Last month, ImagineSoftware hosted its annual client conference, welcoming customers, partners, and industry leaders to San Antonio, Texas for the opportunity to learn and connect around all things Imagine.
In addition to the exciting launch of ImagineOneTM, as well as sessions focusing on the latest technology advancements in revenue cycle management (RCM) software, general discussion also centered around the many challenges today’s healthcare organizations from across the country are facing. Hot button issues included economic downturn, inflation, reimbursement complexities, and labor shortages, all of which were highlighted during guest speaker Dr. Jeff Goldsmith’s opening State of The Industry keynote address. This blog will further explore these trends and the innovative solutions available to help alleviate dwindling revenue, efficiency, and productivity.
Challenges Facing the Healthcare Industry
Economic Downturn
The economy is a key factor that impacts the healthcare industry in multiple ways. According to a recent article from Becker’s Hospital CFO Report, “high-deductible health plans are structured to make enrollees more cost sensitive” with economic downturn often resulting in patients deferring healthcare services due to forbidding high costs, leading to reduced volume and a compromised revenue stream. As stated, “If a consumer has a $10,000 deductible, they're more likely to entertain choices of whether healthcare is urgently needed or if it can wait.”
Inflation
Inflation remains a daunting challenge in the healthcare industry with costs rising in all operational aspects. For healthcare providers to remain profitable, it is vital to have comprehensive visibility of current costs and anticipate future cost trends. This includes understanding the direct costs associated with labor, materials and supplies, and vendor relationships, along with indirect costs related to inefficiencies and backlogs.
Reimbursement Complexities
Another challenge is the complex reimbursement landscape that poses significant barriers to revenue cycle management. Evolving payment models, changing regulations, and insurance providers' denial of claims are just some of the factors contributing to revenue downturns. Hospital-based specialties have been significantly impacted by reimbursement reductions and complicated regulations such as the No Surprises Act. Healthcare providers must embrace creative strategies within this evolving landscape to maintain financial stability.
Staffing Shortages
In addition to an increasing gap for skilled practitioners, the healthcare industry continues to grapple with a shortage of seasoned revenue cycle management professionals, hampering operational efficiency and productivity and, in turn, leading to increased costs. U.S. News reports the U.S. healthcare industry lost an estimated 1.5 million jobs at the start of the COVID-19 pandemic. During the pandemic, at a time when the demand was highest for talent, the supply diminished and the cost of available resources skyrocketed. As Dr. Goldsmith points out, “Hospitals’ operating costs blew up during COVID due to a shortage of clinicians [and] the predations of temporary staff agencies.” Many organizations were forced to look outside the industry to help fill roles, spending exorbitantly on hiring along with training costs to bring these resources up to speed. Moving forward, healthcare providers must explore innovative solutions to automate as many processes as possible while also attracting and retaining viable talent.
Opportunities For Success
Luckily, a plethora of solutions are available to tackle the above challenges and maintain financial and operational stability, as showcased by the Imagine team and more than 20 Imagine-certified partner vendors supporting the conference as integrated sponsors. Highly automated technology for billing, coding, clearinghouse, patient engagement, payment solutions, good faith estimates, eligibility, prior authorization, and advanced reporting all offer positive opportunities for improvement as healthcare groups work to streamline the RCM process.
Numerous speakers at the conference discussed the use of technology to increase operational efficiency and reduce labor costs across two full days of learning, spotlighting robotic process automation (RPA), natural language processing (NLP), artificial intelligence (AI), and machine learning to automate mundane or time-sensitive tasks. This automation not only reduces the burden on medical staff, but also eliminates human errors and improves accuracy, as outlined in the session All-In-One Automation – How?, presented by ImagineSoftware’s Sr. Vice President of Data Science, Rob Gontarek. There is no doubt the incorporation of AI and RPA has made significant strides, and as Gontarek outlined, the use cases in RCM around coding, denial prevention, capacity-to-pay, etc. are endless. Thoughtful automation is an ongoing topic for RCM leaders to help alleviate many of the challenges provider groups face.
Attendees also learned how healthcare organizations can maximize their revenue by leveraging data-driven insights in sessions like Advanced Analytics: All About Reporting, presented by ImagineSoftware’s Chief Client Officer Kurtis Hertzler and Practice Solutions Consultant Jennifer Kroken, both industry veterans and practice advocates. Data analytics can provide personalized care, predict demands for resources based on patient profiles, track treatment outcomes, and identify cost savings opportunities. Intuitive software that allows for enterprise-level transparency, while increasing efficiency, extracting costs, and simplifying operational complexities, is a desperate need for healthcare organizations in order to accurately analyze big data in predicting profitability trends.
Which leads to the unveiling of the quantum leap platform in RCM technology, and the latest crowning jewel within the ImagineSoftware product suite, ImagineOne™. Showcased by ImagineSoftware President & CEO Sam Khashman for the very first time at the conference, ImagineOne™ brings the latest in automated RCM technology to the forefront – a single platform from a single partner with the very latest automation connecting the many layers of the revenue cycle together in a way that seamlessly supports human teams, both behind the scenes and alongside their daily workflows. The adoption of "point solutions” (a tool that exists to solve only one problem within a greater network of complexities) has seen an increase in popularity among healthcare groups over the years, but organizations are quickly finding these solutions create more complications, clunky integrations, and drive misaligned expectations across numerous vendor relationships. As Khashman outlines, "ImagineOne™ will help optimize your processes, achieve your goals effectively, and reduce the cost of billing by 75%+. Furthermore, as the name suggests, ImagineOne™ is an end-to-end platform that natively integrates all Imagine systems and tightly integrates all Imagine-certified partner systems." By utilizing a single-source application to streamline the RCM process and relationship management of a practice, a mutually beneficial partnership can emerge centered around collaboration and meaningful return-on-investment.
Conclusion
As healthcare organizations navigate potential economic downturn, inflation, reimbursement complexities, and labor shortages, embracing innovative solutions is key to optimizing revenue cycle management. Automation technologies such as AI and RPA have made significant strides towards optimizing revenue cycle management, helping alleviate many of the challenges faced by healthcare providers today. Leveraging innovation and automation within an end-to-end platform, plus integrating strategic partnerships, can drive operational efficiency, enhance financial performance, and ensure sustainable growth.
ImagineSoftware's team of experts are devoted to providing valuable knowledge, resources, and tools that can help groups truly succeed in today’s ever-changing environment. At the client conference and always – how can we help you innovate?
Sources
Becker’s Healthcare, “What Risk of Recession Spells for Hospitals”
U.S. News, “Staff Shortages Choking U.S. Health Care System”
The Health Care Blog, “Last in Line: Hospitals Brace for a Chilly 2023”