C-suite views RCM as matter of survival

New Black Book report shows healthcare execs see RCM as a way to stay solvent
By Bernie Monegain
10:37 AM
Doug Brown

The $2.4 billion hospital RCM software and services industry expects double digit increases in 2014 because of business shifts, reimbursement and payment reforms, accountable care participation, ICD-10 coding challenges, physician practice acquisitions, collection issues, and overall declining margins, according to  two reports released Sept. 23 by market research firm Black Book.

The two RCM reports Top Hospital Software Vendors, Revenue Cycle Management: Small/Rural and Community Hospitals under 250 Beds, and Top Hospital Software Vendors, Revenue Cycle Management: Hospitals over 250 Beds, Chains and Networks provide analysis on the replacement RCM market as healthcare systems to upgrade patient billing and collection processes.

More than 1,900 hospital CFOs, CIOs, business office managers, tech and financial staffers contributed their perceptions to Black Book between April 2013 and August 2013. Additionally the business managers of 1,800 physician practices owned by hospital systems also submitted responses, evaluated separately. There were 557 hospital and inpatient organizations represented in the survey.

[See also: Hospitals eager to replace RCM systems.]

“Shifting payment models and regulations are forcing hospital leaders to redirect previously launched budgets, priorities and strategic plans to assess if new RCM solutions can rescue them from imminent hospital layoffs, even bankruptcies," said Doug Brown, managing partner, Black Book Rankings.

“Most hospital CFOs have no choice but to leverage next generation RCM solutions in order to keep their organizations solvent. The reimbursement challenges ahead to get paid may require several new RCM applications, and the frank reality is that a failing RCM could quickly close a marginally performing hospital for good,” Brown said.

HIMSS Analytics found similar market trends earlier this year. In an interview with Healthcare IT News Managing Editor Mike Miliard, HIMSS Analytics Executive Vice President John Hoyt asserted, "There's a new future for reveue cycle." It's time – past time – for replacement, he suggested.

"We're looking at ages 8 to 11 years for these revenue cycle systems" Hoyt said. "Patient billing is different from registration is different from scheduling, but they're generally up there: 8 to 11 years. And that's basically the kind of thing that the auto industry watches. How old are the cars on the road? There's a point at which people just have to start buying new cars."

[See also: RCM tools ill-suited for payment reform.]

In its report Black Book also highlighted the top performing RCM software vendors as ranked by customer satisfaction on 18 client experience-based key performance indicators.

ZirMed, rated No.1 RCM software for large hospital hospitals and academic medical centers over 250 beds. Other large hospital and academic medical center top performing ranked software include: OptumInsight, Conifer Health Solutions, McKesson RelayHealth, Emdeon, SSI Group, MedAssets, Experian Healthcare, Cerner, Passport Health, Craneware, Infor, Quadramed, Obsidian, Convergent, 3M, Meditech, Revenue360, Epic Systems, and Siemens.

SSI Group, ranked first in RCM software for small/rural and community hospitals under 250 beds. Other RCM vendors rated highly by client experience surveying are: Emdeon, Experian Healthcare, ZirMed, Passport Health, MedAssets, OptumInsight, Craneware, CPSI, Cerner, Convergent, McKesson RelayHealth, Streamline Health, Trizetto Gateway, Conifer Health Solutions, Rycan, Quadramed, Epic Systems, Healthland and Allscripts.
McKesson RelayHealth scored highest in customer satisfaction by hospital systems, IDNs, CINs, chains and ACOs for RCM sofrware. Hospital chains, networks and system RCM software additionally receiving top honors are: Emdeon, MedAssets, OptumInsight and ZirMed.


  • Roughly two-thirds (3,000 of all US hospitals) that predicted back in 2012 that they would replace their core RCM solution in 24 months have actually failed to initiate a sustainable RCM plan as of Q3 2013. More than half do not have formal needs assessments or vendor selection processes started either, otherwise remaining in a do nothing/status quo or autopilot stage.28 percent of CFOs blame the multiple clinical and technology projects underway organizationally for keeping their hospitals from upgrading to comprehensive RCM solutions. "In many instances, facilities have focused myopic RCM task forces on ICD-10 coding, physician practice EHR integration, decision support tools, and insurance verification/eligibility, hence distracting the leadership teams from executing a well-structured, end-to-end RCM strategy," said Brown.
  • Hospital CFOs and CIOs wrangle with the prioritization of RCM above all other technology spends in 2014. Although 63 percent of CIOs and 88 percent of CFOs agree current RCMs need to be replaced, the project implementation acquisition, timing and urgency differ.
  • CFOs and CIOs also are polarized on the organizational preference to manage fewer vendors and favor single-source vendors. In a shift from a 2010 Black Book Rankings survey, 85 percent of CFOs were amenable to implementing a one vendor solution set following the direction of the hospital’s clinical information system selection committee. The general sentiment of 77 percent of CFO’s was they could make any RCM solution work if the hospital’s clinical staff was satisfied with the health care delivery element of the system.
  • In the July 2013 survey of the same topic, only 12 percent  of CFOs RCM decision-making will be driven by the system preferences of hospital clinicians. And 88 percent of CFOs are seeking a best-in-breed approach regardless of the vendor count in contrast to 83 percent of CIO’s which high favor a single-source enterprise strategy, in an effort to manage fewer vendors.
  • Among the 91 percent of hospitals over 250 beds making an RCM transformation program functional in 2014, CFOs prefer a seamless bolt on integration with vendors proven to have true financial solutions for facilities that size. In contrast, 87 percent of CFOs in small hospitals under 100 beds expect their RCM strategy will be selected solely on their CIS vendor relationship. Community hospitals in the 100-250 bed range are evenly split, 44 percent for CIS integrated applications and 44 percent for seamless bolt-on products.

"The brakes have been applied to slow the radical RCM change out trend in which eight out of 10 hospitals predicted they would be replacing their RCMs between 2011 and 2013. Thirty-six percent of all CFOs confirm they are reassessing the capabilities of their current legacy, core and bolt-on RCM applications, optimistically looking for options in solutions they already own," said Brown.