The Ongoing Evolution of Healthcare Revenue Cycle Solutions

February 26, 2014

Much like medical practices, revenue cycle solutions are trying to keep up with regulations and other healthcare changes. Here's what you need to know.

As healthcare changes, the way many practices and health systems think about revenue cycle solutions will begin changing as well.

That's according to Elaine Remmlinger, a senior partner and leader of the healthcare IT practice at Kurt Salmon,

a global management and strategy consulting firm.

At this year's Healthcare Information and Management Systems Society (HIMSS) Conference in Orlando, Fla., Remmlinger discussed the state of the revenue cycle solutions market, how it is changing, and how health systems can begin navigating this change during her session entitled "Next Generation Revenue Cycle - Is Now the Time?"

"This is not about just billing, this is about much more, "said Remmlinger. "Depending on your scope, these solutions can help to improve the patient experience, can help enable care coordination, provide the analytics and reporting that we've needed for so long, help you move towards your journey in new payment models ... make you more efficient inside the business office, inside of the various areas that support the front end to the back end, and help improve your bottom line financial performance."

Several factors are pushing revenue cycle management vendors to expand their capabilities, said Remmlinger. These factors include new payment models that reward high-quality, low-cost care; increasing integration between practices, hospitals and other health systems; the transition to ICD-10; and the pressure on practices and health systems to operate more efficiently. “The impact of all of this happening at the same time is tipping the marketplace to move forward with these projects," she said.

Right now, many vendors are focusing on providing more of an "enterprise solution" to revenue cycle, one that can be applied and used throughout the continuum of care (such as within all of the practices and hospitals that are part of an integrated health system). In addition, vendors are exploring more data analytics capabilities and dashboards within their product offerings, said Remmlinger.

Other big changes to the product offerings and the overall market include: fewer add-ons within solutions (because "bolt-ons" are becoming part of the core system) and the push toward more modern technology platforms, she said. In addition, as more vendors provide enterprise solutions with more capabilities, health systems may be working with fewer vendors overall.

"As the needs become more integrated and the lines blur with the clinical environment, it's clearly way more than just about billing," said Remmlinger. Revenue goes from the front end to the back end, including patient management. It now includes care management."

While the scope of revenue cycle solutions is changing, this change will be gradual, she said. Many health systems are reluctant to undergo a conversion due to the scope and financial commitment such a project entails. In addition, many are still focusing on the ICD-10 transition and meeting meaningful use requirements. On the vendor side of things, many of the products simply aren't yet ready for implementation, said Remmlinger.

“While this transition has been occurring for probably a decade now, it’s probably going to go on for another five years before we see these next generation solutions replace the legacy systems and the enterprise systems mature," she said.