Healthcare providers before reeling down the effect of the extended period of misfortune due to COVID-19 were additionally affected by pretentious impact and rising cost of healthcare supplies.
RCM leaders are currently focused on two central themes: safeguarding their revenue and maximizing efficiency with limited resources. Unfortunately, the effects of the great resignation have resulted in a shortage of both administrative and clinical staff, leaving RCM leaders with significant staffing challenges.
As we look forward to 2023, we can anticipate a year of rapid change, consolidation, and innovation across the healthcare industry. There will be a growing adoption of new methods and approaches to work, with significant implications for the revenue cycle. In this context, we will explore some of the trends that are shaping the healthcare landscape and affecting revenue cycle management.
- Acquiring the Fundamentals Right: Healthcare is, was, and will be regarding the patient.
The issue of no-surprise billing and financial transparency has been the subject of intense debate in recent times. Patients are increasingly seeking swift and convenient access to information about services rendered, associated fees, insurance coverage, and their own out-of-pocket expenses. In response to this trend, we expect to see major transformations in the ways healthcare providers engage with their patients, including improved scheduling, greater price transparency, and more flexible payment options. As a result, we anticipate the emergence of innovative solutions and companies that focus on enhancing patient access and experience.
We also expect rising commercialism heading to marked healthcare chains, mostly in urgent care, mental and behavioral health, and dental services.
- Wellness and Value-Based Care
Value-based care is founded on the principle of shifting emphasis from quantity to quality. However, defining what constitutes “value” can be complex. While preventive care is a vital element of value-based care, it is not the sole determinant. Nevertheless, one of the most transformative developments in this area has been the emergence of wellness chains throughout the US. As a result, Americans are adopting healthier lifestyles, leading to longer life expectancies and consequential shifts in healthcare demand. These trends are likely to have a significant impact on the provision of healthcare services in the coming years.
- Labor Shortage
The COVID-19 pandemic and subsequent labor shortages have contributed to a significant increase in burnout among doctors and nurses. As a result of these shortages, several trends have emerged, including the adoption of outsourcing and innovative solutions for clinical documentation. Hospitals and healthcare systems are increasingly turning to virtual clinical assistants and medical scribes to handle clinical documentation and free up clinicians’ time.
Furthermore, the nursing profession is transitioning towards a gig economy model, with nurses choosing to work specific hours at locations of their choosing. The demand for traveling nurses is one indication of this nationwide trend, as nurses look to work for only 6-9 months a year to avoid the strains of nursing jobs.
In 2023, the fight for clinical and administrative talent is expected to intensify. The healthcare industry has seen a significant turnover rate in executive roles traditionally considered highly stable, with up to 30% of top executives in RCM and healthcare finance switching jobs in 2022. As a result, healthcare human resources leaders will need to work closely with finance and clinical teams to ensure adequate staffing levels are maintained.
- Remote Job and Outsourcing
The COVID-19 pandemic led to the widespread adoption of remote working technologies and lifestyles across various industries. However, healthcare decision-makers were slow to adopt these changes, resulting in the loss of administrative teams, especially within the revenue cycle workforce. Unfortunately, when they attempted to re-hire staff, they faced a shortage of labor. To compound this problem, a significant percentage of the clinical and administrative workforce opted for gig economy jobs or relocated closer to their families post-COVID. These trends suggest that the labor shortage in healthcare is expected to persist and intensify over the next decade.
In response to this challenge, healthcare leaders must adopt secure remote technologies and outsourcing/offshoring strategies to mitigate the effects of the labor shortage and locate the necessary resources for their clinical and administrative functions.
- Financial Planning
Healthcare finance leaders face several challenges, including inflation, escalating supply costs, and declining reimbursements. To achieve profitability and invest in innovative technologies, they must adopt various strategies, such as the following:
- Defend the revenue: Providers must prioritize denial prevention to ensure they receive the income they deserve for medical services rendered.
- Arrest revenue leakage: Billing compliance requires collaboration between coding, revenue cycle, and clinical staff. Effective clinical documentation can reduce denials and curb DNFB issues, unlocking additional cash. Improved billing and coding accuracy can increase hospital or healthcare system revenue by up to 20%.
- Do more with less: Healthcare providers must explore the various workflow and edit functionalities available in their software. These functionalities can yield additional revenue with less effort, allowing providers to focus on reducing aged A/R. Appropriate configuration of available tools can also help equip their workforce to do more and extract the maximum yield from the revenue cycle.
- Tasks automation – AI, ML, RPA, and Independent coding
Innovative technologies are emerging to automate tedious and repetitive billing and coding tasks in healthcare systems. Autonomous coding technologies are now practical for use. Healthcare leaders must assess the available options for building or purchasing automation technologies to achieve business outcomes. These powerful new-age technologies have the potential to revolutionize the revenue cycle management process.
- Healthcare funds limping into consolidation and niche powers
Private equity investors are putting their money into themes that will shape the future of healthcare. These include:
In the healthcare provider space:
- Consolidation of large healthcare systems to meet the growing demand for high-quality healthcare services driven by consumerism.
- Expansion of home care and DME services to address the needs of the aging population and to cater to the demand for remote patient monitoring devices and services.
- Consolidation of urgent care chains, behavioral and mental health clinics, physical therapy clinics, and value-based care providers and solutions that prioritize long-term wellness over reactive care.
In the healthcare service provider space:
- Consolidation of revenue cycle providers on a large scale.
- Providers contributing niche solutions such as clinical documentation development, usage management, and analytics.
- Cyber Security
As rogue nation-states and cybercriminal activities continue to rise, companies across different industries need to prioritize cybersecurity. In the healthcare sector, the trend towards remote working, remote patient monitoring, telehealth, and telemedicine makes it even more susceptible to cyber threats. Thus, we expect healthcare organizations to allocate more resources to cybersecurity in the coming years. To ensure robust information security management, forward-thinking healthcare revenue cycle management service providers have already invested in certifications such as ISO27001.
- Great Tech Companies Funding in Healthcare
The major technology companies are each taking their own approach to address the challenge of healthcare costs and quality. Amazon, Google, Microsoft, Oracle, and Apple are investing heavily in healthcare, developing cloud platforms, investing in specialized technologies, creating wearable devices, and promoting telehealth solutions. We predict that their healthcare investments will continue to grow, and over the next ten years, we expect these big tech companies to play an increasingly significant role in shaping the future of healthcare.