Optimizing the Ambulatory Revenue Cycle
By Brad Osgood
In recent years, there has been a significant trend for physician practices to become more tightly aligned with their hospitals either through formal
affiliations or outright acquisitions. While the rationale behind this trend has been frequently discussed and is fairly obvious, these relationships do not
always achieve optimal results related to the ambulatory revenue cycle. Historically, hospitals have been very adept at managing change in the acute setting
while maintaining somewhat of an arms length relationship with their community physicians. As the number of mergers, acquisitions and affiliations has increased,
a comprehensive assessment of the ambulatory environment is often overlooked. This results in significant untapped opportunities, which will be discussed
below.
One of the first areas that should benefit via system integration is the overall patient experience. While many of the leading vendors are making great
strides in improving transparency between the ambulatory and acute setting, it isn’t always necessary to implement a new system to achieve significant gains.
Often times simply performing a comprehensive assessment of current state systems and processes while mindfully defining the desired future state will result in
considerable enhancement of the patient experience. This can result in eliminating redundancy and automation of many manual processes including eligibility
verification, registration, appointment scheduling, referrals and the list goes on and on.
Another critical area where opportunities abound relates to physician practice efficiency and resultant improved clinical care. Too often when physicians and
hospitals join, the focus is on the contractual relationship and the prospect of improving clinical interaction between the entities goes overlooked. In many
cases again, a thoughtful assessment of information flow between the physician’s legacy system and the associated ancillary systems is not completely and
adequately performed. This results in continued redundancy and unnecessary manual intervention by already overworked staff.
Finally, and particularly important given the current economy, one of the most disregarded opportunities is that of ambulatory revenue optimization. Simply
performing a merger of a physician group and hospital system does not address the unrealized revenue that is existent in virtually every “integrated” system.
Remember, many community-based physicians are affiliating or merging with hospitals because they lack the resources and/or the sophistication to keep up with the
complex payer and regulatory requirements. At the same time, most hospital systems lack the agility and/or expertise to maximize the ambulatory revenue
opportunities. This creates a recipe for lost revenue. A comprehensive look at systems and processes can mitigate this risk.
In summary physicians and hospitals must collaborate to achieve the most cost effective, quality care that their patients seek, deserve and now demand. To
maximize the value of these relationships it is imperative to conduct a comprehensive review of people, process and technology to achieve the desired results. In
addition, to sustain any achieved gains, it is also necessary to perform regular “preventive maintenance” on the ambulatory revenue cycle. While the effort to
reengineer is not small, it pales in comparison to the long-term results that can be achieved with the right approach.
VCS has the people, experience and methodologies to help you achieve your optimal ambulatory revenue cycle.
If you need more information please contact VCS at 610.444.1233 or vcs@getvitalized.com.