As the healthcare revenue cycle management process becomes more complex, vendors must adapt to continue to provide effective services to their clients.
Michael Hill, president of EqualizeRCM Services, spoke with Becker's Hospital Review about some of the biggest challenges in RCM and how his company and his management style have adapted to succeed in the healthcare industry. EqualizeRCM Services provides service support for every aspect of the RCM process to hospitals and other healthcare organizations throughout the U.S.
Note: Responses have been lightly edited for length and clarity.
Question: What are some of the biggest challenges in RCM today?
Michael Hill: One major trend I see on a regular basis is that the market requires a BMW, but providers can only afford a Ford Focus. What I mean by that is RCM continues to become more complex, with sophisticated EHRs, denials management tools, a variety of insurance plans and benefits, ICD-10 bundled payments and more. You really need college graduates in the mix to figure this stuff out and to do it effectively, but the industry is predicated on paying people $12 to $14 an hour to do billing and collections, whether that's in a provider's office or with a vendor. So what I've seen is that providers cannot afford what they need to succeed and they're having to take shortcuts at different places along the revenue cycle curve. Taking those shortcuts will end up biting you back somewhere later down the road.
Q: How does EqualizeRCM aim to combat those challenges?
MH: We have a combination of experienced, highly educated people, software wrap-around tools and international operations so that we can provide solutions at a much lower cost. By combining those things, we are able to deliver services to clients they aren't able to provide for themselves.
Q: What are some of the biggest trends in RCM you've witnessed over the past couple of years?
MH: A trend we've seen is that the revenue cycle business is following the consolidation of providers. We're seeing hospital systems grow bigger, physicians joining bigger groups and we're increasingly seeing revenue cycle providers grow bigger as well. There's a shake up going on in the business where the mom and pop revenue cycle providers are struggling to survive and that, over time, is going to reduce the number of vendors out there, effectively reducing some of the hands-on services providers have gotten used to over the years.
Q: How does a provider survive amid the RCM challenges and increasing competition in healthcare?
MH: Providers need to have greater scale and deeper pockets in order to survive in this business amid the competition and all the changes, but you also need additional skills. There's a tendency for providers to focus on the back end in collections — what the patient has left, how much money was collected — but ultimately that's a mistake. The key to successful provider practices of any type are the contracts, the registration department and the medical coding — the pieces that come upfront. If you get all three of those right, you're going to be successful even if you have problems in your back end collections.
Q: What is something interesting you've read recently?
MH: I recently read The World's Most Powerful Leadership Principle: How to Become a Servant Leader by James Hunter. I distributed it to all of my direct reports and had a leadership meeting after to discuss it. To be an effective leader, an effective provider of services, you really have to be thinking about what's important for your team and for your clients and how you go about providing that. If you put those ideas front and center, opposed to one's own career or needs, it'll pay great dividends in the end not only for those individuals as people, but for yourself as a leader and for your company.