Providers look to revenue cycle management to weather sequester and ICD-10

Q&A with Brian Fugere, COO RemitDATA
By Diana Manos
11:06 AM
Brian Fugere, COO of RemitDATA

Healthcare organizations will need to be more effective, cost efficient and productive in the future to not only survive, but also to maintain positive cash flows, according to Brian Fugere, COO of RemitDATA. 

The sequester is negatively impacting reimbursement rates, especially in oncology, and cuts and pending future cuts in Medicare and Medicaid reimbursements are forcing organizations to reevaluate patient population mix as well as operational efficiencies, Fugere says.

[See also: Hospitals ill-prepared for ICD-10.]

In a Q&A with Healthcare IT News, Fugere offers more insight:

Q: What other kinds of RCM issues are being detected in the healthcare market? 

A: Another big issue is of course ICD-10 adoption. With the October 2014 adoption date now only 17 months away, healthcare entities of all types (provider, hospital, payer) are having to evaluate clinical and revenue cycle processes in order to prepare and modify software, processes, and documentation. Many experts are now calling for organizations to build up a sizable cash reserve and accelerate current collections flows to prepare for an expected slow-down in payments as well as possible increased denials post-adoption due to both process and documentation issues.

Q: Currently, what kinds of products are being used to solve RCM issues?

A: “Business analysis” and “analytics” tools are very popular right now. For the first time, health organizations are beginning to use tools that are standard in other industries – BI tools, dashboards, cross-platform and multi-system data warehouses. The challenge in healthcare is to create meaningful KPI’s (key performance indicators) and cross system analytics and bridge the gaps in what are very siloed (or segregated) systems.  

[See also: EHR boosts ROI, revenue for med group.]

Q: What trends do you see?

A: Fear, consolidation and the increased business maturity of healthcare.  For many years, healthcare was a cottage industry and fundamentally still is.  However, organizations will have to mature and adopt what other industries have gone through – the end of high margins making up for bad practices. In order to reach more maturity, we will see lots of consolidation, increased importance of sound business management and improved revenue cycle management performance requirements.

Q: Is there a "hot" product on the market that everyone wants/needs?

A: At the moment, there is no clear leader or “hot” product that everybody wants. Many organizations are looking to their practice management, EMR or billing system vendors for solutions. However, even those vendors are scrambling to fill these new demands. And, there is a big gulf between hospital and practice needs. This is where small, nimble companies like RemitDATA fit in. With platform-neutral solutions, small, agile companies will be filling in the gaps with new technologies /software/analytics. 

Q: Are these products to help correct RCM issues within organizations, or are they new ideas?

A: The methods and processes of identifying, correcting and improving RCM performance are not new. However, until recently, the tools used (spreadsheets, calculators, etc.) were very manual, slow and difficult to scale. The new products automate and move to real time what can take weeks under a manual scenario.  Given the pace of change in the market, manual processes for measuring and controlling the RCM process are no longer enough. The next “new” thing to watch for – combining clinical and finance analytics. Many companies are working on combining the two to be able to tie financial and clinical outcomes. That would lead to better prediction algorithms and population management tools. 

Q: What kinds of products can we expect to see on the market and becoming popular in the future?

A: Including the aforementioned, we will start seeing clinical/financial measures in the near future. As ICD-10 adoption nears, we will start seeing “bridging” tools for ICD-9 to 10 as well as new revenue models tied to the new diagnostic standards.  But don’t forget about ACO’s. I believe we will start seeing more independent tools aimed at the cross-management requirement of the emerging ACO framework.