack: Safeguarding Hospital Revenues in a Downtime Event, Ingenious Med (webinar)
[15] Internet Crime Report 2022, U.S. Federal Bureau of Investigation
[16] Hospitals could be one cyberattack away from closure, Axios
[17] Average duration of downtime after a ransomware attack at organizations worldwide from 1st quarter 2020 to 2nd quarter 2022, Statista
[18] How healthcare is tackling clinician burnout, Becker’s Health IT
[19] Where does it hurt? The many sources of pain in RCM and the potential of AI, Ingenious Med
[20] Where does it hurt? The many sources of pain in RCM and the potential of AI, Ingenious Med
[21] The urgent AI opportunity in revenue cycle management: Creating a competitive advantage, Ingenious Med
[22] 5 insights from VBC leaders, Advisory Board
[23] Where does it hurt? The many sources of pain in RCM and the potential of AI, Ingenious Med
[24] Where does it hurt? The many sources of pain in RCM and the potential of AI, Ingenious Med