Amid a flurry of outsourcing activity, one rev cycle VP says RPA, AI, and other emergent tools are "making us all rethink" traditional cost-saving measures.
Within the past few months alone, Mary Washington Healthcare; Hancock Health; and Brookwood Baptist Health, now part of Orlando Health, have made moves to outsource some or all their revenue cycle operations to external vendors.
They're in good company: According to Kaufman Hall's 2023 State of Healthcare Performance Improvement Report, nearly one-third of respondent organizations were pursuing outsourced revenue cycle solutions, up from 27% in the 2022 report.
Whether outsourcing revenue cycle management to a new vendor or offshore team, cost is typically a driver, but "tech's making us all rethink that," says Michael Mercurio, vice president of revenue cycle operations at Mass General Brigham, a 12-hospital system headquartered in Boston.
Mercurio holds a distinctive vantage point: Aside from managing a team made up of on- and offshore FTEs, he helps other health systems automate their RCM processes as co-founder and executive vice president of strategic relationships at an AI-based medical coding company that launched in 2019 to commercialize the computer-assisted coding solution developed by Mass General Brigham's physician organization billing office.
The intersection of automated and outsourced solutions only stands to grow as nascent tech gains ground in healthcare. Whether it's robotic process automation (RPA), regular ol' automation, or the "complete revolution that's coming in the next three to five years based on AI," Mercurio says these tools are "going to really change, I think, a lot—if not most—of the way we do things, especially in the rev cycle."
Consider a hybrid approach
Just as Mercurio's role straddles vendor and provider, so too does his stance on outsourcing. Instead of contracting with a single entity for wholesale RCM support, he partners with "individual vendors that might do pieces and parts" based on Mass General Brigham's goals, as well as cultural, financial, and operational needs.
Today, roughly 40% of his team's FTEs are offshore, a proportion that he expects to increase in the coming years. "It's going to continue to be a big part of our footprint."
At the same time, though, tech stands to take over much of the RCM work handled today by humans, regardless of their organizational affiliation, says Mercurio, pointing to one of his team's RPA bots that, since its implementation a year ago, has assumed duties previously handled by 10 offshore folks.
Integration and automation are further streamlining performance in house, too. Mercurio just finished combining Mass General Brigham's hospital and professional billing teams. The two-year initiative involved integrating workflows and operations, creating a shared culture, and figuring out how to "act and function like a team," he says. "We're still in that process."
Additionally, the system's rev cycle team is automating more than 80% of their radiology-related coding activity. "The quality is excellent," says Mercurio. "We've seen a reduction in denials and therefore a reduction in cost on the back end, which we've been able to pass back to our practices or reinvest in ourselves by redeploying staff to areas [that] need it."
Beyond radiology, it’s tool now covers pathology, evaluation and management, endoscopy, and surgery, and Mass General Brigham is seeking to expand their use cases "so that we can get a bigger bang for the services that they're providing to us," Mercurio says.
It reflects a larger vision to maximize value from existing solutions, including those used to outsource operations. "Oftentimes, you buy one product, and you don't realize that there are other offerings that that company might have that would be really beneficial to implement," he explains. "So we want to really take a hard look at any of our existing partners if we're trying to do something new in a space or expand with a technology, because it's a lot easier to, you know, add a new statement of work than it is to bring someone new inhouse."
Hold your horses
All this merging and streamlining and automating and innovating means up to 30–40% of current revenue cycle roles might not exist in the next three to five years, Mercurio says.
He's struck in this moment by a quote from Henry Ford: "If I had asked people what they wanted, they would have said faster horses."
In other words, we humans are famously bad at envisioning the future.
"I don't think anybody had space shuttles or electric vehicles in mind in the early 1900s when cars started to become really popular," Mercurio says. "And so I don't think we can really appreciate what's coming next for AI that hasn't been thought of, it hasn't been developed, it hasn't been rolled out or no one's using it, but it's going to massively change the way we do a lot of things."
To stay competitive, he recommends that RCM professionals of all walks sharpen skills that are still distinctly human. "One thing that the AI doesn't demonstrate itself to be really good at yet is critical thinking and problem solving when it requires understanding workflows between physicians and insurance companies and the software used to communicate between the two," he explains. "The folks that can understand a problem … will be the ones that will have opportunities for advancement or staying in an organization because … those are the folks we want on our team anyway — even without AI — are critical thinkers and problem solvers."
Delaney Rebernik is a freelance editor for HealthLeaders.
KEY TAKEAWAYS
Whether outsourcing revenue cycle operations to a new vendor or offshore team, cost is typically a driver, but "tech's making us all rethink that," says one rev cycle VP who is also co-founder of an AI-based medical coding company.
As automated and outsourced RCM solutions grow in tandem, the humans in the loop must stay spry, sharp, and solution focused to succeed.