Optum ranked top healthcare revenue cycle vendor in new Black Book ratings

Optum has topped Black Book's list of RCM software vendors for hospital managed systems, corporations, integrated delivery networks and chains for the third consecutive year.

ZirMed topped the list for large hospitals over 200 beds for the fifth consecutive year. For small, rural and critical access hospitals under 100 beds Navicure took the lead, while Advisory Board was ranked highest for community hospitals with 101-200 beds.

"As RCM transformation disruption accelerates, the top-rated vendors are allowing providers access to the expertise to structure systems and processes that contribute to their unique financial imperatives and strategic goals," said Doug Brown, Black Book's managing partner, in a statement.

"What was once considered a back office function just a few years ago, has evolved into a full end-to-end system that begins even before patient registration," said Brown.

[Also: Mid-cycle losses have healthcare focusing on coding, predictive analytics to improve revenue cycle]

The move into value-based care is forcing healthcare organizations to steer away from outdated approaches to managing revenue cycle, as the line between clinical and financial goals are blurring, he explained.

To determine how the industry is reacting to the shift, Black Book surveyed more than 5,000 management and user-level RCM clients and found found 85 percent of providers are currently in RCM replacement mode or assessment, as a way to optimize fiscal operating environments through 2017.

Ninety-four percent of CFOs believe transformed RCM processes will help their organizations improve efficiency and financial health. According to the report, however, 48 percent are worried their organization's budgets won't allow them to purchase the end-to-end RCM system needed in 2017.

Providers spent more than $10.3 billion from June 2015 - June 2016 on a combination of end-to-end and bold RCM technology, software and outsourced services. Based on provider feedback, Black Book officials predict that number will rise to $11.9 billion by the end of Q2 in 2018.

[Also: Claims denials management tools offer hospitals opportunity to automate revenue cycle processes]

Ninety-three percent of healthcare organization CFOs said they need to eliminate RCM, financial and coding technology vendors not producing a return on investment by the end of the year, which is up from 79 percent in Q4 2015, according to the report.

"As reimbursements come under pressure and costs keep rising, provider CFOs will face unparalleled pressure over the next year to preserve financial solvency, increase productivities in care delivery, implement regulatory mandates and reduce RCM expenses associated with getting paid," he added.

In response, 87 percent of profitable hospitals surveyed said RCM software and staff will be kept in-house for better control and due to its ongoing investment in training and upgrading RCM technologies to help these organizations get the best return on investment, the report said.

But financially-troubled hospitals are looking for a less expensive options for service levels defined for more moderate financial success and an option to alleviate stress from the changing regulatory requirements.

Twitter: @JessieFDavis