Healthcare is in a continuous state of flux, adapting to growing complexities, new technologies, evolving regulatory conditions and the surge of data.
Amid shrinking margins and different patient volumes, health systems across the country are evaluating services across their organizations, looking for ways to streamline operations, boost efficiency and reduce costs.
Revenue cycle management is one area of healthcare that is becoming increasingly complex due to denials, billing errors, potential security threats and changing payer conditions, among other challenges. Because of this, health systems are looking for opportunities in this space, with Adena Health CEO Jeff Graham identifying one RCM partnership as "a real win-win for our health system" in an interview with Becker's.
Chillicothe, Ohio-based Adena recently transitioned 340 revenue cycle department employees to Ensemble Health Partners' payroll as part of a plan to boost the system's financial stability. The employees who transitioned to Ensemble — which Adena partnered with in 2018 —- maintained their salaries and seniority when the change took effect March 5. Many of the employees who transitioned were remote.
"Most organizations don't have the internal resources to stay up to date or be able to effectively deal with certain issues to get paid correctly," Mr. Graham told Becker's. "We partnered with Ensemble … to outsource and share in the management of those operations, which brings great benefit to Adena, but also provides an opportunity for employees to grow their career in a much larger setting."
Mr. Graham cited the increased costs for hospital operations and inadequate reimbursement for care as key reasons for the move and noted that the average hospital expense per patient discharged is up nearly 30 percent since 2019, driven by the nursing workforce shortage. "Frankly, we could no longer absorb those soaring costs, nor can we continue to accept inadequate reimbursement for care," he said.
Hospitals and health systems that handle their own billing and RCM can struggle to keep up with rising costs and the complexities of healthcare, with many finding it challenging to maintain profitability in the current climate.
Outsourcing revenue cycle functions to a third-party company can help health systems control costs and improve their overall RCM. Since January, many systems have partnered with outside companies to achieve this, including Owensboro (Ky.) Health, Waukesha, Wis.-based ProHealth Care, Winchester, Va.-based Valley Health and Charleston, S.C.-based Roper St. Francis Healthcare.