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New Service Brings RCM Process To Blockchain

Much of the discussion around blockchain (that I’ve seen, at least) focuses on blockchain’s potential as a platform for secure sharing of clinical data. For example, some HIT experts see blockchain as a near-ideal scalable platform for protecting the privacy of EHR-based patient data.

That being said, blockchain offers an even more logical platform for financial transactions, given its origins as the foundation for bitcoin transactions and its track record of supporting those transactions efficiently.

Apparently, that hasn’t been lost on the team at Change Healthcare. The Nashville-based health IT company is planning to launch what it says is the first blockchain solution for enterprise-scale use in healthcare. According to a release announcing the launch, the new technology platform should be online by the end of this year.

Change Healthcare already processes 12 billion transactions a year, worth more than $2 trillion in claims annually.  Not surprisingly, the new platform will extend its new blockchain platform to its existing payer and provider partners. Here’s an infographic explaining how Change expects processes will shift when it deploys blockchain:

Change_Healthcare_Intelligent_Healthcare_Network_Workflow_Infographic

To build out blockchain for use in RCM, Change is working with customers, as well as organizations like The Linux Foundation’s Hyperledger project.

Hyperledger encompasses a range of tools set to offer new, more-standardized approaches to deploying blockchain, including Hyperledger Cello, which will offer access to on-demand “as-a-service” blockchain technology and Hyperledger Composer, a tool for building blockchain business networks and boosting the development and deployment of smart contracts.

It’s hard to tell how much impact Change’s blockchain deployment will have. Certainly, there are countless ways in which RCM can be improved, given the extent to which dollars still leak out of the system. Also, given its existing RCM network, Change has as good a chance as anyone of building out blockchain-based RCM.

Still, I’m wondering whether the new service will prove to be a long-term product deployment or an experiment (though Change would doubtless argue for the former). Not only that, given its relatively immature status and the lack of broadly-accepted standards, is it really safe for providers to rely on blockchain for something as mission-critical as cash flow?

Of course, when it comes to new technologies, somebody has to be first, and I’m certainly not suggesting that Change doesn’t know what it’s doing. I’d just like more evidence that blockchain is ready for prime time.

October 6, 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.

Hospitals Aren’t Getting Much ROI From RCM Technology

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.

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.

Providers Work To Increase Patient Payments By Improving RCM Operations

A growing body of research on healthcare payment trends is underscoring a painful fact: that consumers are footing a steadily growing share of their medical bills, and sometimes failing to pay. In response, providers are upgrading their revenue cycle management systems and tightening up their collections processes.

A new analysis by payment services vendor InstaMed has concluded that consumer spending on healthcare services should grow to $608 billion by 2019. This is a fairly substantial number even given the high volume of U.S. healthcare spending, which hit $3.4 trillion in 2016.

The growth in patient spending has been fueled by the emergence of high-deductible health plans, which are saddling consumers with increasingly large financial obligations. According to CMS figures cited in the report, the average deductible for covered workers with single coverage has doubled over the past several years, from $735 in 2010 to $1.487 in 2016.

But despite the increasing importance of consumers as healthcare payers, providers don’t seem to be doing enough to inform them about costs. More than 90% of consumers would like to know what the payment responsibility is prior to a provider visit, but they often don’t find out what they owe until they get a bill. What makes things worse is that very few consumers (7%) even know what a deductible, co-insurance and out-of-pocket maximum are, so they’re ill-prepared to understand bills when they receive them, studies have found.

Providers are waiting longer to collect what they are owed by patients, with three-quarters waiting a month or longer to collect outstanding balances from patients. And problems with collecting patient accounts are getting worse over time.  In fact, a new study from TransUnion Healthcare found that about 68% of patients with bills of $500 or less didn’t pay off the full balance during 2016, up from 49% in 2014.

Meanwhile, patient financial responsibility for care has risen from 10% to 30% of costs over the last few years, with more increases likely. This has led to expanding levels of consumer bad debt for medical expenses.

In attempt to cope with these issues, providers are buying new revenue cycle management systems. A survey released last year by Black Book Research, which included 5,000 management and user-level RCM clients, found that many healthcare organizations are rethinking RCM technology and demanding better performance.

Forty-eight percent of responding CFOs told Black Book that they weren’t sure they had the budget they needed to upgrade to an end-to-end RCM system this year.  Nonetheless, 93% of CFOs said they planned to eliminate RCM vendors, financial and coding technology firms, that are not producing a return on investment, up from 79% with similar plans in Q4 2015.

In addition to investing in newer RCM technology, providers are making it easier for patients to pay via whatever medium they choose. Not only are providers issuing bill reminders via text, and accepting payments online and by phone, they’re also adding new channels like PayPal payments, bank transfers and mobile payments.

June 29, 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.

