Five Fears Healthcare Executives Face Today
In today’s rapidly evolving healthcare landscape, revenue cycle management (RCM) has become more critical than ever. Healthcare executives rely on internal teams and – often most heavily – on RCM vendors to ensure that billing processes are efficient, collections are maximized, and compliance standards are met. Many healthcare executives express significant anxiety about their interactions with RCM vendors. These concerns stem from the potential impact that mismanagement or misalignment can have on a healthcare organization’s financial health and reputation. Among the many concerns that healthcare system executives have regarding the performance of their revenue cycle processes and the vendors they use to support their functions, five big pain points have consistently stayed at the top of surveys, interviews, presentations, and other communications.
We asked Bob Ellison, RSi’s Senior Vice President of Consumer Operations, to talk us through these five hot button issues.
1
Data Security and Compliance Risks
“Let’s hit the stickiest subject first. One of the most pressing fears healthcare executives face is the risk of data breaches and non-compliance with regulations such as the Health Insurance Portability and Accountability Act (HIPAA). RCM vendors handle vast amounts of sensitive patient information. A breach not only jeopardizes patient privacy but also exposes the provider to substantial fines, legal consequences, and reputation damage. RCM vendors may not have adequate security measures in place, or they might lack the vigilance needed to stay ahead of constantly evolving cybersecurity threats. This fear is compounded by the fact that even a minor oversight in compliance can lead to significant penalties, eroding trust between the healthcare provider and its patients,” says Ellison. “
Have you encountered an RCM vendor that doesn’t claim to take online data management and sharing very seriously? But what proof is there to confirm this? Has the company achieved SOC1 and SOC2 levels of Security Compliance? Can they easily articulate their security measures, business continuity and disaster plans? No system is completely impenetrable, but we must have the tough conversations to best protect our organizations and the people whose sensitive information they host. I want to express my sincere thanks to Terry Johnson, RSi’s Chief Information and Chief Info Sec Officer, for the thoroughness and priority his team places on this and requires the rest of us to place on it.”
2
Lack of Operational Transparency
“Another primary concern we hear is a real or perceived lack of transparency in how RCM vendors operate. At RSi, we find that candidly offering broad visibility into our processes, performance metrics, and decision-making criteria creates trust and lessens frustration. For healthcare revenue cycle leaders, losing control over critical components of their organization’s financial health is a legitimate worry.
Without clear and consistent reporting, healthcare operational leaders fear they might not be able to detect underlying issues, such as increasing denial rates or delays in collections, until it’s too late to address them. Apprehension over lack of control can ultimately affect the organization’s cash flow and financial stability, leading to a ripple effect across the entire healthcare system. Sadly, this most often inhibits leadership’s appetite to make the internal and external changes they need to.”
3
Vendor Performance and Accountability
“Now, let’s talk about KPIs! We know that a constant worry exists that vendors might not meet agreed upon key performance indicators (KPIs) such as reducing claim denials, improving collection rates, hitting patient enrollment targets, or ensuring timely follow-up on unpaid claims. This fear is exacerbated when there is a lack of accountability, resulting in prolonged financial challenges and messy, strained relationships.
“CDOs” as we call them at RSi, are Client-Driven Objectives. These are the goals and targets primarily determined by the needs, preferences, and requirements of clients. CDOs must be set and measured by people. These binary, measurable outcomes should be part of any overarching RCM plan. Clients need to know that their service vendor leadership is focused on a mix of profitability and revenue targets, speed, resolutions and feedback loops, customer and/or patient engagement, and scalability.
The truth is, trust is either built or lost through the performance associated with client-driven objectives. This is where RSi upholds two Victory Conditions: 1) Our standard is for every client to be a reference, and 2) Each client utilizes RSi for multiple service lines. We don’t consider ourselves successful until we’ve earned trust beyond our initial engagement.”
4
Cost and Return on Investment (ROI) Concerns
“I want to preface my thoughts on ROI by being crystal clear about how we view contractual compensation at RSi: We are not likely to offer the lowest fees for our work in a fee comparison. RSi is a financially nimble and resourceful organization. We have maintained consistent, organic growth year after year after year – not just 1 or 2 good years. We budget, staff and tech up for effectiveness, scalability, and talent needs. We have the bandwidth to tackle bottlenecks, invest in the latest tech, innovate and automate, and deliver the ROI the client deserves.
I have worked in this field long enough to understand that virtually all healthcare executives are concerned about whether they are getting value for their money. Financial investment in an RCM vendor is significant. Sure, the costs associated with outsourcing RCM may outweigh the benefits, particularly if the vendor is not delivering substantial improvements in revenue and/or operational traction. Bottom line? Settling for stagnant, constricted vendors is the root cause of most issues that concern and frustrate revenue cycle leaders.”
5
Patient Experience Impact
“Last but definitely not least, we know that patient experience causes angst and heartburn. Issues such as billing errors, poor communication, outdated engagement strategies, and/or unpleasant interactions can lead to patient dissatisfaction and tarnish the hospital’s reputation. Patient experience is at the heart of any healthcare organization’s mission. An RCM vendor’s practices might negatively affect patient satisfaction, leading to lack of trust. Lack of trust can have long-term consequences, including patient attrition and negative word-of-mouth, which can be particularly damaging in today’s digital age where reviews and online reputation hits are highly publicized.
How can we help ease the panic? First, commit to model “best in class” patient engagement and advocacy to take a thorough, educated, and empathetic approach to address all available means of resolution, ensure accurate data collection, and provide quality assurance.
Second, we must hire, train, promote, and retain what we at RSi call “A Players.” RSi’s focus on talent recruitment, retention, and development is centered around these core components: Strategic Talent Acquisition; Rigorous Selection Process; Customized Onboarding and Training; Continuous Professional Development; Flex Teams for Volume Fluctuations; Performance Monitoring and Quality Assurance; and Employee Engagement.
This is a tall order and some RCM service providers – like any other challenged employer – are just not good at it. The true core elements for success are the human elements – the expertise, the behaviors, the personalized care, the passion to resolve issues and solve pain paints with a nimble, tailored approach.”
Final comments?
“Revenue cycle vendors are one of the most important resources for a hospital’s financial health and the execution of their patient care mission. Our leadership team welcomes the chance to ease the pain and allay the fears that burden healthcare teams. Step into my (virtual) office…or preferably, let me visit you in your office.”