Small-hospital CFOs: Revenue cycle took backseat to EHR, ICD-10

Revenue cycle upgrades at U.S. hospitals have been pushed aside, in favor of preparation for the October 2015 ICD-10 transition and the chase for incentives tied to electronic health records.

Revenue cycle upgrades at U.S. hospitals have been pushed aside, in favor of preparation for the October 2015 ICD-10 transition and the chase for incentives tied to electronic health records, according to a Black Book survey of chief financial officers.

In fact, two-thirds of hospitals polled in 2012 that intended to replace their revenue cycle management platform with a comprehensive solution still had not upgraded by 2014. The news comes as more small facilities are struggling with lower inpatient revenue and higher costs tied to implementing electronic health records.

[Also: What CFOs think about revenue cycle]

Black Book’s third quarter study found 83 percent of financial leaders at hospitals under 250 beds expect their RCM systems to become obsolete by 2016 if not replaced or upgraded, as most payers will move to value-based reimbursement, rather than fee-for-service. Of that CFO cohort, 95 percent think such a scenario would cost them their jobs.

Still, 51 percent of small, under-250-bed hospitals plan to delay RCM upgrades until after the ICD-10 deadline in 2015.

There are other challenges, too. At small, rural hospitals with fewer than 100 beds, 83 percent of CFOs said they have difficulty finding the kind of human resources support they need to implement new RCM software. That number falls to 66 percent for CFOs at community hospitals between 101 and 250 beds. As for the largest hospital chains, only 24 percent of CFOs saw human resources as a concern.

Another culprit is prioritization, the report finds. When it comes to technological issues affecting hospital income, small hospital CFOs list ICD-10 coding and electronic records integration well above claims and billing, while larger hospital chains see things like interoperability and contractual analysis as much bigger drains on cash.

Small-facility CFOs are also avoiding RCM outsourcing or bolt-on solutions due to staffing concerns, and most expect to cling to their legacy RCM system into the near future.

Black Book researchers polled more than 8,000 financial, technological or administrative staff from hospitals or physician practices for the report.

Here’s a deeper look at the data:

Source: Black Book Market Research