Patient Billing And Collections Process Needs A Tune-Up

A new study from a patient payments vendor suggests that many healthcare organizations haven’t optimized their patient billing and collections process, a vulnerability which has persisted despite their efforts to crack the problem.

The survey found that while the entire billing collections process was flawed, respondents said that collecting patient payments was the toughest problem, followed by the need to deploy better tools and technologies.

Another issue was the nature of their collections efforts. Sixty percent of responding organizations use collections agencies, an approach which can establish an adversarial relationship between patient and provider and perhaps drive consumers elsewhere.

Yet another concern was long delays in issuing bills to patients. The survey found that 65% of organizations average more than 60 days to collect patient payments, and 40% waited on payments for more than 90 days.

These results align other studies that look at patient payments, all of which echo the notion that the patient collection process is far from what it should be.

For example, a study by payment services vendor InstaMed found that more than 90% of consumers would like to know what the payment responsibility is prior to a provider visit. Worse, very few consumers even know what the deductible, co-insurance and out-of-pocket maximums are, making it more likely that the will be hit with a bill they can’t afford.

As with the Cedar study, InstaMed’s research found that providers are waiting a long time to collect patient payments, three-quarters of organizations waiting a month to close out patient balances.

Not only that, investments in revenue cycle management technology aren’t necessarily enough to kickstart patient payment volumes. A survey done last year by the Healthcare Financial Management Association and vendor Navigant found that while three-quarters of hospitals said that their RCM technology budget was increasing, they weren’t necessarily getting the ROI they’d hoped to see.

According to the survey, 77% of hospitals less than 100 beds and 78% of hospitals with 100 to 500 beds planned to increase their RCM spending. Their areas of investment included business intelligence analytics, EHR-enabled workflow or reporting, revenue integrity, coding and physician/clinician documentation options.

Still, process improvements seem to have had a bigger payoff. These hospitals are placing a lot of faith in revenue integrity programs, with 22% saying that revenue integrity was a top RCM focus area for this year. Those who would already put such a program in place said that it offered significant benefits, including increased net collections (68%), greater charge capture (61%) and reduced compliance risks (61%).

As I see it, the key takeaways here are that making sure patients know what to expect financially and putting programs in place to improve internal processes can have a big impact on patient payments. Still, with consumers financing a lot of their care these days, getting their dollars in the door should continue to be an issue. After all, you can’t get blood from a stone.

October 1, 2018 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.

Investors Competing For Health IT Opportunities

A new study has concluded that investors are hungry for health IT investment opportunities, in some cases battling competitors for particularly attractive companies. The report concluded that investment firms see health IT as a lower-risk way to get a cut of the healthcare market than other possible targets.

The analysis by Bain & Company, which looks at 2017 numbers, said that the number of health IT investment deals completed last year rose to 32 from 23 in 2016.

The value of disclosed deals fell from $15.5 billion in 2016 to $1.9 billion in 2017. This is not a sign of weakness in the sector, however. The 2016 deals volume was pumped up by two megadeals (acquisitions of MultiPlan and Press Ganey), which were valued collectively at $9.9 billion. Meanwhile, in 2017 only one deal exceeded $800 million.

Deal counts and volume aside, there’s no question that investors are still very interested in acquiring or taking a stake in health IT companies, Bain reports. According to its study, there are many good reasons for their excitement.

“Investors find HCIT target attractive not only because HCIT companies play a vital role in promoting technology adoption in healthcare but also because they bear less of the direct reimbursement and regulatory risk that affect other healthcare sectors,” the report says. “With a limited set of scale assets on the market and corporate buyers willing to pay premiums for those that do become available, valuations remain high and competition intense.”

The report notes that most of the health IT buyouts in 2017 involved biopharma investments, particularly among companies using IT solutions and advanced analytics to streamline development a testing of drugs. Such deals include the buyout of Certara, which offers decision support technology for optimizing drug development, and Bracket, which sells technology for managing clinical trials.

However, investors were also interested in EMR and practice management vendors. Given that just a handful of big vendors block of the market for hospital IT, they looked elsewhere.

In particular, investment firms were interested in consolidating some of the many vendors selling ambulatory care EMRs platforms supporting specialties like gastroenterology. For example, investors picked up a $230 million stake in Modernizing Medicine, which offers EMR and practice management systems for specialties such as dermatology and ophthalmology, Bain said.

In the future, investors will gain interest in revenue cycle management software. In addition to investing in or acquiring RCM tools for providers, investors may target RCM software helping patients pay their bills. For example, private equity firm Frontier Capital bought a majority stake in medical card company AccessOne last year.

Bain also predicts that Investors will pay growing attention to clinical decision support platforms, driven in part by legislation requiring doctors to use clinical decision support tools before ordering complex diagnostic imaging of Medicare patients.

