RCM market to reach $14.6B by 2016


It has been monsoon season for physician practices in the financial sector — from the stop-go antics of electronic medical record implementation to the shifting platforms of value-based reimbursement and ICD-10 preparation, practices have been hammered by one downpour after another.  And while many chose to seek refuge beneath the roof of acquisition, others have been fervently playing the revenue cycle management IT market in search of self-relief, a new analysis from Frost & Sullivan confirms.

According to the report, U.S. Physician Revenue Cycle Management: Overview and Outlook, the market for revenue cycle management systems is expected to make — and, for all intents and purposes, has already made — huge bounds between now and 2017.

Researchers yielded the following figures regarding projected market growth:

All information and data courtesy of Frost & Sullivan. Presentation by PhysBizTech.

"Survey after survey shows physicians are frustrated with the numerous administrative hassles associated with managing a medical practice, particularly around dealing with third-party payers," Nancy Fabozzi, Frost & Sullivan Connected Health Principal Analyst and author of the report, said in a prepared statement. "Reimbursement complexities are traditionally driven by the need to comply with myriad requirements of various government and commercial payers, which together account for 85 to 95 percent of physician income. Today, more than 50 percent of payments to doctors come from private insurance, and another 30 percent come from government plans, mainly Medicare and Medicaid. Healthcare reform will bring a significant increase in the number of patients covered under Medicaid. This situation, combined with declining Medicare reimbursement and ongoing battles over the sustainable growth rate, will likely accelerate declining profit margins."

A future due to be wrought with increased patient loads, new payment methods and models, and a desire to close information gaps between systems via data linkage was put forth as a possible explanation as to why the RCM market will pick up steam.

Furthermore, according to Frost & Sullivan: “As physicians look to a future of declining reimbursements, increased audits, and tightened criteria for meeting patient quality, safety and outcomes metrics, most have no choice but to leverage next-generation RCM solutions to help mitigate new challenges around getting paid. Frost & Sullivan finds the physician RCM market is primed for transformation as practices prepare for increased patient loads and new payment and delivery models. Changing market dynamics are increasing the need for solutions that offer features such as patient portals with online bill pay; real-time claims adjudication; automated rules-based workflow; clinical and financial analytics; mobile charge capture; and full capabilities to support the switch to ICD-10.”

The full analysis can be found here.