Navigating the unknowns of an underperforming revenue cycle

The move to value-based care has created headaches for many healthcare organizations, especially when it comes to realigning expectations and strategies for revenue.  

But according to Harold McDonald, MBA, vice president of revenue cycle with Medi-Centrix, the right analytic tools and a fresh mindset can dramatically transform the notion of revenue cycle management. 

McDonald’s organization, a New Jersey-based provider of revenue cycle solutions and support, emphasizes the integration of first-rate data analytics, improved workflows and better business intelligence to optimize the entire process. By focusing on improving the efficiency of staff and cash flow, McDonald believes healthcare organizations can not only see improved financial success, but also elevate the overall patient experience, with more time available for direct care.  

“A key consideration,” he said, “is to ask, ‘How are you actually measuring performance?’ You need to get [over] the idea of measuring based on your budget or your financial projections and more naturally look at your actual yield. I think people are being seduced by the bright, new shiny object, which is the whole idea of value-based care. The reality is that probably 90% of your business is still really driven by the fee-for-service world, so you can’t ignore it.” 

McDonald will discuss revenue cycle strategy along with two executives from New Jersey’s Jefferson Health — Jennifer Lucas, MBA, senior director of finance and decision support, and Carmen Ciervo, DO, FACOFP, chief physician executive and executive vice president — during April’s MGMA20 | The Financial Conference in Nashville, Tenn.
 
McDonald emphasized that analytics are absolutely critical to optimized RCM, no matter how big the organization.

“It’s all about truly embracing the analytics, all the data that’s out there, and having a team go through training again and really understand what their analytics are telling them about themselves, as it’s unique to their environment,” he said. “They can add value with those analytics, but they really have to engage in them. Some think it’s just those guys down in the room with no windows running through programs and looking at P&L (profit and loss) rather than really looking at the dashboard components of the analytics and what it means about how you could drive business.”  

Ultimately, revenue cycle management needs to be positioned as a shared responsibility across the entire organization, requiring improved skill sets matched with better-integrated technology to more efficiently guide and optimize the clinical and financial aspects of care. 

And more than just a short-term solution, the speakers noted that improved RCM is an absolute necessity as payers increasingly embrace value-based models, necessitating a change on the part of providers to optimize value and minimize risk. The result, McDonald said, is a clearly defined set of steps to ensure maximum cash yield attainment from those payer contracts.

ADDITIONAL RESOURCES FOR MGMA20 | THE FINANCIAL CONFERENCE:

• "Taking the fear out of new codes and embracing eConsults"
• "Managing financial risk through patient risk scoring"
• "Using analytics to automate and streamline your medical practice's revenue cycle"
• "The upside of downside: Innovative strategies for protecting downside risk"
• "Transforming primary care: A closer look at the CMS Primary Cares Initiative"