Following the financial challenges in the healthcare sector in 2022, many healthcare systems are grappling with the task of creating a profitable revenue cycle. According to Becker’s Healthcare, costs have surged while revenue growth dipped to 5.1% last year from 11.3% in 2021. This has led healthcare systems to search for methods to optimize their current revenue cash flows while also providing top-notch healthcare to all their patients.
The economic crisis caused by COVID-19 has been a key catalyst for numerous current trends in Revenue Cycle Management (RCM) in healthcare. Notably, there has been a strong trend towards automation and the incorporation of artificial intelligence (AI) in healthcare operations. There’s also a shift to outpatient services as payers are increasingly demanding longer observation stays.
Automation has been instrumental in driving down the cost of care, mitigating administrative backlog, and enabling faster patient care. As AI grows in prominence, algorithms are increasingly being employed to harvest data for forecasting future trends such as patient behaviors, billing patterns, and denial trends.
Healthcare systems are placing a higher emphasis on improving patient experiences, especially with Medicare moving in the direction of a value-based care model. Providers will be paid based on specific metrics like cost, quality, effectiveness, efficiency, and timeliness.
Healthcare systems are working to streamline patient experiences by enhancing payment options, optimizing the diagnostic experience, reducing waiting times, and increasing patient involvement in their own care. In doing so, they aim to improve not only the healthcare system but also their business success, by yielding higher profit margins and boosting patient retention.
The Centers for Medicare and Medicaid Services (CMS) are transitioning to a value-based care program to enhance patient health outcomes. The goal is to incentivize healthcare providers to put more focus on the value rather than the volume of care they provide. Payment amounts will be determined based on the results of care delivery, such as the quality.
By 2023, CMS aims to enroll all Medicare and most Medicaid beneficiaries in the value-based care program. More information about this program is expected to be shared by Medicare and Medicaid Innovation in due time.
As we head into 2024, healthcare systems are striving to find ways to boost operational cash flows and enhance revenue growth, marking a future of continued transformation for RCM.
