Rough Seas Ahead for Value-Based Care? How RCM Can Steady The Ship

By Infinx
June 2, 2017

As we were reviewing this week’s news, one sentence jumped off the page,“…an estimated 30 to 40 percent of medical bills contain errors.” That’s a boatload of lost money and a lot of valuable time spent tracking it down. That statistic was part of an article published in Health Data Management entitled “How Artificial Intelligence can Help Improve Revenue Cycle Management Efforts”.

Incorporating AI into RCM may indeed be a good idea, but there is one fly in that ointment. Before any advanced technology can make a difference, the fact that stronger healthcare RCM is central to practice profitability has to be embraced. The current atmosphere tends to lean toward “any RCM system is a good system”, a belief that we are trying to change.

The Health Data Management article agrees, saying “Healthcare is constantly evolving, and as the number of patients increases, the need for more accurate and efficient back-end systems for healthcare providers is stronger than ever. Automation can assist with tasks such as patient scheduling and claims processing, by increasing efficiency and restoring the balance between paperwork and people.

“By harnessing the power of automation, healthcare providers can focus more on providing a more patient-centric practice, in turn giving patients the treatments they deserve.”

We say, “Hear, Hear!” to that.

Not so fast…rough waters ahead?

Then there is the latest analysis of the Trump administration’s 2018 proposed budget. A recent column in Forbes Magazine says that the budget “throws up roadblocks to value based care and population health models”.

It goes on to say that by cutting funds to nutrition ($190 billion from the Supplemental Nutrition Assistance Program) that helps prevent people from getting sick in the first place, “Trump is moving in the opposite direction of the private sector’s speedy move to value-based care.” Most large insurers like Aetna, UnitedHealth Group, Anthem, and Blue Cross/Blue Shield plans are moving most of what they pay toward value-based and population health models.

In other words, it’s a mess looming around the corner. That’s the bad news. The good news is that healthcare executives have made up their mind that they are going to proceed with the business at hand. That means that rather than get caught up in the daily turmoil out of Washington, they are going to steer their ships into calmer waters where they can deliver the best possible care for patients.

Healthcare executives are charting their own course

A recent survey by HealthLeaders Media shows that “…expectations for net patient revenue growth from value-based payment models is bullish.” The May 2017 HealthLeaders Media Value-Based Readiness Survey shows that even though value-based care is still in the “early-adopter” stage, healthcare executives expect robust growth in the share of patients in value-based programs.

Survey respondents say:

  • 26 percent of their patients are currently in value-based programs.
  • In 3 years’ time that number is forecasted to double to 52 percent.

Survey results also reveal that hospitals are leading the way in value-based adoption.

  • A greater share of hospital patients (32 percent) are currently in value-based programs than those in health systems (27 percent) and physician organizations (20 percent).
  • Looking ahead three years, a greater share of patients will be in value-based programs at hospitals (58 percent) and health systems (55 percent) than physician organizations (45 percent).

It’s clear that we are in a constant state of flux. It looks like stability is going to have to come from healthcare managers who have an iron hand and the resolve to steady the ship, move forward and conduct business in a way that protects the integrity of their systems and improves outcomes for their patients.

We think that same tenacity should be exhibited when it comes to RCM. Any old system isn’t good enough. Comprehensive systems that handle insurance verification, pre-registration, patient pay estimates and pre-authorizations in one platform are the standard to seek. Best practice RCM systems offer one solution, one stop, more efficiency, more patients, and more revenue.

About the Author



Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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