It’s no secret to anyone in the industry that hospitals and healthcare organizations are facing workforce shortages. The lack of nurses, caregivers, and other frontline medical professionals gets most of the attention from the mainstream media. But other areas, such as revenue cycle management (RCM), are also struggling. While this is troubling for hospitals and healthcare organizations, it presents an opportunity for RCM outsourcers to become a vital partner who can alleviate some of the pressure facing these organizations.

Coming Up Short

RCM departments are important pieces of the healthcare puzzle as they substantially influence the patient experience and organization’s bottom line. Most often, a patient’s very first experience with a hospital typically involves either registration or admission personnel. Yet it is difficult for these key staff members to deliver exemplary customer service when they’re doing their job as well as the job of two or three other people.

Of course, the patient’s experience doesn’t end upon exiting the premises. Now comes the critical work of ensuring the timeliness and accuracy of the billing, as well as ensuring insurance has paid their portion. And hospitals and healthcare organizations can ill afford the cash flow challenges that arise when too few people are available for insurance follow-up, denials management, and other critical RCM tasks.

The workforce landscape has changed dramatically since the global pandemic forced many employees to shelter-in-place and work remotely. Corporations around the world laid off staff in response to the resulting reduced revenue. Hospitals and healthcare organizations were not immune, laying off staff as patient volume decreased.

As restrictions have relaxed, companies have discovered a shift in worker priorities, with many individuals preferring to work completely remotely or in a hybrid environment. In addition, soaring wage costs, implementation of sign-on bonuses, outsourcing of jobs, and greater use of automation have all played a role in mitigating the current staffing shortages at many hospitals and healthcare organizations. And now that patients have started to return, they are struggling to fill positions.

Just how bad is the workforce shortage?

According to one 2020 survey, nearly half (48 percent) of healthcare organizations said they were facing a severe shortage within their revenue cycle management or billing department.

And according to a Healthcare Financial Management Association (HFMA) survey, nearly 60 percent of healthcare finance leaders reported having 100 or more vacancies across all hospital operations. Among those, almost 20 percent had more than 600 open roles.

When it comes to the revenue cycle department, all survey respondents reported having at least one vacancy. And around 25 percent noted that they would need an additional 20 or more employees to have a fully staffed revenue cycle department.

To Outsource or Not to Outsource

RCM leaders are basically left with two options — keep RCM efforts in house (whether fully staffed or not) or invest in the expertise of outsourcing professionals.

For some, making the necessary investments in personnel and technology to create in-house RCM processes that are as efficient and effective as possible seems daunting. Filling all the necessary employee openings (assuming the budget doesn’t get cut) is difficult enough considering knowledgeable talent has gone elsewhere and the time to onboard new employees eats into revenue recovery impact. Add in having to explore the different RCM solutions available, secure budget for the necessary investments, then integrate the new RCM software into the existing infrastructure and it’s no wonder some RCM leaders are looking to invest their time and budget with outsourcers who already have the talent and infrastructure in place.

So much so that the healthcare RCM outsourcing market is expected to grow by $1.67 billion from 2022 to 2026.

Opportunity Awaits

Healthcare leaders who are considering outsourcing their RCM activities are looking for outsourcers with innovative solutions that justify the decision. Most critically, outsourcer solutions must include purposeful automation.

Whether via outsourcers or used in house, hospitals and healthcare organizations are increasingly looking at automation and artificial intelligence to help address revenue cycle staffing shortages. Automation can increase staff productivity and drive the ability to do more with less by reducing redundancies and administrative burden. It can enable staff to focus on higher yield and revenue-producing tasks. It can also reduce denials and write-offs, as well as help staff adapt to fluctuating volume and improve patient financial experiences. That is probably why, in 2021, the number of health systems using revenue cycle automation increased by 12 percent, rising from 66 percent to 78 percent.

Healthcare organizations have implemented automation to help with several RCM tasks, including:

• Insurance follow-up
• Complex claims
• Denial management
• Program enrollment
• Patient-pay follow-up
• And more.

Outsourcers must include these tasks as part of their back-end RCM offering to stay competitive.

In addition, any outsourcer must help hospitals and healthcare organizations streamline their processes and increase the speed to revenue. Outsourcer solutions must also include patient engagement strategies that drive self-service and create an improved patient financial experience.

To set themselves apart from the competition and expand their talent pools past state lines, outsourcers must deliver a solution that includes critical workforce performance management tools. It must also drive process consistency, quality assurance, and provide performance transparency to remote team members. All of this will not only help you gain a bigger piece of the provider pie by being able to serve organizations across the country, but also make you attractive to the growing remote talent pool.

The Future is Now

The trend is clear — and the opportunity for growth is here for outsourcers. Previously adequate home-grown solutions will become more arduous to maintain and likely will not scale at the speed your business requires as you scoop up these new client opportunities. Outsourcers must be ready for this active market shift and be able to serve the full needs of RCM processes, including a personable client and patient experience.

Are you ready?

This is the first article in a two-part series about dealing with RCM workforce shortages in the healthcare industry. Stay tuned for the final article.

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