Under intensifying margin pressures, revenue cycle can no longer be viewed as the cost of doing business; instead, it must be treated as a more strategic asset. For vendors in the space, this approach could mean both good and bad news. More providers may look to third parties for support—but in such a crowded market, providers are struggling to separate signal from noise.
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At the end of 2018, Advisory Board hosted our first ever Revenue Cycle Executive Summit. Across the two-day, provider-only meeting, revenue cycle leaders discussed challenges and potential solutions related to capturing the most possible revenue at the lowest possible cost.
In this Q&A with Jessie Goldman, Robin Brand, Senior Director with our new Revenue Cycle Advancement Center research team, recapped key themes and takeaways from the summit and offered some important lessons for vendors to keep in mind moving forward.
Question: Who was at the inaugural Revenue Cycle Executive Summit?
Robin Brand: We hosted 14 leaders, mostly VPs of Revenue Cycle or Chief Revenue Officers, from hospitals and health systems across the country. As we thought about the invite list, we wanted to ensure good organizational and geographic diversity.
Q: What topics did you cover and what were the group's key takeaways?
Brand: We focused on three topics that we are consistently asked about by revenue cycle leaders: payer denials, patient financial experience, and AI in revenue cycle.
Payer denials: Everyone in attendance agreed that they are overwhelmed by denials, which confirmed our assessment that denial management is a nationwide, payer-agnostic challenge. We learned that providers have already invested significant time and dollars into denial prevention—in some cases taking steps towards payer partnerships—but we don't expect the momentum to stop here. While no given product or solution has the power to eliminate all denials, providers will likely explore solutions, including those that help undercover root cause of denials and offer real time data to aid denial prevention.
Patient financial experience: More providers are thinking about patient financial experience as a holistic journey, rather than discrete events that primarily take place during and after care delivery. Leading up to the summit, we surveyed 1,000 consumers and found that 90% consider pre-care price estimates to be somewhat or extremely important. Because of that, I was encouraged by the group's general consensus around the value of a pre-service bill and expect to see more investment in tools that can ease the overall financial experience.
On a related note, we also had a robust discussion around CMS' new price transparency requirements. Most attendees agreed that while posting a chargemaster online will mean little to a patient, it is worth investing in price estimation tools that can increase point-of-service collections and improve overall odds of getting paid.
AI in revenue cycle: Revenue cycle leaders are generally interested to see how AI might improve efficiency—but like many other hospital executives, they want help separating AI hype from reality. For example, many have lingering questions about the best use cases, whether they should build or buy the solution, and if buying, how to assess and select the best vendors. And beyond the technical aspects of AI, they want to ensure they're investing in solutions that they're able to successfully integrate into existing workflow.
Q: Did any discussion points or member reaction surprise you?
Brand: Like most Advisory Board meetings, we started the day with a Revenue Cycle State of the Union. We examined new government priorities, the rise of the activist employer, and the emergence of hospital-less IDNs. And throughout the discussion, we tied those forces back to revenue cycle leaders' day-to-day work. I thought the group would gravitate towards those direct implications, but was surprised to find they were more interested in discussing the broad shifts to the industry. In retrospect, I think this speaks to a broader shift we're seeing across revenue cycle departments in which they're moving from being a siloed operation to one that holds more strategic power across the entire organization, and thus benefits from understanding that bigger picture.
Q: What advice would you offer to vendors working in this space?
Brand: First, as I alluded to across the key topics, the growing focus on revenue cycle will open opportunities both for vendors that have been at it for years and those that are just getting started in this market. But the rapid movement has side effects on the provider-vendor relationship. Both at the summit and in the months since, revenue cycle leaders have expressed feeling overwhelmed by the number of potential products or solutions they can invest in.
Just as revenue cycle leaders are evaluating their position within broader system strategy, vendors cannot lose sight of the fact that they are one piece in a complex puzzle. For example, do not brush over how a solution will fit in with existing revenue cycle processes, including other third party programs, workflow, or staff requirements. Being upfront and clear about the actual versus theoretical value of the solution or partnership can help set you apart in a very crowded market.
Q: What more do we have to look out for from your research team?
Brand: Right now, our team is working on a range of research that will cover physician office revenue cycle, revenue integrity departments, and revenue cycle staffing and engagement. The research will be released this summer, but look out for blog posts and other research teasers in the meantime.
Follow the patient financial journey—from pre-care through billing and collections
Follow the patient financial journey, from pre-care through billing and collections. Learn a patient's questions and fears that arise at each step, and what tools and support your revenue cycle program must proactively provide.