As EHR, revenue cycle tools overlap, experts say there's room for both

One system may be a challenge for some organizations, but it is imperative that clinical and revenue sides align, experts say.

With features of revenue cycle and electronic health records platforms starting to converge, groups like Cerner, Craneware and Premier Revenue Solutions are hoping they will be able to rid organizations of myriad providers by offering a sole solution.

But many experts are wary that any one vendor will be able to fill the needs of hospitals, particularly large systems.

"When I do hospital assessments, they often have 40 to 50 systems and small might have 10 to 20," said Vince Ciotti, principal with H.I.S. Professionals LLC. "The reality is that hospitals are so complicated that no one vendor will be able to do everything."

[Also: Hospitals shopping for end-to-end revenue cycle suites]

Ciotti said that few EHR vendors offer all of the necessary modules needed for a hospital, including laboratory services or all of the information insurers need. Areas like coding, emergency systems and obstetrics are all done better by 3M, EDIS and GE respectively than can be found in integrated systems, he said. Without expertise in particular areas, suite products may fall short for providers. Judy Hanover, research director for IDC's Health Insights business, said she has seen suite EHR products and hospitals that have seen benefits with charge capture, but said there is also often less optimization than with true revenue cycle management systems.

"There are capabilities in RCM systems that aren't in those tools … I don't think they are ever going to be 100 percent submerged in the EMR product."

Hanover said she has seen health systems reporting losses when converting to a single EHR system with revenue capabilities. They have charge capture and cash flow issues because bills don't go out as quickly, there is no dedicated software to connect to payers, more claims are denied and denied payments aren't reconciled as well, she said.

Sandra Wolfskill, director of healthcare finance policy and revenue cycle MAP at the Healthcare Financial Management Association, said she doesn't think either kind of system will take over the market because they have very different functionality. The systems are also driven by different regulations and requirements like the billing rules for claim forms.

"They are parallel and need to work together," she said.

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Communication will be key between the two moving forward, Wolfskill said. There is some of that now – like bar code scans in an EMR that create a transaction on the revenue side – but not nearly enough. One system may be a challenge for some organizations, but it is imperative that clinical and revenue sides align. And if they aren't going to be integrated, then they will have to have to interface better than they currently do.

"I can think of no time in EMR and RCM history where them talking was more important," said Todd Rothenhaus, chief medical officer for athenahealth.

Healthcare spending is moving toward paying for value; providers are dealing with increasing penalties from payers; and insurers are paying for more treatments – like care transitions and chronic care management – as long as they can be captured for billing. For all of these reasons, Rothenhaus said RCM and EMR systems will have to communicate.

"I do think it's going to be an awakening for the industry and it shouldn't be so hard," Rothenhaus said.

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