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CFOs will spend more for revenue cycle technology, but providers still struggle to realize benefits

About 90 percent of those surveyed say an increase in consumer responsibility for the bill will impact their organizations.

Susan Morse, Associate Editor

Nearly three-quarters of the 125 chief financial officers and revenue cycle executives surveyed by Navigant plan to increase the amount hospitals spend on healthcare technology. However, many are struggling to see the financial benefit of the tools, especially when it comes to the electronic health record, according to the survey

In fact, more than half said they can't keep up with EHR upgrades.

"There's not an engagement we see that does not involve technology as part of the solution," said Navigant Managing Director Jake Morris, who co-presented the survey results at Healthcare Financial Management Association's Annual National Institute in Orlando this past June.

When asked which revenue cycle capability their organization is most focused on over the next year, 79 percent said technology-related capabilities, according to the joint HFMA-Navigant survey.

But what executives really want to see is more revenue integrity reporting to determine just how revenue cycle functions improve financial standing and boost overall patient engagement.

[Also: Smaller practices invest in costly transition to value-based care]

"With all the EHR rollouts, the topic of revenue integrity is definitely a theme," Morris said. "The technology, the cost of it, how to get ROI, the goal is to get interconnective. There's some stress around it to see margins improve, that's coming through loud and clear." 

What's surprising from the Navigant\HFMA survey is that only half of providers said they had a revenue integrity department to track accurate coding, charge capture, reasonable pricing for services and other financial reporting, Morris said.

Those that have established revenue integrity programs are benefitting from them, he said. Sixty-eight percent of those with a revenue integrity program realized an overall increase in net collections.

[Also: Healthcare industry should employ behavioral economics to change outcomes, increase financial success]

"With the market shifting and the importance of clinical outcomes, what's interesting to me is that the market needs to catch up faster,"

Morris said. "Eighty to 90 percent of hospitals need this integrated effort for revenue integrity."

The University of Alabama at Birmingham Medicine Clinical Operations CFO Mary Beth Briscoe also said she was surprised because revenue integrity focuses on aspects which support the billing process, which is also how Medicare gets its quality data from providers. Organizations should be analyzing this same information to improve the clinical and billing processes.

"It is not only that the bill paints a clinical picture, it also paints a financial picture," said Briscoe, a co-presenter of the survey findings. "That bill is a communication tool to third party payers on how we deliver care. Our bill is at the intersection of providing high quality care, coupled with compliant, complete billing practices."

[Also: Communication, training, education should lead revenue cycle operations, HFMA policy expert says]

If a missed code means missed revenue, technology needs to pick up the aberration, not just record everything that's going on, Briscoe said. It needs to flag the exceptions.

"We need to make sure what happens at bedside is captured accurately," Morris said.

While technology is needed to improve revenue cycle management, technology alone will not lead to better financial health, experts believe.

"Technology in and of itself is not the answer," Briscoe said. "It's not just more technology, it's having people skilled to run the technology."

That means other staff needs to be freed up to concentrate on the patient and how the hospital is interacting with them, Briscoe said. 

Most hospitals are in the midst of making changes that incorporate technology and put a focus on the patient.

The Navigant\HFMA survey shows 90 percent or providers are concerned about consumer self-pay, especially as high-deductible plans mean patients pay more in out-of-pocket costs.

For example, the University of Alabama at Birmingham, a large academic medical center, pursued an HFMA initiative that offers organizations ways to have patient-friendly communications, Briscoe said.

"Our patients can have a great clinical experience," Briscoe said, "If they don't have the same financial experience, we've let them down. I think the focus is more around improving the interaction."

One way Alabama has improved the interaction is more upfront discussions with patients about payment, she said. This also decreases the back-end work.

"It's getting the patient comfortable with the bill and presenting them with options to make payment convenient," Morris said.

Judi Fox, CFO at Rutland Regional Medical Center in Vermont, also discussed the intersection of technology and patient engagement during a different session at ANI.

According to her, interoperability is needed to merge medical records into one shared record, she said. All providers need to have access to information on the same patient they're all treating.

It's easier to share information within the same four walls of one organization. What is missing is the sharing of information among care providers within the community, between primary care and home health providers and specialists such as cardiologists. 

"Many organizations are on a journey to develop it," Fox said. "The obstacle is interoperability, to share disparate records. We're in the discovery stage, trying to understand whether we can build our own data warehouse."

More survey findings

CFOs seemed to be more realistic about their organization's capabilities. Forty percent of CFOs, compared to 54 percent of revenue cycle leaders, said they were quickly able to use new functional releases from EHR.

Forty-one percent said they did not measure the effectiveness of technology changes. Thirty-eight percent measured IT's effectiveness by how it impacted the hospital's return on investment. Another 35 percent looked at an overhead reduction.

In clinical documentation, 95 percent had deployed an integrity technology solution for inpatient care, but only 35 percent had done the same for outpatient.

Nine in 10 of executives believe consumer responsibility for healthcare costs will continue to affect revenue. Rural providers were almost twice as concerned.

Most providers now offer a consumer-friendly patient portal that offers online payment options and 63 percent offer cost-of-care estimation tools.

But only 14 percent use advanced modeling tools for predicting propensity to pay.

Providers are focused mainly on technology to drive their revenue cycle management improvements. Tactics range from revenue integrity efforts, according to 22 percent of respondents, to 18 percent who are focused on physician and clinician documentation. Another 18 percent are putting the priority on business intelligence and analytics. Others, in decreasing percentages, are focused on EHR workflow and reporting, self-pay management, coding, labor utilization and staff training and incentives.

When asked which revenue cycle capability their organization is most focused on for improvement over the next year, 79 percent of respondents suggested technology-related capabilities, including business intelligence analytics, electronic health record-enabled workflow or reporting, revenue integrity, and coding and physician/clinician documentation.

Providers are struggling to leverage tech power and EHRs in particular – 51 percent said their organizations can't keep up with EHR upgrades or fail to maximize functional workflow and reporting improvements. 

Twitter: @SusanJMorse

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