Revenue Cycle Management – Discovering the New World…. of Value Based Care

Much like Christopher Columbus during his voyages of discovery in the 15th century, revenue cycle departments are discovering that their world may indeed be round and sense that the new world of value based healthcare services is where they will soon land, if not already there. Both the regulatory environment and the newly engaged patient community are more educated than ever before as to what is available to them as consumers of health. Education coming from their payers as well as organizations such as Healthgrades and with apps on each person’s smart devices, these capabilities are literally at their fingertips.

Much of the provider ecosystem has completed their EHR implementations over the last 4 years and  some of these organizations are looking to update their financials or ERP/RCM applications which have been postponed over the years. Now  that there is more pressure from systems to focus on concepts such as “pay for performance”, the movement to new methodologies of care are being assessed.  Solution vendors are seeing an uptick in their sales cycles to provider systems, leveraging the recent merger between two of the large healthcare vendors last year. I’ve heard the phrase “2 wrongs don’t make a right” mentioned in this context.

The HFMA provides the MAP award for revenue cycle and the process as to how to win that award. On the HFMA site, it states that the “MAP Award for High Performance in Revenue Cycle recognizes hospitals, health systems, and physician practices whose innovative and effective strategies have enabled them to achieve excellence in revenue cycle performance”. How many days outstanding Net AR do they have and if you are in the low 30s (days), its understood that you are doing exceptionally well. Reporting is becoming an all important focus in this regard and expect to see that area of analytics to come more into focus in the coming months and years as payment reform occurs.

The “For Profit” healthcare organizations are acquiring healthcare providers that are currently “not for profit organizations and now have had layoffs in the healthcare ecosystem, that was previously unheard of due to the need for those individuals and their years of domain experience and knowledge.


The driver for the future will be around analytics and data that will help in the decision making to drive patient care and outcomes as well as the effect of physician engagement and it’s relationship with these positive outcomes with the hopes of increasing quality and reducing the cost of care.  The hope is to effectively create a model and hopefully, the foundation for better patient care through process, people and technology.