Robert Rodger’s Guide to Revenue Cycle in Healthcare - Cover

Robert Rodger’s Guide to Revenue Cycle in Healthcare

Revenue cycle management has undergone some of the most dramatic changes in healthcare tech over the last few years. Enough so that KLAS has heard the clarion call from providers asking for a summit to set expectations and develop a framework for success between providers, payers, and vendors. 

Held at the picturesque setting of the mountains of Park City, Utah, attendees of KLAS Research's inaugural Revenue Cycle Management Summit were lucky enough to have Robert Rogers, a seasoned VP of Revenue Cycle Management, share his insights on automation in the realm of healthcare IT.  

Robert—most recently having served as the VP of Revenue Cycle Optimization at Allegheny Health Network—opened KLAS’ inaugural Revenue Cycle Summit by laying out his guidebook to innovating in the revenue cycle management (RCM) area.  

His insights could genuinely be expanded from just a keynote address into a guide for beginners in the RCM space. In lieu of that, I trust he’ll permit KLAS to share some of his insights here. 

To provide context, KLAS has now spent years gathering the right groups of people into rooms to tackle the big problems in healthcare and look at big issues, like interoperability, payer/provider relations, and so on. Unlike many other gatherings in our industry, these events are less informational and more collaborative. One attendee described the discussions as “elbows on the table, phones down.” KLAS seeks to sit in the middle, mediating and reporting on successes. 

While RCM has been a topic of research for KLAS for many years, this year was the first time we applied this collaborative approach to the subject. And between the setting in Park City and Robert’s remarks, attendees had the perfect backdrop within which to hold this crucial conversation. 

Key Insights from Robert:  

Embrace Change  

The hot topic on everyone’s mind was autonomous coding. The financially minded in the room readily acknowledged the cost-savings inherent in this change. Others, however, recognized that “autonomous” is often code for “replacing a real person with a real family who needs a real job, with a robot.” 

Robert emphasized the importance of automation in the modern healthcare industry. He shared his personal journey, detailing how, after early involvement in process automation in the AEC industry, a personal accident in 2008 made him pivot to healthcare. Through his own inpatient experience following a significant accident, he started to recognize the problems plaguing healthcare. “When you’re lying on your back for four months as an inpatient, you really get to see the inefficiencies.” The truth is, there’s plenty of work for innovators to do without causing the immediate, wholesale expulsion of human coding teams. Robert suggested that those in attendance focus on shaping meaningful progress for automation in RCM. 

Setting the Stage for Discussion  

One of the truisms of healthcare is that there’s quite a bit of noise. Robert encouraged attendees to focus on parsing out what works vs. what doesn’t. He highlighted the importance of collaboration in getting that done. As with many KLAS summits, attendees were expected to take off the “hats” they came with (“I’m a vendor/payer/provider”) and instead focus on how to build a framework for the entire industry of players in this space, who couldn’t all be nestled into a conference room in the mountains for this conversation. 

Short-Staffed, Long on Technology? 

In an ironic twist of fate, while many at the conference worried about the perceived impending layoffs caused by autonomous coding, others cited staffing shortages as one of the key reasons to adopt a coding solution. There are heavy regional divides on the issue of staffing your coding departments in the US.  For those with a shortage, Rogers stressed that traditional methods might not bring staff back, so technology may have to fill the gap. He further discussed the shift from fee-for-service to value-based care and how it introduces more risks. Again, he extolled the virtues of the role technology can play in offsetting risks in a value-based world. 

How Robert’s Insights Can Inform Your Work: 

Given that Park City’s tram couldn’t possibly fit everyone in the RCM world on board, here’s a helpful breakdown of things to remember on your autonomous coding journey: 

  1. Establish Strong Partnerships: Rogers emphasized that the success he achieved was possible due to strong partnerships both from a buyer's perspective and with vendor partners. 
  2. Benchmark Against Others: Engage with vendors who can provide insights into what other organizations are doing, giving a better idea of what’s achievable. 
  3. Learn the Lingo: It’s essential to know the difference between various terms related to automation, such as integration vs. automation or intended vs. unintended automation. 
  4. Find Champions: Having in-house champions, especially in the revenue cycle area or among clinicians, can significantly impact the successful implementation of an automation solution. 
  5. Share Ownership: ROI and defining metrics are joint responsibilities. This understanding between vendors and healthcare organizations can lead to more effective implementations. 
  6. Use the Best-Fit Solution: While vendors like Epic offer comprehensive solutions, Rogers acknowledges that sometimes the best solutions may lie outside the primary EHR. It's a balance between maximizing ROI and navigating the challenges of integration. 

The truth is, the robots are coming. Whether they’re coming for jobs or to save the day might depend on where you’re sitting. At the end of the day, autonomous coding stands as a beachhead for the expansion of AI/ML-based solutions into healthcare. Properly implemented, they promise to reduce costs, unburden overworked teams, and create joint wins for payers and providers alike. Keep an eye out in the coming weeks for KLAS’ Autonomous Coding Framework to further help health systems embark on this journey.