Revenue cycle management enters consumer age

Revenue cycle management enters consumer age

Patients finding voice, as vendors prep new offerings

The healthcare revenue cycle management process, having stayed steady for so many years, is now undergoing lightning-fast change on many different fronts.

Whether it’s big picture (the Affordable Care Act, which, thanks the Supreme Court’s 6-3 decision in King v. Burwell this past June, finally looks to be here to stay) or small (the myriad choices patient now have when it comes to choosing and paying for their care), providers find themselves in an uncertain world when it comes to getting paid.

Stuart Hanson, chair of the HIMSS Revenue Cycle Improvement Task Force doesn’t hesitate when asked what the biggest immediate impact on RCM is, at least in the near term: “The increase in consumer financial responsibility is the number one issue,” he says.

“We’ve seen this flood of consumers with high-deductible health plans, whether they came from a public or private exchange, or their employer,” says Hanson, senior vice president of healthcare consumer payment solutions at Emdeon. “Providers are now, in earnest, starting to grasp how quickly this paradigm shift is occurring.

“If you were in the hospital space 10 years ago you probably collected about 5 percent of your revenue from patients, maybe as much as 10,” he adds. “In the past 18 months or so, that number has shifted dramatically. Now it’s more like 30-35 percent.”

Part of that, of course, has to do with the growing impact of Obamacare, points out Pamela Jodock, senior director, health business solutions at HIMSS.

“Large numbers of people signing up under ACA chose high-deductible health plans, which was not the trend that was anticipated,” she says. “That dramatically accelerated the impact of self-pay on providers.”

There’s a whole lot of talk these days about the shift from volume to value, of course. But there’s also a lot uncertainty about just what that means – and what it will continue to mean in the long term.

“We’re still as a market trying to determine, what exactly does value-based reimbursement look like? How do we define it? How do we associate price to value?” says Jodock.

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