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Top 2017 RCM Issues In Healthcare And 2018 Projections

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Regarding revenue cycle management issues, 2017 was a year filled with rapid policy changes, a renewed search for stability in all corners of healthcare, and continued debate on the merits of value-based care and bundled payments. Out of control medical billing errors, the power of data analytics, and the fight over the Affordable Care Act led the headlines. You could say it was just another typical year in the dynamic healthcare paradigm, and 2018 promises to be just as exciting.

Thankfully the calendar always turns and with it comes the possibility of creative solutions to complex problems. Here’s a look back at some of the top issues that emerged in 2017 and a peek at what we think will top the list in 2018.

A National call for value-based care

There were more than a few reports, debates, and conversations about the merits of value-based care. Two that caught our eye included the National Academy of Medicine and the Interdisciplinary Autoimmune Summit.

The National Academy released a report called Vital Directions that named Competencies and Tools to Shift Payments from Volume to Value as one of its priorities for creating a workable healthcare system for the nation. “American health care needs to be reformed to bend the cost curve and to deliver better, less expensive care to patients, which is increasingly possible,” they said.

The Interdisciplinary Autoimmune Summit featured presentations on how to create value-based care in rheumatology practices by focusing on seven areas; less geographic variation in care; use of shared medical records for research; a total joint registry; preventive health services; precision medicine; a center for patient-centered outcomes research; and systems integration.

Who’s on first?

Talk about conflicting messages. The debate on bundled payments couldn’t have been more confusing. On the one hand, doctors reported that they preferred bundled payments because fee-for-service is too unstable and unpredictable. One survey showed that both hospitals and payors project bundled payment will account for 17% of medical payments in five years, yet only half of the payers and just 40% of providers say they’re ready to implement bundles. On the other hand, a Bain & Company survey of 980 physicians found that 70% of physicians prefer to use a fee-for-service model, citing concerns about “the complexity and quality of care associated with value-based payment models.”

The Affordable Care Act and other labyrinths

We don’t have enough space here to recount all the twist and turns of the fight to dismantle the ACA. Suffice it to say that it was a roller coaster. In the midst of the raucous journey, a report out of the Center for Health Insurance Reforms (CHIR) at Georgetown University Health Policy Institute admonished states to step up to protect consumers. The report suggested that Departments of Insurance in each state use their role as regulators to protect consumers and promote market stability. That was on the heels of a report that the new healthcare landscape was going to be “a mess.” That’s how Tripp Jennings, chief value and informatics officer at Palmetto Health described it at the Pop Health Forum 2017 in Boston. According to Jennings, the only thing that can save healthcare is data analytics and lots of it.

1 + 1 does not equal 2

Medical billing errors and bad consumer debt policies spent a good amount of time in healthcare trade press headlines and the mainstream consumer press too. In May, we captured seven of the numerous national and local headlines that focused on medical billing mistakes including one that screamed $68 Billion in Medical Billing Errors Puts Physicians’ Livelihood in Jeopardy. Experts say more than 80 percent of medical bills contain errors, in part because there are 68,000 ICD-10-CM codes and 87,000 ICD-10-PCS codes. To add insult to injury, medical debt collection practices received a black eye from a review of 17,701 collection complaints submitted to the Consumer Financial Protection Bureau (CFPB). The CFPB said that some medical debt collection practices are “aggressive and inappropriate” and that problems are “widespread and harm Americans.”

2018 projections in Healthcare

 

There are as many predictions about what the big healthcare issues will be in 2018 as there are new year’s resolutions, but we have a pretty good idea of what will rise to the top. Here’s what we think you should keep your eyes on:

  • Smart use of analytics: Causal and machine learning, Big Data, and analytics are readily available now, but it’s the smart use of those powerful analytical systems that will matter. There’s a boatload of data in healthcare from medical devices, electronic medical records, labs providers and patients themselves. Getting the data out of silos to make sense of it and improve patient outcomes is the challenge. Healthcare executives will have to invest in the analytical systems that can make that happen.
  • Cybersecurity: The older the IT system, the easier it is to hack. Global hackers proved this in 2017. Managing IT security and replacing legacy systems will be vital to protecting patient data and privacy in 2018. Besides, AHIMA says that health information management professionals should pay close attention to the issuing of additional “minimum necessary” requirements regarding patient privacy.
  • Opioids: Regardless of what healthcare sector you work in, the battle against opioid abuse will probably touch you. Payers, providers, and regulators are going to have to work together to stem the tide of overdose deaths, which some estimates put at 64,000 in 2016. Congress will be asked to figure out how to fund the effort, but eventually it will have money attached to it.
  • Value-based payments: This is an issue that is not going to go away. The shift to value-based care will continue to gain steam, and value based payments is a pillar of the effort. Watch for physicians to gravitate toward this reimbursement model and away for fee-from-service as payors implement the systems necessary to make it work.

There will, of course, be many more issues at hand in the coming year. Population health and the social determinants of health will have to take a front seat if we are to positively impact health and use wellness as a strategy to reduce healthcare costs. The ACA will continue to change, and Medicaid and Medicare have a target on their back. Telemedicine is beginning to take hold, much to the chagrin of traditional physicians, and consumers are driving demand. There will be no lack of challenges.

One thing is for sure, physician practices and healthcare systems of all sizes will survive only if their internal systems are rock solid. Healthcare revenue cycle management will be the watchword of 2018 for those who want sustainable operations. Making sure that patient care delivered is patient care reimbursed is, and always will be, the only way to survive.

InfinxTop 2017 RCM Issues In Healthcare And 2018 Projections

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