In addition, investment firms are keeping their eye on population health management software vendors. It’s not clear yet which companies will dominate the sector, and how these platforms will evolve, so dealmakers are hanging back. Still, within a few years they may well begin to throw money at PHM companies.

June 28, 2018 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.

Time To Leverage EHR Data Analytics

For many healthcare organizations, implementing an EHR has been one of the largest IT projects they’ve ever undertaken. And during that implementation, most have decided to focus on meeting Meaningful Use requirements, while keeping their projects on time and on budget.

But it’s not good to stay in emergency mode forever. So at least for providers that have finished the bulk of their initial implementation, it may be time to pay attention to issues that were left behind in the rush to complete the EHR rollout.

According to a recent report by PricewaterhouseCoopers’ Advanced Risk & Compliance Analytics practice, it’s time for healthcare organizations to focus on a new set of EHR data analytics approaches. PwC argues that there is significant opportunity to boost the value of EHR implementations by using advanced analytics for pre-live testing and post-live monitoring. Steps it suggests include the following:

  • Go beyond sample testing: While typical EHR implementation testing strategies look at the underlying systems build and all records, that may not be enough, as build efforts may remain incomplete. Also, end-user workflow specific testing may be occurring simultaneously. Consider using new data mining, visualization analytics tools to conduct more thorough tests and spot trends.
  • Conduct real-time surveillance: Use data analytics programs to review upstream and downstream EHR workflows to find gaps, inefficiencies and other issues. This allows providers to design analytic programs using existing technology architecture.
  • Find RCM inefficiencies: Rather than relying on static EHR revenue cycle reports, which make it hard to identify root causes of trends and concerns, conduct interactive assessment of RCM issues. By creating dashboards with drill-down capabilities, providers can increase collections by scoring patients invoices, prioritizing patient invoices with the highest scores and calculating the bottom-line impact of missing payments.
  • Build a continuously-monitored compliance program: Use a risk-based approach to data sampling and drill-down testing. Analytics tools can allow providers to review multiple data sources under one dashboard identify high-risk patterns in critical areas such as billing.

It’s worth noting, at this point, that while these goals seem worthy, only a small percentage of providers have the resources to create and manage such programs. Sure, vendors will probably tell you that they can pop a solution in place that will get all the work done, but that’s seldom the case in reality. Not only that, a surprising number of providers are still unhappy with their existing EHR, and are now living in replacing those systems despite the cost. So we’re hardly at the “stop and take a breath” stage in most cases.

That being said, it’s certainly time for providers to get out of whatever defensive crouch they’ve been in and get proactive. For example, it certainly would be great to leverage EHRs as tools for revenue cycle enhancement, rather than the absolute revenue drain they’ve been in the past. PwC’s suggestions certainly offer a useful look on where to go from here. That is, if providers’ efforts don’t get hijacked by MACRA.

May 5, 2016 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.

The 2015 #HIT99 Results Are In

Thanks to everyone who participated in the #HIT99. The #HIT99 was announced on July 6th and nominations were opened. We saw a wide variety of nominations and a lot of new additions that I’d never seen before. For me the #HIT99 and #HIT100 are all about social discovery and showing gratitude to your social media peers. I know I experienced both of those during the process. I hope you did as well.

A big shout out to Steve Sisko (@shimcode) for aggregating, cleaning, and otherwise analyzing all of the data associated with #HIT99 nominations. I can only imagine the time he spent working on it. It’s hard work, so thank you Steve!

No list like this would be appropriate without recognition of Michael Planchart (@theEHRGuy) who created the first (and many subsequent) #HIT100. Hopefully this list will honor what he started.

Details:
Here are a few quick observations on the rankings and participation:

  • Includes all tweets tagged with #HIT99 and/or #HIT100 from 7/6/15 through 7/27/15
  • 633 accounts made nominations
  • 319 UNIQUE accounts were nominated
  • Total of 1650 valid nominations were made
  • People were allowed to vote for themselves
  • RT’s of a nomination were counted but only once. (meaning if a person RT’d multiple tweets made by different accounts and that RT contained a nomination already contained in a different tweet the person RT’d, then only one instance of the nomination via RT would be counted)

And a few other notes about the #HIT99 and #HIT100 data that was collected and posted below:

  • Steve Sisko is cleaning up the raw data so it can be posted and shared with the community. You can watch for it to be posted on Steve’s blog shortly. Update: You can download the raw #HIT99 data here.
  • Feel free to post the #HIT99 list to your blog, social media site, paper, LinkedIn group, tattooed on your chest, or wherever else you’d like to post it. Share away. No attribution is necessary unless you want to attribute the #HIT99 community on Twitter.

We really hope that those in the community will take the #HIT99 data and do really cool things with it well beyond what I’ve posted below and what Steve will post on his site. If you need some inspiration or want to join forces, you might start by looking at what Don Lee (@dflee30) has started doing.

