Black Book, a leading market research firm in healthcare, recently released its annual report on the 2014 State of the Revenue Cycle Management industry. What is clear from the survey is that practice managers and physicians both recognize that effective revenue cycle processes are the lifeblood of their practice. Streamlined patient registration, insurance and benefit verification, charge capture, and claims processing are essential to maintaining practice viability. There is major flux in the industry as many practice owners turn their attention to improving their revenue cycle systems and processes and increasingly consider working with a partner dedicated to providing these services.
Some Key Survey Findings:
- 90% Solo and Small Physician Practices with In-House billers and collectors expect to outsource most or all of their medical billing functions in the next 24 months
- 42% of all small physician practices (1 – 5 practitioners) with employed billing staff hope to move billing out-of-house to an outsourcer in next twelve months
- Additionally, 81% of physician practices, whether networked, independent or part of a large group or hospital system anticipate declining-to-negative profitability in 2015 due to diminishing reimbursements and underutilized or inefficient billing and records technology.
- 91% of business managers fear that the ramifications of their outdated and/or auto-piloted revenue cycle management systems, particularly those not integrated to EHRs, will force their physician to sell the entire practice operation to a larger physician group or hospital within 12 months or face practice dissolution
- 87% of business managers are certain their old practice management and revenue cycle cannot accommodate upcoming regulatory requirements and updates such as ICD-10. Nearly 98% state the practice’s financial software and workflows are unprepared for ACO participation
- 90% of business managers in practices still independent confirm that an innovative, seamless RCM/PM/EHR system would ensure long term practice independence, and greatly improve productivity and profitability
- 89% of all Physician practices agree their billing and collections systems/processes need upgrading
- 21% are considering an upgrade of their RCM software within 6 -12 months. 88% expect a current RCM system upgrade within 6 months
- 90% of physicians currently replacing their EHRs are seeking a seamless single source vendor, and prefer vendors that offer software, outsourcing, and consulting options in their EHR/RCM/PM transformation
These findings are consistent with a 2012 study by Accenture on Physician Alignment, where physicians where 74% of primary care physicians responded that they lack effective financial controls over their practice.
Practices that would like to remain independent but don't have unlimited financial or human capital are increasingly considering "in-sourcing" as an option. With insourcing, practices can leverage the resources and capabilities of a trusted, stable partner that has the significant expertise, technical knowhow and capital required and is focused on ensuring the practice's financial success. In this way, practices can leverage the benefits of operational scale, technical expertise and capital investment of a business partner. By working with a company that is wholly focused on business operations and revenue cycle optimization, practices can maintain control over all clinical decisions and thrive as an independent practice.
Sources: BLACK BOOK(TM) 2014. A Division Of Brown-Wilson Group Inc., Black Book Polls & Surveys http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture-Clinical-Transformation-New-Business-Models-for-a-New-Era-in-Healthcare.pdf#zoom=50