Revenue cycle outsourcing in growth mode

As ICD-10 looms, value-based reimbursement remains clouded in uncertainty and many technology vendors under-deliver on their promises, more and more hospitals are outsourcing their revenue cycle management processes.

A new report from Black Book research finds that many RCM platforms – some which are more than a decade old – are missing the advanced functionality needed to meet the demands of new reimbursement models. As hospital leaders take stock of new financial software, much of which is still in evolving as details of value-based payments continue to come into focus, many are turning to outsourced services in the interim.

"As hospitals and physician practices grapple with intense pressure to optimize revenue cycle management processes, outsourcing has emerged as a powerful solution to the challenges of a rapidly changing healthcare model," said Doug Brown, managing partner of Black Book, in a press statement.

Among the findings of Black Book's report:

• Seventy-nine percent of chief financial officers are looking to cut ties with RCM vendors that are not producing a return on investment in 2016; more than half of them (54 percent) believe outsourcing revenue cycle management processes will allow them to become more efficient and better positioned financially.
• RCM transition activities are being coordinated through advisors and consultants at 17 percent of hospitals surveyed, and a huge majority of those organizations (78 percent) have yet to settle on a vendor for the new era of value-based reimbursements.
• Seventy-three percent of medical group practices working with consultants on accountable care reimbursement strategies are considering outsourcing RCM in 2016 as they evaluate technology vendors.
• Eighty-three percent of hospitals now outsource some accounts receivable and collections. Contract management and denial management follow next with 58 percent and 55 percent, respectively. More than two thirds (68 percent) of physician groups with more than ten practitioners now outsource some combination of collections and claims management.

Black Book also ranked the top RCM outsourcing vendors for various categories of healthcare providers: Optum360 was tops for hospital managed systems corporations, networks and chains; Emdeon was the choice for small hospitals (fewer than 150 Beds) and Conifer Health for larger facilities (150 beds or more). Other top-ranked firms among surveyed hospitals: The Advisory Board, McKesson/RelayHealth, Dell, Adreima, MedAssets and TruBridge