As disruptions associated with healthcare transformation continue to drive uncertainty across the organization, a growing number of providers are shifting their focus to comprehensive partnerships for greater benefit. A full-service revenue cycle outsourcing model is emerging that encompasses everything from patient registration to HIM to account resolution, and includes activities performed by hospitals, physicians and clinicians. It touches financials, hospital operations, information technology, compliance and risk-avoidance.
The notion that hospitals choose revenue cycle outsourcing only for cost containment and stimulating net patient revenues is rapidly fading as financial leaders also seek ways to spend less time managing minutia and more time leading strategic initiatives.
Successful collaboration with a trusted outsourcing partner can lead to financial improvements, reduced costs and superior operations, and best of all—more time to do what is strategically important. This reality has led to a shift in how the industry thinks about revenue cycle outsourcing. Fewer hospital leaders are asking reactive questions. Instead, organizations of all sizes are now asking strategic questions, like: "What can we do to create an organization capable of achieving greater things given today's challenges, reimbursement headaches, and regulatory and compliance changes and how do we get there?"
In fact, last year alone, emerging complexities and expectations prompted more than 200 hospitals to establish new full-service revenue cycle partnerships. This is in addition to hundreds of new partial outsourcing relationships.
When it comes to selecting an outsourcing partner, the question is not just about cost-containment and revenue enhancement. It's about finding a partner that can deliver the scale, expertise, technology, standardization, competitive edge and integration that will contribute most effectively to your organization's strategic direction.
Providers need a partner with the scale to offer a breadth of services; one that can work effectively with key payors on their behalf, and who can detect trends earlier and help negotiate better options and results. This allows hospital leaders to deal with one vendor—not dozens—and expect to superior results.
Consider a partner's expertise in responding to emerging compliance and reimbursement models on the horizon. While these are areas most hospitals leaders are contemplating, superior outsourcing partners will have already successfully implemented them.
Healthcare providers should seek partners who are investing in the newest and best-of-breed technologies and doing the hard work of integrating systems and normalizing data. Chances are most organizations' information technology resources are already overwhelmed and underfunded, and they don't have the financial ability to make capital investments that would improve them. Clinical needs usually trump revenue cycle needs. Insist on a partner who understands the importance of real-time business intelligence, data integrity and benchmarking, all connected and working together.
Multi-provider systems seeking standardization often struggle with the difficulties of inherited, and disparate, platforms that seldom communicate effectively. An outsourcing partner can deliver a common data platform with crosswalk data elements, common definitions and the ability to benchmark more effectively, all in one place and providing actionable data when and how providers need it.
Outsourcing partners can also make it easier for providers to be more flexible in managing volume and service fluctuations. For example, reimbursement models are emerging that will focus on reducing admissions. Experts can help predict the impact of these trends and find the sweet spot of variable volumes and their impacts on staffing so that action can be taken to rapidly flex up or down for optimal efficiency.
Many provider organizations are seeking competitive advantage through mergers, acquisitions and joint ventures. Evidence is growing that outsourcing partners are becoming an integral part of their growth and integration strategy. Having a world-class business and technology platform—and the ability to bring systems and processes together—makes an organization significantly stronger. Finding a partner that has core competency in integration, data management and normalization helps accelerate post-merger integration timing and reduces risk.
Building the business case for full-service revenue cycle outsourcing includes several components, such as a baseline cost analysis, benchmarking costs and net revenue performance, technology integration and business intelligence, not to mention cultural fit.
A partner must have the ability to execute the project, using formalized full-scale project management resources and protocols to deliver on implementations. Change management is key.
As regulatory changes occur, providers should insist on dedicated compliance programs with ethics and compliance officers and protocols embedded in their daily operations. In short, they need a partner who is expert enough to keep their organization highly compliant.
You partner should stay ahead of the technology curve to cut down on errors and improve productivity. They must be able to integrate disparate systems to realize their full value. As delivery models go beyond the walls of hospitals and into external sites, such as post-acute provider facilities, providers need to find a partner who can integrate and normalize data.
The race is on. As transformation disruption accelerates, providers are getting smarter and starting to structure relationships that contribute to their strategic goals and their financial imperatives. They need to choose a partner wisely, and select the one with the scale, expertise and technology to meet healthcare providers' particular needs.