During a learning session at Becker's 11th Annual CEO + CFO Roundtable, Ed Gaines, vice president of regulatory affairs and industry liaison for Zotec Partners, led a discussion with healthcare leaders on the current regulatory environment and how it's expected to affect the industry and revenue cycle management in 2024.
Mr. Gaines framed the executive discussion with a "SWOT" analysis, exploring the current state of hospital, health system and physician revenue cycle strengths, weaknesses, opportunities and threats. Participants also discussed trends and challenges in patient payments and the role of technology — particularly artificial intelligence — in creating better patient financial experiences and managing organizational reputation.
Below are the key themes that emerged in Mr. Gaines' SWOT analysis.
4 takeaways:
1: Strengths
Navigating the COVID-19 pandemic has fostered a sense of greater collaboration in the hospital, health system and physician community. Similarly, healthcare leaders have stepped up collective advocacy efforts amid landmark legislative changes, such as the No Surprises Act. On the business side, patient demand remains strong, despite many new competitors (think: Amazon's One Medical) for lower-acuity patients.
2: Weaknesses
As provider organizations strive to improve margins, patient loyalty and care quality, many are turning to technology. But meeting patients' expectations for personalized, streamlined digital experiences — similar to those provided by prominent brands like Uber and Amazon — is a persistent challenge. As healthcare disruptors and payers increase primary care offerings, hospitals and health systems continue to grapple with staying competitive. Other competitors include ambulatory surgery centers (amid the shift to outpatient care), as many hospitals continue to bear cost burdens of emergency care per the provisions of the Emergency Medical Treatment and Labor Act.
3: Opportunities
Considering the strengths and weaknesses discussed, hospitals, health systems and physicians have myriad opportunities for improvements in 2024 that will ultimately benefit the revenue cycle. These include opportunities to educate large employers on payer denial tactics, advocacy efforts and holding organizations (i.e., payers, Medicaid officials and entities) accountable for non-compliance.
4: Threats
Mr. Gaines highlighted the many threats to provider organizations. For physician groups and ASCs, these include dwindling payer reimbursements and increasing costs amid inflation. Hospitals and health systems face similar threats, in addition to the aforementioned competitive pressures to attract new patients and retain current ones.