Vital Signs: A June 2024 revenue cycle management healthcare news wrap-up

June has been a busy month for medical practice revenue cycle management (RCM) news. This month’s column covers a range of topics, including increases in work relative value units (wRVU), ongoing clinical documentation challenges, the use of large language models (LLM) to combat administrative burdens, publicly reported quality data, and more. 

As medical practices strive to promote revenue integrity and compliance, these revenue cycle management news stories can help spark meaningful conversations and best practices. 

Here’s a roundup of 7 newsworthy stories to share with physicians and staff in your medical practice.

The specifics: According to MGMA’s 2024 Provider Compensation Data Report, primary care, surgical specialties, and nonsurgical specialties in physician-owned practices reported higher median wRVU in 2023 versus 2022. Advanced practice provider wRVU levels in private practices were largely unchanged from the previous year.

Why it matters: Increased wRVUs could reflect increased reliance on new technologies and automation. It could also reflect increased pressure to meet rising demands for care. Finally, it could generate more revenue as medical practice expenses remain elevated.

What’s next: Increasing wRVUs is an important part of financial sustainability. However, physicians must also continue to look for ways to streamline efficiency, contain costs, and promote revenue integrity. 

The specifics: Nearly 78% of physicians, nurses, and other professionals say they finish work later than desired or need to work at home due to excessive electronic health record (EHR) documentation tasks, according to the first American Medical Informatics Association (AMIA) TrendBurden Survey. Seventy-four percent say the effort or time required to complete documentation tasks impedes patient care.

This is in line with Tebra’s recent survey in which 65% of respondents agreed that EHR documentation reduces patient care time. 

Why it matters: The EHR documentation burden continues to exacerbate burnout, necessitating best practices and other strategies. 

What’s next: Be sure to check out AMIA’s toolkit for reducing the EHR documentation burden. Another great resource? These tools from the American Academy of Family Physicians help physicians become more efficient. Use them to redesign the clinical visit, optimize the EHR, and update evaluation and management (E/M) coding. 

The specifics: According to MedCentral’s 2024 Medical Practice Physician Report, 66% of physicians say administrative work is a key factor that challenges their medical practice. It's followed closely by reimbursement issues (57%) and staffing shortages (56%).

Similarly, in a recent Tebra survey, 82% of respondents said charting and documentation was the top most time-consuming administrative task. Our survey found that 24% of providers spend 5 to 10 hours weekly on billing and payment processes alone.

Why it matters: These and other challenges (e.g., staff turnover, EHR documentation burden, billing/coding requirements, self-pay patient collections, and retail clinic competition) make it challenging for physicians to sustain a profitable business. 

What’s next: Physicians must take proactive steps to promote financial sustainability. The MedCentral survey identifies several potential options that physicians currently leverage. A top option is to add nonphysician practitioners (56%). Another is to add or upgrade the patient portal (34%). Some options address scheduling, such as implementing new scheduling (32%), expanding office hours (23%), and creating a rigorous no-show policy (19%). Practices can also increase public relations efforts (24%) and expand their referral network (16%). 

In addition, close to half of respondents said they had a side gig in the past year, typically to bring in extra income. These gigs include taking online medical surveys for extra income, working part-time as a medical director at a nursing home or hospice program, and teaching or giving lectures.

Another option is to not accept insurance. Close to one-fifth of all physician respondents said they already switched to direct primary care. 

The specifics: CMS recently announced it would conclude its accelerated and advance payment program for the Change Healthcare/Optum payment disruption (CHOPD) on July 12. 

Why it matters: After July 12, 2024, CMS will no longer accept new applications for CHOPD accelerated or advance payments. 

What’s next: CMS will continue to monitor for other effects of the cyberattack on Medicare providers. It will also engage industry partners to address any remaining issues or concerns. If a practice continues to have difficulty billing or receiving payment, CMS says to contact Change Healthcare and/or the medicare administrative contractor (MAC). Not sure of your MAC? Visit the CMS website for more information.

Meanwhile, CMS also alerted the health sector to 14 new cyber vulnerabilities, encouraging providers to implement patches or mitigations swiftly. 

Discover how to protect your practice from cyber threats with our comprehensive guide on cybersecurity in healthcare. From identifying vulnerabilities to implementing robust security measures, get the insights and strategies you need to protect patient data. Read the full guide now.

The specifics: A recent article published in American Family Physician highlights how physicians can use large language models (LLMs) to decrease administrative burden and combat burnout. For example, LLMs can help with documentation, patient monitoring, and patient inquiries. In the future, physicians may use them to suggest diagnostic possibilities, recommend ancillary evaluations and other treatments, close preventive service gaps, and monitor and respond to chronic conditions. 

Why it matters: Despite the advantages of leveraging LLMs, the article's authors say these models also carry risks. For example, LLMs may generate authoritative yet wrong answers to queries. They may also potentially replace family physicians with other AI-enhanced clinicians, such as advanced practice providers, who are allowed to practice with a greater scope.

What’s next: Physicians will increasingly need to guide the development and implementation of LLMs in clinical care settings. Critical next steps for physicians include actively beta testing new technology, staying abreast of new LLM developments and revenue cycle management news, and collaborating with medical informatics specialists to operationalize new tools.

The specifics: In its 269-page June report to Congress, the Medicare Payment Assessment Commission (MedPAC) voiced concerns about the adequacy of future Medicare payments to physicians, particularly in light of rising costs. 

Why it matters: The gap between payments and costs could incentivize clinicians to reduce the number of Medicare beneficiaries they treat or stop participating in Medicare entirely.

What’s next: MedPAC is currently exploring alternatives to current-law payment updates. This press release provides a good overview of potential changes. 

The specifics: CMS recently added new 2022 Quality Payment Program (QPP) performance information for doctors, clinicians, groups, virtual groups, and accountable care organizations to the clinician and group profile pages on the Medicare.gov compare tool and in the Provider Data Catalog (PDC). 

Why it matters: Patients with Medicare can now use this information to make informed healthcare decisions. 

What’s next: Learn more about what data is reported and what patients may see when they review your profile. Note that any information that’s publicly reported must meet established public reporting standards. 

Check back next month for more revenue cycle management news.