Billing due for an upgrade
Eighty-seven percent of all physician practices agree their billing and collections systems need upgrading, according to a recent survey. The majority favor moving to a fully integrated practice management, EHR and medical software product, accessible through the cloud on any browser or device.
The first of eight revenue cycle management studies to be released by Black Book, the "Top Physician Practice Management & Revenue Cycle Management: Ambulatory EHR Vendors," is an analysis of the convergence of the replacement EHR market with the needs of physician practices to upgrade patient billing processes.
According to Black Book Rankings, the RCM software and services industry recently surpassed the $12 billion in the ambulatory physician practice segment due to demands encountered from reimbursement and payment reforms, accountable care participation, ICD-10 coding challenges and declining revenues.
The new survey of healthcare financial leaders, more than 8,000 CFOs, CIOs, administrators and support staff of U.S. hospitals and physician practices contributed their perceptions to Black Book between April 2013 and August 2013.
Forty-two percent of those surveyed said they are considering an upgrade of their RCM software within six to 12 months. Ninety-two percent of those seeking an RCM/PM upgrade or system replacement are considering an EHR-centric application, the study found.
According to the study, 72 percent of physician practices - whether networked, independent or part of a large group or hospital system - anticipate declining-to-negative profitability in 2014 due to diminishing reimbursements and underutilized or inefficient billing and records technology.
"Over the past year, the overwhelming desire to keep practices from being acquired or selling out has changed drastically," noted Doug Brown, managing partner of Black Book Market Research, in releasing the results of the study.
"As evidenced by the growing number of meaningful use failures and immature EHR systems dropping off the competitive market, far too many EHRs falsely claimed to integrate seamlessly into practice and revenue cycle management systems," said Brown. "Fewer systems had evidence of seamless integration across revenue cycle management, clinical communications and analytics solutions."
"These innovative systems are transforming thousands of physicians increase collections, streamline operations, acclimate to reimbursement reforms, provide productive workflows and improve patient care," added Brown.
The Black Book eight-part series also names the top-ranked vendors in customer satisfaction and client experience among RCM software and outsourcing services providers, as well as RCM transformation consultants.
The No. 1 ranked seamless ambulatory EHR/practice management/revenue cycle management vendor in the 2013 Black Book user survey was Irvine, Calif.-based Kareo Inc., which integrates also with several EHRs and more than 20,000 users nationally.
The survey also named other top seamless EHR/RCM/PM performers: Care360/Quest Diagnostics, Care Cloud, athenahealth, eClinicalWorks, Vitera, McKesson, Optum, SimplifyMD, Greenway Medical, Practice Fusion, GE Healthcare, Epic, e-MDs, NextGen, Allscripts, ChartLogic, ADP AdvancedMD and Henry Schein MicroMD.
On the hospital side, it seems that an RCM refresh - or replace - will be necessary as well.
"We have a new future with Medicare on payment reform," John Hoyt, executive vice president of HIMSS Analytics, told Healthcare IT News Managing Editor Mike Miliard back in May. "We've been nipping away at trying to save money in Medicare for years, but we need fundamental change, and we all know it. And it's coming in the form of ACOs or bundled payments and this type of thing."
"The revenue cycle systems we've had, for the past 10 years, are not prepared to do that," Hoyt said.
Ralph Bernstein, senior vice president of Minneapolis-based U.S. Bank Healthcare Payment Solutions, sees the collection of patient receivables as the most important revenue cycle issue for providers.
"Without some critical changes to provider workflow and revenue cycle management practices, providers will, in coming years, spend even more time and money chasing patient receivables and dealing with increased levels of uncollectible patient responsibility dollars," he said.
Other key findings from Black Book's physician survey:
• 71 percent of physician practices are considering a combination of new software and outsourcing services to improve their RCM systems.
• 89 percent of those state a preference for a single source vendor for all RCM PM and EHR modules.
• 89 percent of physicians currently replacing their EHRs are seeking a seamless single source vendor, and prefer vendors that offer software, outsourcing and consulting options in their EHR/RCM/PM transformation.
• 96 percent of practices achieving meaningful use 1 attestation and/or highly satisfied with EHR vendor performance agree that fully-integrated practice management/revenue cycle management systems equipped with EHR software is the key to ensuring practice survival and even independence from hospital or large group acquisition.
• 88 percent of business managers fear that the ramifications of their outdated and/or auto-piloted revenue cycle management systems, particularly those not integrated to EHRs, will force their physician to sell the entire practice operation to a larger physician group or hospital within 12 months or face practice dissolution.
• 86 percent of business managers are certain their old practice management and revenue cycle cannot accommodate upcoming regulatory requirements and updates. Nearly 100 percent state the practice's financial software and workflows are unprepared for ACO participation.
• 97 percent of business managers confirm that an innovative, seamless RCM/PM/EHR system would ensure long-term practice independence, and greatly improve productivity and profitability.
• 88 percent of hospitals and 76 percent of large physician groups procuring independent physician practices find there was little/no useful salvageable technology (EHR, PM or RCM) in the acquisition of practice assets.
• 81 percent of practices acquired in last 12 months had attempted an EHR or upgraded PM implementation.
• 63 percent of independent practices believe an attempted technology upgrade or implementation was necessary to improve practice value prior to an acquisition. Ninety-eight percent of independent physicians claim that short sighted IT acquisitions, as part of their practice sell off plans to hospitals and larger clinics, actually devalued their practice's worth.