Survey of Hospital Revenue Cycle Leaders Sees a Future of More Automation, Remote Work

COVID-19 has moved through the healthcare workforce like a wrecking ball, claiming the lives of more than 3,600 frontline staff and taking a physical and mental toll on countless others. But a new survey shows how the pandemic’s upheaval extends beyond the direct care staff to those who keep the financial engines running—and how nothing will be the same going forward.

Commissioned by AKASA and conducted through the Healthcare Financial Management Association's (HFMA) Pulse Survey program, the Annual Report on Revenue Cycle Automation, released Thursday, was conducted from May 19 to June 22, 2020. For most health systems, this came after they had suffered the first wave of canceled surgeries and screenings and created protocols to see patients, either through telemedicine or under strict guidelines to prevent spread of the SARS-CoV-2 virus. But for most, even with federal relief under the CARES Act, the revenue roller coaster continued throughout 2020.

The survey reached 587 chief financial officers and revenue cycle leaders at hospitals and health systems across the United States. According to a statement from AKASA, it has a confidence level of 95%, with a margin of error of plus or minus 5%.

Automation already dominates revenue cycle operations in hospitals and health systems, with more than 66% of health systems and hospitals using some form of it. The pandemic only propelled the holdouts to move toward automation, with 60% of provider groups that have not jumped on board saying they planned to do so by the year’s end.

Besides the ability to ramp up quicky, healthcare leaders are looking for systems that can accommodate remote work—and some predict that certain workers who fled offices due to COVID-19 will never return to traditional settings. Findings showed:

• 75% of organizations will restructure revenue cycle operations in response to the pandemic
• 32.4% plan more permanent work-from-home staffing; this was especially true among larger entities with $1 billion to $10 billion in net patient revenue.
• 23.3% don’t plan to change their current approach, will keep the ability to quickly shift to remote work if needed
• 14.2% plan more automation; the highest-revenue entities planned the most automation.

Which operations are most likely to be automated? Financial leaders responded they use automation for some or all of the following:

• adjustment posting, 60.6%
• billing edits, 51.1%
• claim status, 48.4%

Most of all, health leaders want customization: 90% of healthcare financial leaders want automation systems built for healthcare revenue cycle management, not some other purpose.

Authors of the report say that as the pandemic continues into 2021, they expect revenue cycle leaders “to be increasingly sophisticated in their analysis of automation solutions and better able to distinguish the approaches that overpromise and underdeliver from those that provide a solid return on investment.” They note that many health systems use multiple vendors for different revenue cycle needs.

"With revenue cycle automation firmly in place within two thirds of the healthcare market, it is clear that automation is here to stay," said Malinka Walaliyadde, co-founder and CEO of AKASA, which is a provider of United Automation services. "The opportunity going forward for provider organizations is to expand their ambitions and scope for automation within the revenue cycle."