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White Paper
Prioritizing Investment in the RCM Patient Experience
Summary
Chronically problematic RCM experiences are proven to result in lost revenue, lower profit margins, higher costs, and increased collection problems. Fortunately, healthcare providers can take focused, effective action to streamline their RCM-related patient interactions—and thereby improve their financial performance while also providing patients with better access to the clinical care they need.
By: Sunay Shah, Executive Director of Product and Strategy at Change Healthcare
Patrick Drewry, Vice President of Product Mangemen at Change Healthcare
Healthcare providers have a lot on their plates: delivering great clinical care, coping with increasingly complex payer requirements, complying with ever-changing regulatory mandates, and maintaining a qualified workforce in a challenging labor market.
So why should financial decision-makers choose to prioritize investment in their patients’ RCM experience now?
The answer, of course, is that every healthcare provider’s financial performance is more contingent than ever upon a seamless, positive patient experience across the entire revenue cycle—and across all communication channels.
Every dollar wisely invested in an enhanced patient experience, across the revenue cycle, pays off in:
- Higher revenue
- Higher margins
- Fewer coverage denials
- Reduced collection costs
- Greater long-term patient retention
- More word-of-mouth recommendations
- Lower labor costs
- Reduced staffing requirements
Collectively, these benefits translate directly into improved bottom-line financial performance. And that improved bottom-line performance is ultimately what funds everything else any healthcare provider hopes to achieve.
Symptoms of poor RCM engagement
Under-investment in the patient’s RCM experience rears its ugly head in many ways. The most obvious one is the patient’s confusion about their bill. More than half of patients surveyed report problems with the billing process. Those problems inevitably result in employee time spent answering questions and/or collection issues.
Healthcare billing has become such an issue in patients’ lives that nearly three-quarters say their billing-and-payment experience is now an important factor in their choice of healthcare provider.
And the problem is rapidly getting worse. In 2019, 42% of patients said a negative RCM experience would keep them from returning to a healthcare provider. In 2022, that number shot up to more than 63%.1
A poor RCM experience can manifest in many other ways as well. The more often you ask the same patient for the same information, the greater the probability that that someone will make a mistake that snarls intake or payment.
And you’ll frustrate a Millennial patient who expects to be able to interact with you entirely digitally if you keep sending them paper. On the other hand, if you try to force an older tech-averse patient to do business with you online, you can easily wind up with a collection problem that could simply have been avoided.
Some prospective patients may even go elsewhere entirely if they’re forced to spend too much time on hold—or find your intake process too cumbersome.
When people have medical problems, they’re often stressed and vulnerable. And they expect their healthcare experience to be seamless and center around their personal preferences.
Patients are also becoming more and more likely to leave healthcare providers bad reviews due to poor experiences, which can lead to negative financial outcomes for the provider. As of this writing, more than 27% of those surveyed have done so. But that number is going to inexorably increase, because the patients most likely to post bad reviews are those in the 30-44 age range—a demographic that will represent a larger percentage of patient populations as they get older and more likely to need healthcare services as they older.
As patients exercise more choice in their healthcare, chronically problematic RCM experiences will lead to poorer retention rates and a diminished ability to grow local market share.
Problematic experiences, inadequate automation, and inexperienced resources across the revenue cycle will also drive up labor costs. At the typical healthcare organization, about 20 people are involved in the process of scheduling, registering, and financially clearing a patient for an appointment. So the process is inordinately expensive and way too slow.
So something about the patient RCM experience obviously needs fixing. But what?
Fragmentation of RCM operations cause challenges
Patient experience problems are in large part due to the fragmentation of operations. RCM is comprised of many distinct functions: registration, scheduling, coding, claims management, authorization, etc. Some of these functions are performed in-house. Others are outsourced. But they are almost invariably siloed to at least some extent.
So a patient’s experience with these functions will also tend to be fragmented—unless a provider takes concrete steps to integrate that cross-function experience.
Functional silos also lead to the siloing of a provider’s communications channels. That is, some functions may still rely heavily on print and/or voice communications, while others make more extensive use of email and web portals.
Chronically problematic RCM experiences lead to poorer retention rates and diminished market share
I was charged incorrectly or didn’t know what I was charged for.
This channel fragmentation creates a chaotic, confusing experience for customers—who are forced to communicate with providers in seemingly random ways, often using the channels they prefer least.
Poor patient experiences across the revenue cycle are thus not just the result of fragmented functions. They are caused by the fact that patient interactions are driven by whatever each RCM function happens to find expedient for its own purposes—rather than by the needs and expressed preferences of the individual patient.
The good news is that, once identified, this underlying RCM malaise can readily be treated.
