Considering Outsourced Services? Choose Wisely

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

Considering Outsourced Services? Choose Wisely

Summary

 

As the world of healthcare becomes more complex, healthcare executives are searching for ways to curb costs quickly and substantially while remaining competitive and profitable. Outsourcing is one way to reduce inefficiencies and eliminate redundancy. Let's explore some of the pain points health systems and hospitals face along with the pros and cons of using an outsourced vendor.

 

Balancing Quality and Cost

 

Hospitals are facing dwindling margins, reductions in federal support, and increased patient expectations. It is in an organization's best interest to reduce costs without sacrificing quality. Quality and value are what patients seek. It is challenging to keep quality high, and costs low as increasing patient costs are at an all-time high. Why are costs so high? Because of inefficiencies and redundancies that stem from three key areas. 

 

Pain Points

 

Today's healthcare organizations' top three pain points are people, process, and technology. Attracting the most talented and vast pool of providers to rural areas is a constant struggle. Turnover is high, and ensuring staff is up to date with ever-changing governmental requirements and adequately trained in the right skill sets and competencies is costly and time-consuming. A second pain point – process, consists of poorly defined workflows and issues like charge reconciliation and denial management requiring improvement across the revenue cycle. Regarding technology, many organizations are still operating with legacy platforms while others struggle to manage non-communicating disparate software systems. Covid-19 compounded these issues by adding hiring freezes, vaccine mandates, and labor shortages. Healthcare leaders need a partner to strategize with and provide them with the stability and scalability to tackle these challenges. 

 

 

Break-Even Point

 

According to a recent Black Book survey, the average hospital will need to reduce its costs by 24 percent by 2022, just to break even.1 Healthcare leaders feel the pressure and face doing more with less. As a result, they need to be open to out-of-the-box approaches, like embracing new workflows, breaking the status quo, and exploring the possibility of cross-pollinating disciplines (nurse with pastoral care experience or emergency department director overseeing cardiology). Outsourcing may offer relief.

 

Pros

 

Outsourcing areas like release of information, coding, and cancer registry introduces knowledgeable and competent resources to manage critical operational areas while allowing hospitals to better focus on core business needs and patient outcomes. Outsourcing service lines, such as diagnostic imaging, will enable hospitals to offer access to cutting-edge medical services without making the substantial investment necessary to purchase or upgrade expensive in-house equipment. Outsourced vendors have the increased flexibility to configure resources to meet swiftly changing market needs, making them nimbler than most organizations.

 

Cons

 

Outsourcing is not a cure-all. Risks can be high. In 2018, 15,085,302 patient records were breached.2 Data breaches and patient confidentiality concerns are highest among business associates and third parties. Additional concerns are I.T.-related challenges and quality and control issues. Implementing a risk management program coupled with using vendors possessing extensive industry experience will help mitigate these risks. Reputable outsourced HIM vendor services will remote into a virtual private network (VPN), preferably the hospital’s, to access their systems rather than extract protected health information (PHI) out of the hospital's system into their own. So that data connected through the VPN tunnel protects a patient's PHI by encrypting it. This connection is secure, compliant, controlled, and always monitored against breaches, further alleviating risks. 

 

Conclusion

 

It is up to the provider to do significant due diligence by working with the right vendor to define the scope of work, outline the standards and objectives to be measured, build cyber-security and HIPAA compliant measures into the contract, and write up the total cost of each possible scenario in a service level agreement. Having a well-defined SLA will reduce any possibility of miscommunication or scope creep. In an era of fiscal constraint, different countries see outsourcing as critical to successfully providing quality care in both the public and private sectors.3 Much is gained through outsourcing if providers weigh the pros and cons, mitigate risks, and choose vendors who use best-practice methodologies.

 

 

Resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151401/

https://blackbookmarketresearch.com

https://revcycleintelligence.com/news/80-of-hospitals-vetting-full-revenue-cycle-management-outsourcing

https://www.hippajournal.com/2019-data-breach-barometer-report-shows-massive-increase-in-exposed-healthcare-records/

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