I personally thought it would be fun to post 3 interesting lists for great healthcare social discovery: the #HIT99, New Additions to the #HIT99, and #HIT99 Nominees with 1 Vote. So, without further ado, here are those lists: …Read more

July 31, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

9 Sectors of Healthcare IT Investment

Much of what we talk about here is new investments and new companies in healthcare IT. Much of the future of healthcare is built around these investments. SoCal HIMSS recently shared a great image that broke out the healthcare IT investment environment into 9 sectors:

Here are the 9 healthcare IT investment sectors mentioned:

  • ACO Tools
  • ACO-Oriented RCM
  • Employer Wellness
  • Benefits Management
  • Health Consumers
  • Patient Engagement
  • Big Data
  • PM & EMR
  • Remote Care

I always love seeing healthcare IT opportunities broken down into sectors like this. No doubt, we could all think of a company we could start in pretty much every sector. Although, certainly some are more saturated than others (see PM & EMR for example).

Are there any other sectors of healthcare IT investment that you don’t think are included in the sectors listed above?

July 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Population Health Management (PHM) – The New Health IT Buzzword

For some reason in healthcare IT we like to go through a series of buzzwords. They rotate through the years, but usually have a very similar meaning. The best example is EMR and EHR. You could nuance a difference between the two terms, but in practice they both are used interchangeably and we all know what it means.

With this in mind, I was intrigued by an excerpt from Cora Sharma’s post on Financial Analytics Bleeding into Population Health Management:

It appears that “population health management” (PHM) just has a better ring to it than “accountable care” or “HMO 2.0”. Increasingly, PHM is becoming an umbrella term for all of the operational and analytical HIT tools needed for the transition to value-based reimbursement (VBR), including EHR, HIE, Analytics, Care Management, revenue cycle management (RCM), Supply Chain, Cost Accounting, … .

On the other hand, HIT vendors continue to define PHM according to their core competencies: claims-based analytics vendors see PHM in terms of risk management; care management vendors are assuming that PHM is their next re-branded marketing term; clinical enterprise data warehouse (EDW) and business intelligence (BI) vendors argue that a single source of truth is needed for PHM; HIE and EHR vendors talk about PHM in the same breath as care coordination, leakage alerts and clinical quality measures (CQM); and so on.

Cora is right. Population Health Management does seem to be the latest buzzword and for some reason feels better to people than accountable care. I guess it makes sense. People don’t want to be held accountable for anything. However, they love to help a population be healthy.

Coming out of 30+ meetings with vendors at HIMSS this year I was asking myself a similar question. What’s the difference between an HIE, healthcare analytics, business intelligence, data warehouses (EDW) and even many of the financial RCM products? I see them all coming together into one platform. I guess it will be called population health management.

To Cora’s broader point in the post, there is a real coming together that’s happening between clinical and financial data in healthcare. All I can think is that it’s about time. The division of the data never really made sense to me. The data should be one and available to whatever system needs the data. ACOs are going to drive this to become a reality.

May 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Study: Doctors Favor Integrated EMR, Practice Management System

While large institutions may not be jumping onto cloud-based technologies — or admitting it, in any event — the majority of doctors in a new Black Book survey are gung-ho on cloud solutions to their revenue cycle management dilemmas, according to a new piece in Healthcare IT News.

A new Black Book study, “Top Physician Practice Management & Revenue Cycle Management: Ambulatory EHR Vendors,” surveyed more than 8,000 CFOs, CIOs, administrators and support staff for hospitals and medical practices.

The research has concluded that 87 percent of all medical practices agree that their billing and collections systems need to be upgraded, HIN reports. And the majority of those physicians are in favor of moving to an integrated practice management, EMR and medical software product, Black Book concluded.

According to Black Book rankings, the revenue cycle management software and services industry just crossed the $12 billion mark, pushed up by reimbursement and payment reforms, accountable care trends, ICD-10 and declining revenues.

Forty-two percent of doctors surveyed said that they’re thinking about upgrading their RCM software within the next six to 12 months. And 92 percent of those seeking an RCM practice management upgrade are only planning to consider an app that includes an EMR, Healthcare IT News said.

It’s no coincidence that  doctors are trading up on financial tools. Doctors are playing catch-up financially in a big way, with 72 percent of  practices reporting that they anticipate declining to negative profitability in 2014 due to inefficient billing and records technology as well as diminishing reimbursements. (On the other hand, it’s not clear why doctors aren’t still seeking best-of-breed on both the EMR and PM side.)

While selecting an integrated PM/EMR system may work well for practices, it’s going to impose problems of its own, including but not limited to finding a system in which both sides are a tight fit with practice needs. It will be interesting to see whether doctors actually follow through with their PM/EMR buying plans once they dig in deep and really study their options.

September 13, 2013 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.