Top 10 revenue cycle trends

1. A move towards pricing transparency 🔍

There have been public calls for more pricing transparency in healthcare for decades, but limited public interest in an issue that few felt (or could even attribute) acutely. The explosion of high-deductible plans has turned those disparate sparks into a flame. 

With the executive order issued in June explicitly aiming to force providers and plans to operate with greater transparency, many RCM operations will scramble to set up the infrastructure necessary to support transparency. Given that few have the technology, operations, or infrastructure in place to offer transparency, it will take time, but there is finally momentum.

2. Widespread automation 🤖

If there was a healthcare executive at the JP Morgan conference who didn’t speak about automation, I must have missed it. 2019 saw automation technologies prove themselves across a number of functions, particularly on the administrative side, providing organizations with the case studies and evidence needed to push through new initiatives.

3. Heightened focus on security 🔐

As evidenced by the media fervor over Ascension's partnership with Google, consumers are becoming increasingly concerned about the privacy and security of their personal data. This increased awareness is coming amidst a broad movement of data towards the cloud and many, if not all, revenue cycle functions to outside service providers. Providers will mitigate risk by demanding higher standards of security and compliance from all their vendors. Good news for audit and certification firms.

4. Ambient AI-driven transcription doesn’t pan out 💻

2019 saw a number of startups such as Robin, Notable, and Suki hoping to take the technology that had made Alexa and Siri household names and use it to finally free physicians from documentation--an AI scribe that would passive listen to an encounter and create notes. Unfortunately, the bar for accuracy combined with the technical challenge of distilling a conversation (rather than direct dictation) to accurate and concise clinical notes is far beyond current technology. Expect to see these startups narrow their focus to something that looks a lot like Nuance’s current offerings or shift their focus to other parts of the patient journey or physician experience.

5. More provider-payer collaboration 💸

As frustration with the increasing inefficiency of the traditional revenue cycle process has grown and value-based payment initiatives begin to demonstrate positive returns, expect to see both sides continue to find new and creative ways to align interests to reduce costs and increase predictability and transparency for both sides.

6. Clean, well-structured data 🧱

As both vendors and providers continue to see their efforts to adopt new technologies get blocked or hamstrung by issues of data access, format, and fragmentation, look for large investments in data unification efforts that will allow organizations to more easily adopt or build in-house solutions.

7. Growth in outpatient CDI 📁

The AHA has reported that outpatient revenue is now roughly equivalent (95%) to inpatient revenue for American hospitals[1]. Naturally, with the increased revenue comes increased revenue risk. Thorough and accurate documentation in the outpatient setting will play a more meaningful role in revenue integrity than ever. As coding automation rates increase due to technologies like ours, look for RCM operations to increasingly deploy their coders to outpatient CDI efforts alongside the adoption of tools like Iodine and Artifact Health.

8. VC 🤝 RCM

One of the PE community’s favorite hunting grounds is about to be overrun by Stanford grads in Patagonia vests. Over the last couple of years, we have seen a remarkable number of companies coming through YCombinator or being funded by tier-one venture funds that are focused on addressing various pieces of the revenue cycle. While not all of these firms have found strong product-market fit, they have educated the venture capital community on both the scale of the revenue cycle industry and the opportunities for technology to transform it.

9. Providers accelerate their efforts to outsource their revenue cycle 🚪

R1 is projecting a 12% annual growth in outsourced RCM through 2022. That number may turn out to be conservative as automation technology and offshore labor pools drive substantive cost and efficiency benefits to scaled RCM operations.

10. Better measurement and analytics 📊
With better infrastructure, data, and tooling, RCM operations will be empowered to measure and track all the things they have always been wanting to and a handful they probably haven’t yet imagined that they could.

[1] https://www.advisory.com/daily-briefing/2019/01/08/hospital-revenue

Photo: Tomasz Frankowski