In 2017, much of the buzz in the U.S. healthcare industry was created by the attempts to repeal and replace the Affordable Care Act (ACA). While the ACA is still alive in 2018, it remains to be seen if any disruptions will occur. The focus is on quality, outcomes, and value-based care. With changing federal regulations and mandates, medical billing companies are striving to help healthcare providers overcome the challenges of easing revenue pressures and maintaining cash flow. Here are the healthcare trends to look out for in 2018:
- Revenue cycle management challenges: To stay financially relevant, healthcare organizations need to reduce costs, prevent claims denials, and collect patient payments. As a Deloitte report points out, creating a positive margin in an uncertain and changing healthcare scenario is a major challenge. Providers are also adopting new cost reduction strategies such as alternative staffing models, encouraging outpatient services, and reducing administrative and supply costs. Coding and documentation improvement efforts aimed at improving reimbursement are expected to be driven by predictive analytics and clinical decision support. According to a new report from Transparency Market Research, healthcare providers will look to medical billing outsourcing to manage their financial resources and this trend is expected to continue through 2023.
- Shift from volume to value: Much of the changes in the health care scenario are driven by the shift from volume volume-based care (fee for service) to a value-based reimbursement structure (fee for value). As reimbursement is based on the quality of health care services, healthcare providers are striving to deliver the best care at the lowest cost, thereby improving the patient experience. Organizations will need quality technical infrastructure and actionable internal analytics by medical billing experts to properly measure the impact of value-based programs and identify opportunities for improvement.
- Improving the patient experience: This follows from the value-based care paradigm. A study commissioned by Change Healthcare in 2017 found that investing in patient engagement solutions was a top priority for 72% of providers and 80% of payers surveyed. Health care providers and payers are devoting more resources to provide consumer-like patient experiences. Mobile healthcare solutions are a key strategy in engaging patients and their families in quality improvement efforts to improve the patient experience.
- Increase in mergers and acquisitions: Mergers and acquisitions, such as joint ventures and affiliations are on the rise in health care.With geographic barriers, new healthcare reforms and rising expenditure driven by clinical and technology advances, rising labor costs, and aging and growing populations, providers are looking to collaboration to gain efficiencies and economies of scale. However, consolidations will be successful only if they improve care delivery and reduce costs, says a Healthcare Financial Management Association report.
- “Smart” health care: Information and Communication Technology (ICT) now has an increasing important role in improving the quality of healthcare. Digital technology is driving smart healthcare or eHealth, leading to improved diagnostic tools, better and more cost-effective treatments, and devices that improve the quality of life for patients and providers. Smart health care and electronic health records (EHRs) have demolished the barriers of hospital walls. Telehealth has vastly improved access to healthcare services by overcoming geographical barriers. Portable patient-monitoring devices, operating room scheduling software, and robotized surgery are other examples of how innovations are redefining the quality and delivery of care. Deloitte notes that “hospitals of the future are being built through redefined care delivery, digital and AI technologies, and enhanced talent development”.
- Cybersecurity concerns: As cyber attacks become more sophisticated, cybersecurity is a major challenge for healthcare organizations. This is driving investment in measures to keep their sensitive data secure. Cybersecurity risks have increased with patients taking a more active role in their health and wanting access to their data. They are investing in healthcare risk management to prevent, detect, and mitigate potential threats, reduce liability exposure, keep patients safe, and also enhance financial stability. According to the 2017 HIMSS Analytics HIT Security and Risk Management Study, 71 percent of healthcare clinical leaders consider risk assessments as the key driver for decisions on where to invest in IT security.
- Threat of infectious diseases: Antibiotic-resistant health care-associated infections are increasing and leading to increased morbidity, mortality, and health care costs. MedPage Today reported William Schaffner, MD, of Vanderbilt University School of Medicine, as saying, “The biggest issue in infectious diseases in 2018 will be the progressive occurrence of multi-resistant antibiotic infections that will challenge us to provide effective treatment”. The 2017-2018 influenza season has been challenging and intense across the country, and has resulted in many pediatric deaths.
According to Telecoms and Computing Market Reports, the global healthcare business process outsourcing market is expected to grow at CAGR of 10.3% during the period 2017-2022. Outsourced medical billing services are a cost-effective option to overcome technological and financial constraints as healthcare providers strive to manage their revenue cycle, improve patient care, and tackle the growing burden of chronic and infectious diseases.