Frost & Sullivan: Physicians Focus on RCM Solutions to Prepare for New Wave of Financial Challenges Physician practices accelerate investment in end-to-end solutions to automate and streamline the complex revenue cycle workflow
MOUNTAIN VIEW, Calif., June 25, 2013 /PRNewswire/ -- America's physicians are struggling with unprecedented disruption brought on by the transition to electronic health records (EHRs), mandatory upgrade to ICD-10, and, most significantly, the emerging shift to value-based reimbursement. Operational and financial challenges around reimbursement are often cited as contributing to the shrinking number of independent medical practices, as many physicians seek refuge under the umbrella of hospital ownership. While the vast majority of medical practices currently deploy some kind of IT solution to manage patient scheduling/registration, medical billing, and claims processing, many of these solutions are outdated, stand-alone applications, and often provided by a variety of different vendors.
New analysis from Frost & Sullivan's (http://www.connectedhealth.frost.com) U.S. Physician Revenue Cycle Management: Overview and Outlook, 2012-2017 research finds the market for physician RCM applications and services was valued at $11.1 billion in 2012. Market revenues are expected to grow 21.6 percent over the next five years, peaking at $14.6 billion in 2016. After 2016, revenue growth is expected to retrench due to various factors including increased market saturation and increased adoption of lower cost, web-based solutions. The overall compound annual growth rate (CAGR) over the forecast period of 2012 to 2017 is 3.9 percent.
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Frost & Sullivan Connected Health Principal Analyst Nancy Fabozzi, author of the analysis, notes many physicians are expressing dissatisfaction with the status of their profession.
"Survey after survey shows physicians are frustrated with the numerous administrative hassles associated with managing a medical practice, particularly around dealing with third-party payers," commented Fabozzi. "Reimbursement complexities are traditionally driven by the need to comply with myriad requirements of various government and commercial payers, which together account for 85 to 95 percent of physician income. Today, more than 50 percent of payments to doctors come from private insurance, and another 30 percent comes from government plans, mainly Medicare and Medicaid. Healthcare reform will bring a significant increase in the number of patients covered under Medicaid. This situation, combined with declining Medicare reimbursement and ongoing battles over the sustainable growth rate, will likely accelerate declining profit margins."
In many cases, the IT solutions currently in use in medical practices are not fully integrated with other business and clinical solutions, including EHRs. Lack of integration leads to data and information gaps that can increase the rate of claims denials and bad debt. Stand-alone billing and practice management solutions are on the wane in the market today as medical practices move towards integrated, end-to-end systems that unite front and back office data flows, provide seamless access to clinical data from EHRs, and rationalize and streamline the entire RCM process. As physicians look to a future of declining reimbursements, increased audits, and tightened critera for meeting patient quality, safety, and outcomes metrics, most have no choice but to leverage next-generation RCM solutions to help mitigate new challenges around getting paid.
Frost & Sullivan finds the physician RCM market is primed for transformation as practices prepare for increased patient loads and new payment and delivery models. Changing market dynamics are increasing the need for solutions that offer features such as patient portals with online bill pay; real-time claims adjudication; automated rules-based workflow; clinical and financial analytics; mobile charge capture; and full capabilities to support the switch to ICD-10.
U.S. Physician Revenue Cycle Management: Overview and Outlook, 2012-2017 is part of the Connected Health Growth Partnership Service program, which also includes: US and European Digital Pathology Systems Market, U.S. Hospital Revenue Cycle Management, and EMR and EHR Market in APAC. 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. Physician Revenue Cycle Management: Overview and Outlook, 2012-2017
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