Healthcare is one of those industries where it is hard to know what is going to happen next. It is difficult to plan or predict, but we must remain nimble and be ready to pivot and deliver if ever the need arises. Case in point, COVID-19 had substantial impacts on our documentation and submission practices, but if you look for it, negative impacts in life will always provide opportunity for betterment in the future. Did it (COVID) provide opportunities and point out shortfalls in our organizations and facilities? It sure did, but, we must overcome and drive forward understanding that we are now in a world where we must accomplish more with less.
Healthcare IT Today recently released multiple RCM predictions for the coming year and two of our own were featured. You can connect with them on LinkedIn and see the predictions below:
Along with these predictions, I polled some other subject matter experts in our organization, and these were the RCM predictions they produced for 2022:
Sustainability, Security, Technology costs and less risky Artificial Intelligence
According to the National Healthcare Expenditure Accounts (NEHA), total US healthcare care spending hit $4.1 trillion in 2020 (about 20% of GDP, >$12k per person), and we might expect a >9.7% annual growth in 2021 as the impact of COVID-19 was further realized. With rates of obesity and chronic disease climbing without evidence of deceleration anytime soon, sustainability or better yet survivability of the costliest healthcare system in the world continues to be a leading issue for our great nation.
Technology-enablement, including Artificial Intelligence (AI), was positioned to help reduce costs and has achieved great progress, but technology costs has simultaneously skyrocketed due to increasing data security concerns. 2021 was a challenging year for healthcare data breaches, with over 40 million patient records being compromised primarily through malicious and criminal attacks as reported to Health and Human Services, and according to a recent IBM study the average cost of 1 million breached records is nearly $40M. This has raised giant barriers to entry for new technology solutions, increasing startup security compliance needs, lengthening sales cycles, and ultimately requiring costlier financing, further blunting the cost-saving benefits from technology.
My prediction (and hope) is that you will see new technology-enablement solutions introduced that lower the security aspect of total technology costs without compromising the safety of patient records, beginning with approaches to AI that won’t require enormous amounts of sensitive data be shared between a healthcare provider organization, and an AI solution vendor. That approach, along with a greater emphasis on preempting AI bias associated risk (AI bias will be on my list of predictions for 2023 as it gains greater attention this year), will help technology-enablement regain its momentum on increasing sustainability for our US healthcare system, and at 20% of GDP sustainability for our nation as a whole.
- Automation technology within the Registration, Care Management (including UM), Medical Coding, and Billing will be accelerated. Clinics and Hospitals alike will continue to seek automation for charge capture and coding.
- Claims denials will continue to receive the focus to reduce the leakage of revenue for care that has already been provided. This is an area that will require further adoption of technology solutions to reduce the technical errors and denials. The administrative cost for providers and payers is significant where innovation through technology solutions can help bridge the gap.
- Future predictions would be for payment transactions between payers and providers to have less friction. Settlement of claims payment would become near real time rather than the current process which is quite abrasive and on average takes 40-50 days. Technology will help deliver a better less labor-intensive process to receive reimbursement for care delivered.
If I had to describe the environment for the payment industry, it would have to be in words of “I want it NOW”.
With COVID-19 and the PHE environment in which we live, we have witnessed healthcare transform and almost overnight make the switch to automation and utilize digital tools like never before. Patients are consumers and continue to look for convenience in how they receive care but also how they can pay for it. This can be evidenced by patient surveys that we all get in the mail/email.
My prediction for 2022 is that we continue to look for ways that are customized for the patient. Developing automated payment methods that the patient can essentially have access to 24/7. Our approach should be tailored to fit the needs of our patients which suggestively would offer them flexible payment options as using cash seems to be a thing of the past.
Patients are looking for convenience, not only in their care but in their payment/insurance experience as well. Patients want a smooth journey from start to finish. I believe that as we continue in the virtual environment, offering patients a more solid estimate of what they can expect to pay so that there are less surprises when the final bill is sent to them.
Healthcare is certainly not a one-size-fits-all type of system. Thinking of individual’s finances are just as important as thinking about how we are going to care for them. I have often said that a patient’s financial health sometimes outweighs the physical health.
Technology continues to evolve and so should the healthcare industry. Convenience along with outstanding care should be at the forefront as we navigate into more of a digital space. Providing up-front information for the patient, checking in with them more often, open lines of communication with regard to their out-of-pocket expenditures will also form a more solid relationship with the provider.
Suggestively, we need to tailor our revenue cycle methodology around what best fits for the patients in which we serve. Meeting them where they are.
Let us know what you think, or if there is any way we can serve your RCM adventure, by emailing us at firstname.lastname@example.org.