by Carrie Bauman
A few weeks ago, I was fortunate enough to receive an invitation to a RevCycle Match executive board meeting as the group discussed revenue cycle analytics. In listening to 14 RCM leaders discuss their challenges, requirements and hopes for the future, I came away with the following learnings.
During the pandemic, cashflow was anemic for most practices, and expenses increased. As financial pressures for practices mounted, a buying opportunity for health systems emerged. Many health systems (and private equity too) did a lot of acquisitions during the pandemic and now they find themselves in the midst of converting disparate information systems to the health system standard solutions – or making plans for a conversion. Until then, the patchwork quilt of information systems makes it extremely difficult to create transparency and manage RCM holistically.
A few of the attendees stated that their health systems recognize the tremendous potential locked up in data that is currently going unused. Most acknowledge disparate analytics systems as well as BI (business intelligence) and report writing tools throughout their organizations. Some RCM leaders are evaluating their options on how to best leverage this data into actionable results. RPA (robotic process automation) and BI were the two most frequently mentioned initiatives.
Epic is Tough for RCM
From an RCM perspective, Epic contains a plethora of data. However, getting useful data back out is difficult. Report writing was a challenge called out by several participants. Dependence on IT for Clarity report writing resources was specifically cited as a universal pain. Since Clarity is also used for clinical reports, the business side of healthcare is often de-prioritized in lieu of clinical needs.
Staffing is a Pervasive Pain Point
Staffing continues to be a big problem for revenue cycle and IT departments. Nearly everybody on the call indicated that retaining report writing talent was a challenge that hampered getting much needed data out of their Epic. Some even shared funny stories about camping out in key leadership offices just to get their reports prioritized and written (Funny but not funny…). And finding the extremely rare combination of RCM knowledge and report writing skills was harder than finding a needle in a haystack.
Data Needed for Transparency to Denials
Issues associated with getting information out of Epic to better manage denials were a particular refrain. Because Epic is so difficult for RCM leaders to deal with, most leaders reported having a “hodge podge” of reports that did not fully meet their needs. Epic Cubes, Pulse Reports and Slicer Dicer were mentioned as providing a little help but not at the level that is required. The group mused, “Why should every single Epic client have to create these reports from scratch themselves? It does not make sense.”
All was not doom and gloom for Epic and the revenue cycle. They were seen as good at reporting today’s status. Longitudinal data and the availability of trends and actionable insights, however, remains a challenge. Once a problem is identified, it often takes an assist from an IT report writer to dig into it. By then, the same issue has often re-occurred multiple times and is costing real money. When it comes time to create roll up reports for leadership that include trends, predictions and historical context, great pain is involved in meeting those informational needs.
Missed Opportunities
Benchmarking and sharing between RCM leaders whose organizations use Epic was also seen as a missed opportunity. Everybody on the call felt that benchmarking and networking with peers was incredibly valuable.
Specific Purpose Solutions
Many board members are investigating third-party solutions specifically built for RCM. However, they are also meeting with resistance from their CIOs who challenge them to get what they need from Epic – even if it only meets some of their needs and causes considerable pain to do so. A tension exists between preserving the investment in Epic and procurement of a purpose-built RCM analytics platform that provides everything revenue cycle leaders need right out of the box to ensure a predictable and high performing cash position.
Data Rendering is a Dud
A few RevCycle Match members use data rendering tools as a stop gap solution to get data out of Epic. Most participants agreed that this was better than nothing, but this strategy was only allowing them to limp by rather than taking performance to the next level.
The Denials Niche
Some RCM leaders have been successful with securing investment for niche platforms, with denial management analytics being the most frequently mentioned. In Epic, denials are broken into about fifteen aspects, and it is difficult to piece the entire process together. The consensus was that the structure for denials data makes it incredibly difficult to know how well you are really doing and what to do about it.
The A/R Niche
Accounts receivable solutions are sometimes procured through Finance and the RCM department can get access to a bit of insight this way. While A/R solutions do a decent job at solving one segment of the RCM issues, the group was quick to point out that this approach still leave lots of room for revenue leakage in other areas and across workstreams too. Without a comprehensive approach to RCM analytics, they will continue to leak cash.
Grade Payers with Scorecards
Payer scorecards were a strong area of interest, and particularly surrounding denials. For example, healthcare organizations want to know what percentage of denials they have no hope of overturning. By de-prioritizing those denials in favor of others that are likely to be paid, they will be able to collect more cash and collect it faster. Gaining insight into how long it takes a payer to pay a claim, what claims are likely to be overturned, how long does it take to process a denial, looking at metrics by provider, location, service line, etc., and turnaround times for resolutions are key metrics that they are anxious to receive.
And on the accounts receivable side, these key RCM leaders want to know what are the biggest contributors to A/R. They want to be able to look at this data by payer, payer type, financial class, code and more. They are eager to leverage machine learning to identify complex patterns and eventually build a more forward leaning revenue cycle that accurately predicts what will be paid and when. They are hopeful that ML will be able to identify which payers will have issues and why.
Turnabout is Fair Play
Providers have been measured on performance for quite a while now. Comparison data of payer performance would certainly shine a new light onto the revenue cycle and create some leverage for health systems when they negotiate contracts.
Short Time to Value is Critical Success Factor
Time to value was another theme. Many analytics projects drag on. The executive sponsor may retire, leave, or simply get tired on a mired project. For these reasons, analytics platforms that are comprehensive right out of the box were felt to have higher value than those providing a build your own report tool and data. RCM leaders are experts in revenue cycle. They are not experts in databases and complex report writing. They need a solution that takes these facts into consideration.
Belief in the Power of RCM Analytics
RCM leaders view purpose-built analytics platforms as a tool for doing their job. When well implemented, an RCM analytics platform has the potential to become an extension of the human team by automating low-risk, high repetition tasks like delivering automatic KPIs and other regular reports. It can find the top reasons for denials, identify providers whose patients are not as likely to pay, create trends for payers with high denials and slow payments, and more. AI can also prioritize work queues that optimize cash collections and recommend actions to resolve denials. All of this and more results in more time for RCM leaders to perform high value activities that create predictable, high performing cashflow.
About Carrie Bauman
Carrie Bauman is the VP of Marketing for WhiteSpace Health. She earned a BA in Communication and BS in HIM from The Ohio State University, RHIA credential from AHIMA, and master’s preparation in healthcare administration from Central Michigan University. After spending more than 7 years leading HIM departments and implementing technology, she transitioned to the healthcare IT vendor side and has lead marketing teams of early-stage companies to successful exits.
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