Revenue Cycle Management Muscles Atop Hospital Priorities As C-suites Wrangle With 2014 Budgets, Black Book Survey Reports

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Never before has hospital viability been so closely tied to a single organizational venture: revenue cycle management transformation. As 2014 ushers in ICD-10, collective meaningful use demands, interoperability, reimbursement reform, accountable care, analytics and decision support needs, upgraded clinical systems and patient marketplace shifts, hospital executives with typically competing agendas for budget allocations, unite to pool provisions and give precedence to next generation RCM for organizational survival.

The frank reality is that a currently failing RCM strategy could quickly close a marginally performing hospital for good.

In a series of eight research reports on the 2013 State of the Revenue Cycle Management industry, Black Book™ releases comprehensive findings of IT and services users on the trends and directions of hospitals and physician practices. The top ranked vendors in customer satisfaction and client experience among RCM software and outsourcing services providers, as well as RCM transformation consultants are announced.

The latest RCM studies released today are the "Top Hospital Software Vendors, Revenue Cycle Management: Small/Rural and Community Hospitals under 250 Beds", and “Top Hospital Software Vendors, Revenue Cycle Management: Hospitals over 250 Beds, Chains and Networks". Both research sets provide analysis on the replacement RCM market as healthcare systems strategize the upgrades to patient billing and collection processes.

According to Black Book™, the $2.4 billion hospital RCM software and services industry expects double digit increases in 2014 because of business shifts, reimbursement and payment reforms, accountable care participation, ICD-10 coding challenges, physician practice acquisitions, collection issues, and overall declining margins.

Over 1,900 respective hospital CFOs, CIOs, business office managers, tech and financial staffers contributed their perceptions to Black Book™ between April 2013 and August 2013. Additionally the business managers of 1,800 physician practices owned by hospital systems also submitted ballots, evaluated separately. 557 hospital and inpatient organizations were represented in the survey.

“Shifting payment models and regulations are forcing hospital leaders to redirect previously launched budgets, priorities and strategic plans to assess if new RCM solutions can rescue them from imminent hospital layoffs, even bankruptcies," said Doug Brown, Managing Partner, Black Book Rankings LLC.

“Most hospital CFOs have no choice but to leverage next generation RCM solutions in order to keep their organizations solvent. The reimbursement challenges ahead to get paid may require several new RCM applications, and the frank reality is that a failing RCM could quickly close a marginally performing hospital for good,” Brown said.

Black Book™ also announced the top performing RCM software vendors as ranked by customer satisfaction on eighteen client experience based key performance indicators.

Zirmed, rated #1 for large hospital hospitals and academic medical centers over 250 beds. Other large hospital and academic medical center top performing ranked software include: OptumInsight, Conifer Health Solutions, McKesson Relay Health, Emdeon, SSI Group, MedAssets, Experian Healthcare, Cerner, Passport Health, Craneware, Infor, Quadramed, Obsidian, Convergent, 3M, Meditech, Revenue360, Epic Systems, and Siemens.

SSI Group, ranked first in small/rural and community hospitals under 250 beds. Other RCM vendors rated highly by client experience surveying are: Emdeon, Experian Healthcare, ZirMed, Passport Health, MedAssets, OptumInsight, Craneware, CPSI, Cerner, Convergent, McKesson Relay Health, Streamline Health, Trizetto Gateway, Conifer Health Solutions, Rycan, Quadramed, Epic Systems, Healthland and Allscripts.

McKesson Relay Health scored highest in customer satisfaction by hospital systems, IDNs, CINs, chains and ACOs. Hospital chains, networks and system RCM software receiving top honors are: Conifer Health Solutions, Emdeon, MedAssets, OptumInsight, Passport Health and ZirMed.


Roughly two-thirds (3,000 of all US hospitals) that predicted back in 2012 that they would replace their core RCM solution in 24 months have actually failed to initiate a sustainable RCM plan as of Q3 2013. More than half do not have formal needs assessments or vendor selection processes started either, otherwise remaining in a do nothing/status quo or autopilot stage.

28% of CFOs blame the multiple clinical and technology projects underway organizationally for keeping their hospitals from upgrading to comprehensive RCM solutions. "In many instances, facilities have focused myopic RCM task forces on ICD-10 coding, physician practice EHR integration, decision support tools, and insurance verification/eligibility, hence distracting the leadership teams from executing a well-structured, end-to-end RCM strategy," said Brown.

Hospital CFOs and CIOs wrangle with the prioritization of RCM above all other technology spends in 2014. Although 63% of CIOs and 88% of CFOs agree current RCMs need to be replaced, executive teams differ on agendas for project implementation acquisition, timing and urgency.

CFOs and CIOs also are polarized on the organizational preference to manage fewer vendors and favor single-source vendors. In a shift from a 2010 Black Book Rankings survey, 85% of CFOs were amenable to implementing a one vendor solution set following the direction of the hospital’s clinical information system selection committee. The general sentiment of 77% of CFO’s was they could make any RCM solution work if the hospital’s clinical staff was satisfied with the health care delivery element of the system.

In the July 2013 survey of the same topic, only12% of CFOs RCM decision making will be driven by the system preferences of hospital clinicians. And 88% of CFOs are seeking a best-in-breed approach regardless of the vendor count in contrast to 83% of CIO’s which high favor a single-source enterprise strategy, in an effort to manage fewer vendors.

Among the 91% of hospitals over 250 beds making an RCM transformation program functional in 2014, CFOs prefer a seamless bolt on integration with vendors proven to have true financial solutions for facilities of similar size and mix. In contrast, 87% of CFOs in small hospitals under 100 beds expect their RCM strategy will be selected solely on their CIS vendor relationship. Community hospitals in the 100-250 bed range are evenly split, 44% for CIS integrated applications and 44% for seamless bolt-on products.

"The brakes have been applied to slow the radical RCM change out trend in which 8 out of 10 hospitals predicted they would be replacing their RCMs between 2011 and 2013 . 36% of all CFOs confirm they are reassessing the capabilities of their current legacy, core and bolt-on RCM applications, optimistically looking for options in solutions they already own," said Brown.

About Black Book™
Black Book Rankings, a division of Black Book Market Research LLC, provides healthcare IT users, media, investors, analysts, quality minded vendors, and prospective software system buyers, pharmaceutical manufacturers, and other interested sectors of the clinical technology industry with comprehensive comparison data of the industry's top respected and competitively performing technology vendors.

The largest user opinion poll of its kind in healthcare IT, Black Book™ collects over 400,000 viewpoints on information technology and outsourced services vendor performance annually. For methodology, auditing, resources, comprehensive research and ranking data see

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