US Physician Revenue Cycle Management

  • June 2013
  • -
  • Frost & Sullivan
  • -
  • 132 pages

This study provides a roadmap for understanding technology applications and collection services used in the physician revenue cycle management (RCM) market. Included is an overview of trends in physician demographics and medical practice organization, national health expenditures, and healthcare reform. The study discusses physicians' adoption of health information technology including EHRs and practice management systems used for revenue cycle and outlines key trends in next generation RCM technology. Competitive market issues including business and pricing approaches and profiles of key competitors are provided. Market forecasts for the total market and key market segments (applications and services) for 2012 through 2017 are included.

Executive Summary
•Revenue cycle management (RCM) solutions are used to help medical practices maximize the collection of payments from insurance companies and/or patients by rationalizing a number of complex processes and steps that occur across the entire patient-accounts pathway.
•A number of different applications are utilized to address specific tasks involved with managing the physician revenue cycle. RCM applications are usually classified in two segments—stand alone applications, which are installed or web-based applications designed to support a specific function related to RCM but are not integrated with end-to-end practice management systems or clinical systems; and integrated applications, which are installed or web-based applications that combine end-to-end practice management capabilities and may also be integrated or interfaced with clinical system, system (electronic health records).
•In addition to applications, many physicians use a range of services to help manage the RCM process. These services are performed by independent billers, practice management companies, or RCM technology vendors.
•A large number and variety of vendors serve the physician RCM market. Many vendors offer both applications and services, while others specialize in one or the other. Some vendors only address the physician market and some sell products and/or services across a variety of care settings that includes hospitals.
•Today, there are well over Xtechnology vendors serving the physician RCM market in some capacity. In addition, there are over X vendors of RCM services for the physician market, many of which are small one-person businesses. Many competitors in the physician RCM market offer both technology (applications) and services.
•In recent years, RCM solutions have taken a backseat to clinical solutions because of providers’ focus on adopting electronic health records (EHRs) needed to meet meaningful use (MU). As the MU program matures, medical practices are expected to shift their focus to RCM in order to prepare for changes in reimbursement and patient demographics.
•The emphasis in the health IT market is increasingly expanding beyond EHRs into the next wave of tools needed to support accountable care, particularly next-generation RCM, which includes solutions for patient engagement, analytics for clinical decision support and risk management, and team-based care coordination.
•Today, revenue cycle processes and workflows are receiving unprecedented attention as medical practices realize they must take every measure to maximize revenue and address inefficiencies and shortfalls in getting paid fully and on a timely basis. Many medical practices will need to significantly re-engineer their entire RCM function, and most seek solutions that offer robust integration between clinical and financial systems.
•The current penetration of physician RCM applications, both stand-alone and integrated systems, is about X%. Many RCM applications used in medical practices today are legacy systems that have been in use for many years and most are not fully integrated with end-to-end practice management systems or clinical systems.
•In terms of services, it is estimated that approximatelyX% of physician practices use some kind of external service to help manage their RCM needs. Vendors charge medical practices a percentage of the total reimbursement collected from payers or patients. The majority of revenue attributed to the physician RCM market are due to services rather than applications.
•Total revenue for the US physician RCM market is estimated at $X million for the base year, 2012. This figure includes revenue derived from RCM applications and services. Computer hardware is excluded from this calculation.
•Total market revenue is expected to increase X% from 2012 to 2017. Market revenue is expected to peak at $X million in 2016. After that, total revenue is expected to decline to $X million in 2017, primarily as a result of increased market saturation, the move from installed software to web-based solutions, and downward price pressures impacting the increasingly competitive market for RCM applications.
•The total market revenue CAGR for the period 2012 to 2017 is X%.


Key Questions This Study Will Answer

• What does the physician RCM process entail, and what are the key products and services utilized for this process?
• What drives the current need for physician practices to adopt new RCM products and services, and what are the next generation functionalities that are most sought after?
• What are key macro trends impacting the physician RCM market today, and how will these influence the demand for RCM products and services over the next 5 years?
• What are the key competitive metrics encompassing the market for RCM products and services?
• What is the current penetration of RCM products and services used in physician practices, and who are the leading vendors providing these solutions?
• What are the expected revenues for the total physician RCM market and key market segments over the next 5 years?

Table Of Contents

Table of Contents

Executive Summary 4
Study Scope and Research Methodology 11
Macro Trends: National Health Expenditures and Physician Demographics 18
Introduction to Physician Revenue Cycle Management 42
Information Technology Systems in Physician Practices 51
Total Physician Revenue Cycle Management Market -
External Challenges: Drivers and Restraints 68
Competitive Market Structure 80
Competitor Profiles 87
Forecast and Trends 103
Demand Analysis 116
The Last Word 119
Appendix 126

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