Revenue cycle management has seen ups and downs in recent years. What awaits us for managing the revenue cycle?
Last year we saw the continued emergence of automation and AI. We also saw a battle for price transparency.
We continued the trend of previous years and also saw that healthcare organizations faced patient expectations, government regulations, and a growing number of technological options.
Let's take a look at some of the revenue cycle management (RCM) trends we're preparing for in 2020.
The ongoing struggle for transparency in health care prices
Transparency trajectories across health care prices have taken place across the country in 2019. Expect the fighting to continue in 2020.
A Waystar study, published in August 2019, found that lack of price transparency was the single largest contributor to the negative patient experience. Governments are pushing for more transparency in healthcare and healthcare organizations are adapting.
Last year we saw that healthcare organizations implemented strategies to better manage patients' financial journeys. We expect healthcare organizations to take the next step in 2020.
Some organizations have published the chargemaster online, giving patients complete transparency about how much services cost. Because batch master prices are not necessarily the prices charged to the patient, these resources can be difficult for patients to interpret.
In June 2019, the Trump administration signed an executive order stating that health systems provide cost estimates to patients in advance.
Look for more transparency and better access to prices for patients as we move through 2020.
Higher demand for revenue cycle management RCM outsourcing
Income cycle management outsourcing is increasingly popular with healthcare organizations - and it has been a trend for years.
The trend towards outsourcing revenue cycle management is expected to continue in 2020.
Income cycle management companies advertise benefits such as risk and reward sharing, creating a win-win solution for partner organizations. Healthcare organizations can create a sustainable, high-performing engine while still enjoying growing cash flow.
As income cycle management outsourcing companies become more competitive, outsourcing is becoming an increasingly attractive option for healthcare organizations.
More cybersecurity battles and ransomware attacks
Cybersecurity has been a priority for healthcare organizations for more than a decade and this trend is expected to continue into 2020.
Cyber attacks are not going to stop anytime soon. Healthcare organizations need a coherent cybersecurity strategy to remain competitive.
In April 2019, the U.S. government reported 44 data breaches in healthcare, the highest number of healthcare breaches reported in one month since the government began detecting healthcare breaches in 2010. The previous record was set in April 2018, when there were 42 violations.
Ransomware attacks are especially common. Last year, Carbon Black released a study that found 66% of healthcare organizations have experienced a ransomware attack in the past 12 months.
Higher volumes and patient yield
Hospitals nationwide ended in 2019 with an increase in the profitability of hospitals. The increase was related to increases in patient net revenues and service volumes. Hospitals treated more patients - and made more money with those patients - than ever, according to a report by RevCycle Intelligence.
This profitability increased despite a slight increase in delivery costs, increases in bad debts, increases in charity, and mixed performance on expenses.
More than 800 hospitals across the country saw particularly high volumes in custom layoffs, emergency room (ER) visits, and operating room (OR) minutes.
It was a positive trend after a difficult year. The December 2019 increase was the first annual increase in the operating EBITDA margin in six months. Hospital operating margins also increased by 171.8 basis points compared to November 2019.
Overall, EBITDA margins grew 136.9 basis points year-on-year in December 2019. This trend may continue until 2020.
CFOs are getting more involved
The role of the CFO in healthcare has changed in recent years. 2020 may well be the year when it becomes even clearer.
CFOs are expected to continue to play a leading role at every level of the healthcare organization. Modern healthcare CFOs don't just listen: they act.
Larry Todd, IT Leaders Revenue Cycle Healthcare, recently recommended that CFOs go beyond listening and begin implementation:
"... any implementation will affect the organization's revenues, so it is very important that CFOs are involved in the implementation project and are informed of the key elements of the project that could jeopardize the organization and its revenues."
In the same article, Linda Hoff of Legacy Health described how CFOs should have a specific interest in not only financial matters but also in patient satisfaction and quality. All statistics are closely intertwined:
"You have a passion for what you do within your facilities, how you interact with patients. You should be as interested in patient satisfaction and quality as you are in financial administration. If you don't have that passion for all of those aspects, you will be yourself today don't really get into a CFO role for the day. "
Surprise billing is still under attack
The surprise invoice was beaten at the end of 2019. In December, members of Congress announced the extension of a two-pronged investigation of oppression practice. As a result of this expansion, the research will now look at temporary employment agencies and health insurers.
That same month, a study by Health Affairs found that annual health care expenditures for employer-sponsored health insurance patients would drop by $ 40 billion if specialists were unable to bill outside the network.
A report from the Kaiser Family Foundation, published in June, found that one in six Americans received a surprising medical bill in 2017, despite being covered by health insurance.
As surprise billing continues to make headlines across the country, surprising billing practices will continue to be attacked.
Look for these trends and more to make headlines in revenue cycle management by 2020.