Frost & Sullivan: Growing Reimbursement Challenges Force Hospitals to Reengineer Revenue Cycle Management
Ensuring financial stability in an era of transformative change drives demand for next-generation RCM solutions
MOUNTAIN VIEW, Calif., April 17, 2013 /PRNewswire/ -- Today, hospitals are facing the twin burdens of Medicare and Medicaid cuts stipulated by the Affordable Care Act (ACA) — estimated at more than $150 billion in reductions over the next 10 years — in addition to the specter of additional cuts from the Budget Control Act of 2011. Most hospitals have long deployed automated systems to address core processes around revenue cycle management (RCM). However, these legacy IT applications often have outmoded technology platforms that lack the advanced functionality needed to address new models of care delivery and reimbursement. In addition, the complexity of medical billing and collections has created fragmented workflows across the patient accounts pathway, resulting in gaps and inefficiencies that lead to lost revenue.
New analysis from Frost & Sullivan's (http://connectedhealth.frost.com) U.S. Hospital Revenue Cycle Management: Overview and Outlook, 2012-2017 research finds the market for RCM applications and services in U.S. hospitals will grow significantly and steadily over the next five years. From the valuation of $1.90 billion in 2012, the total U.S. hospital RCM market is forecast to reach $3.07 billion in 2017, representing a 61.6 percent increase from 2012. The majority of revenues will come from replacements and/or updates of legacy RCM systems, in addition to an increased use of managed services and consultants that provide niche services around specific RCM pain points.
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Revenue cycle processes and workflows are receiving unprecedented attention as hospitals seek to ensure maximum collections in the face of growing financial challenges. Healthcare reform and the push for deficit reduction is forcing hospitals to address long-standing inefficiencies and shortfalls around the RCM process, driving the market for a host of next-generation RCM solutions.
Frost & Sullivan Connected Health Principal Analyst Nancy Fabozzi, author of the analysis, emphasizes the urgency hospitals are feeling around the need to ensure financial stability for the future. "The focus in recent years was clearly on installing or upgrading clinical systems, particularly electronic health records (EHRs), and that is still a top concern for many healthcare providers," explained Fabozzi. "But the reality of 2014 is sinking in fast."
Legacy RCM solution providers, particularly the large, diversified healthcare IT (HIT) vendors, failed to innovate over the past decade, which opened the door for vendors of point solutions that provide added functionality to core systems.
"However, as competitive pressures heat up and the market for clinical systems matures, the large, established HIT vendors will increasingly take on more of an entrepreneurial spirit and broaden their efforts to drive innovation across all their product offerings, not just clinical solutions," continued Fabozzi. "This scenario will likely create a highly dynamic market characterized by robust M&As as large vendors seek to quickly add new functionalities required by healthcare reform."
The hospital RCM market is primarily a replacement market, and this may or may not include a switch in vendors. Explained Fabozzi, "hospitals, in general, are rather conservative and most would prefer not to rip and replace unless they must."
U.S Hospital Revenue Cycle Management: Overview and Outlook 2012-2017 and its companion analysis, U.S. Physician Revenue Cycle Management: Overview and Outlook, 2012-2017, are part of the Connected Health Growth Partnership Service program, which also includes research in the following markets: health information exchange, health data analytics, telehealth, emerging wireless technologies, acute care information systems, enterprise clinical information systems, and billing and revenue cycle management systems. All research services included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.
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U.S. Hospital Revenue Cycle Management
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