Hospitals Aren’t Getting Much ROI From RCM Technology

Posted on July 24, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

If your IT investments aren’t paying off, your revenue cycle management process is clunky and consumers are defaulting on their bills, you’re in a pretty rocky situation financially. Unfortunately, that’s just the position hospitals find themselves in lately, according to a new study.

The study, which was conducted by the Healthcare Financial Management Association and Navigant, surveyed 125 hospital health system chief financial officers and revenue cycle executives.

When they looked at the data, researchers saw that hospitals are being hit with a double whammy. On the one hand, the RCM systems hospitals have in place don’t seem to be cutting it, and on the other, the hospitals are struggling to collect from patients.

Nearly three out of four respondents said that their RCM technology budgets were increasing, with 32% reporting that they were increasing spending by 5% or more. Seventy-seven percent of hospitals with less than 100 beds and 78% of hospitals with 100 to 500 beds plan to increase such spending, the survey found.

The hospital leaders expect that technology investments will improve their RCM capabilities, with 79% considering business intelligence analytics, EHR-enabled workflow or reporting, revenue integrity, coding and physician/clinician documentation options.

Unfortunately, the software infrastructure underneath these apps isn’t performing as well as they’d like. Fifty-one percent of respondents said that their organizations had trouble keeping up with EHR upgrades, or weren’t getting the most out of functional, workflow and reporting improvements. Given these obstacles, which limit hospitals’ overall tech capabilities, these execs have little chance of seeing much ROI from RCM investments.

Not only that, CFOs and RCM leaders weren’t sure how much impact existing technology was having on their organizations. In fact, 41% said they didn’t have methods in place to track how effective their technology enhancements have been.

To address RCM issues, hospital leaders are looking beyond technology. Some said they were tightening up their revenue integrity process, which is designed to ensure that coding and charge capture processes work well and pricing for services is reasonable. Such programs are designed to support reliable financial reporting and efficient operations.

Forty-four percent of respondents said their organizations had established revenue integrity programs, and 22% said revenue integrity was a top RCM focus area for the coming year. Meanwhile, execs whose organizations already had revenue integrity programs in place said that the programs offered significant benefits, including increased net collections (68%), greater charge capture (61%) and reduced compliance risks (61%).

Still, even if a hospital has its RCM house in order, that’s far from the only revenue drain it’s likely to face. More than 90% of respondents think the steady increase in consumer responsibility for care will have an impact on their organizations, particularly rural hospital executives, the study found.

In effort to turn the tide, hospital financial execs are making it easier for consumers to pay their bills, with 93% of respondents offering an online payment portal and 63% rolling out cost-of-care estimation tools. But few hospitals are conducting sophisticated collections initiatives. Only 14% of respondents said they were using advanced modeling tools for predicting propensity to pay, researchers said.