The cure: Patient-driven RCM interactions
Providers can remedy the problems that currently plague their inefficient, off-putting patient interactions—and thereby reap the associated financial benefits—start by making smart investments in front-end RCM improvements.
Key RCM investments will typically include:
- Implementation of a shared omni-channel communications platform across all RCM functions so that providers can flexibly interact with patients via mail, phone, email, web, text, mobile app, and/or in person as appropriate.
- Data integration/exchange and coordinated function-to-function handoffs across all RCM functions to ensure a “single version of the truth” and to eliminate redundant requests for information.
- Customization tools that allow patients to specify their preferred communications channels, payment types, notification/alert triggers, and other relevant RCM experience attributes.
- Expansion of payment options to include easyto- configure financing and popular alternative payment services such as ApplePay and Venmo.
- Better online self-service resources such as searchable transaction histories and chatbots.
These technology investments should obviously be accompanied by a concerted effort to address patients’ #1 concern: bills and statements that are simple, accurate, and easy to understand.
By making these investments in their RCM frontend capabilities, providers can make life easier for both patients and RCM staff across the end-to-end revenue cycle experience:
Frictionless engagement
Patients can quickly and easily initiate engagement with the healthcare provider by phone, online, or in person. And because the provider already has their relevant personal information, patients will gain a stronger sense of “belonging” to the provider’s community of care.
Facilitated access to care
Patients are quickly guided to the appropriate level of care without needless call transfers or undue time on hold. Patients are also guided through each episode of care with helpful notifications, alerts, and information.
Supportive financial clearance
The right patient-benefits counselors can help patients clearly see what their financial responsibilities are so they can make responsible, informed decisions. They are also guided to resources that can help them with their responsibilities—including financing plans and funding assistance programs.
These improvements in the patient’s RCM experience will become even more important as clinical care becomes more sophisticated, as costs continue to rise, as payers place greater clearance burdens on providers, and as competition for patient dollars intensifies.
By making smart investments, providers can remedy the problems that plague their RCM process.
Have you posted a bad review for a healthcare provider due to a bad financial experience?
A high-ROI decision
Rationalization of a patient-centric RCM process can positively impact patients’ physical, financial, and emotional health. But that’s far from the only reason healthcare providers should prioritize investment in RCM front-end modernization.
In fact, investments in a patient-centric RCM experience pays off for providers in many ways that every financial decision-maker should find immensely appealing.
These payoffs include:
Higher revenue
When providers take administrative and financial friction out of their patient-provider relationship, they deliver more care to more patients with more consistently reliable compensation.
Faster collections
When revenue cycle technology and people are integrated across the front-end, more patient responsibility revenue is collected earlier in the patient journey.
Higher margins
According to a study by Accenture, hospitals that deliver a superior patient experience achieve 50% higher net margins than their average peers.
Fewer coverage denials
77% of providers implementing patient-centric RCM saw their initial denial rates decrease—while 74% achieved a decrease in their final denial (write-off) rate.
Reduced collection costs
Patients are far less likely to become collection problems if they understand their bills, are given ways to pay those bills that they personally find convenient and can easily set up installment financing plans.
Greater long-term patient retention
93% of patients say a good financial experience is a deciding factor for returning to a certain medical provider.
More word-of-mouth recommendations
75% of hospitals have seen improvements in their Net Promoter Score as a result of front-end RCM investments. That’s an important KPI given that a third of consumers consult friends and family for referrals and receiving a referral makes a given patient four times more likely choose a provider.
Optimizing labor costs
By automating patient interactions and relying on labor from lower-cost of living areas providers are more likely to get those interactions right the first time. This helps healthcare providers substantially reduce workloads on administrative support staff, optimize labor costs, and reduce the burden on clinical staff who are often called upon to help straighten out patient billing issues.
Reduced staffing requirements
Labor isn’t just a cost. It’s also a limiting factor in driving revenue—and a top reason that 46% of healthcare providers are behind on their revenue goals. By relieving pressure on revenue cycle staffs, better-automated and coordinated patient experiences help eliminate this revenue bottleneck.
Combined, these financial payoffs add up to game-changing performance for providers facing assaults on their top and bottom lines from all directions.
Or, as one C-level healthcare provider executive put it, “You can’t put enough money into the revenue cycle, because every dollar you put in is going to generate a return for you.”
KPIs reported improved following investments in RCM front-end enhancements
Improve revenue and lower cost
Every dollar you invest in delivering a seamless journey for patients pays off in benefits that can include higher revenue, fewer denials, and reduced labor costs. Change Healthcare RCM Complete™ can help providers deliver an improved patient experience and better financial outcomes for your organization.