RPA and ROI: Making the Business Case for Healthcare Automation

Healthcare organizations see automation as vital to increasing net revenue, reducing costs, and improving the patient experience. While robotic process automation will certainly address inefficiencies across the revenue cycle and provide quantitative benefits, the technology can also yield operational and qualitative benefits.

In making the business case for RPA, revenue cycle leaders will want to highlight the many advantages the technology can bring to their organizations while bearing in mind the need to set realistic expectations about automation and its impact on their ability to better manage people, process, and technology.

In this final installment of a three-part series on the value of robotic process automation to effective revenue cycle management, the focus turns from RPA use cases for the revenue cycle and RPA implementation and service models to RPA and return on investment.

Wide range of RPA benefits

Many financial leaders view the ability of RPA to automate their workflows as directly linked to a hard-dollar return on investment. But according to Cloudmed Vice President of Automation Matt Jarvis and Vice President of Workforce Automation Lynne Hildreth, the market is likely overselling, and simultaneously under-recognizing, RPA’s potential for ROI, in part because vendors without direct revenue cycle experience are measuring the wrong indicators or failing to account for other changing variables.

“The exact dollars and cents that come out of RPA do not always translate,” warns Hildreth. “Based on our own findings, the vast majority of revenue cycle leaders are not looking to eliminate positions through RPA adoption despite promises of labor savings. Oftentimes, organizations actually promote staff to higher levels and/or they’re redeployed to other areas to support the organization.”

This reality poses obvious problems for revenue cycle leaders feeling the pressure to justify RPA projects based on an assumption of an actual reduction in headcount. “But many organizations are looking beyond the hard dollars, finding greater value in knowing that a task will happen the same way every time and reduce compliance risk,” Hildreth adds.

In other words, healthcare organizations with experience using RPA technology understand that automation has a multitude of benefits: quantitative, operational, and qualitative, and individual use cases often drive value across all three.

Quantitative

Automation technology can drive labor savings and revenue increases by eliminating rote tasks and reliably taking actions to avoid delayed or denied reimbursement, especially in high-volume claim populations. RPA may not necessarily reduce an organization’s overall headcount but will allow staff to focus on more revenue-generating tasks than they otherwise would.

Operational

RPA can bring improvements to turnaround times, service levels, and capacity that are targeted toward streamlining complex processes to work more seamlessly. In the often-fragmented technology landscape health systems face, automation often plays a role in bridging the gaps between systems to facilitate a more unified consumer and caregiver experience.

Qualitative

Augmenting bots into your workflow can lead to greater accuracy, consistency, compliance, and risk management. The reliability of completing a task in the same way every time, with automation working around the clock and monitoring itself, can provide peace of mind and lower an organization’s risk profile.

When discussing RPA benefits, Hildreth and Jarvis say revenue cycle leaders should temper expectations of a dramatic reduction in headcount and point out that it can be more complicated to measure the true sources of value, such as the impact of freeing staff from more mundane, repetitive tasks to focus on complex assignments where human logic and decision-making truly shine. 

“Healthcare organizations need to think in advance about how much time they expect to save on automated processes and, more importantly, their plans for redeploying staff,” says Jarvis. “I’ve never been to an organization where every task was completed at the end every day, so it’s far more likely that automation will enable staff to complete work they otherwise wouldn’t get to, or would scramble to achieve at month- or year-end, than outright eliminating positions on a large scale.”

New baselines, measurements, and expectations

Automation such as RPA technology can be a real game-changer. But when the game changes, so too must the approach to evaluating performance and measuring success.

“Before healthcare organizations go live with automation, they must make sure to revisit their productivity metrics,” Hildreth notes. “Not doing so is the fastest way to ensure the revenue cycle team is not on board with automation if staff think they will be held to the same productivity standards for more complex tasks as they had with more basic assignments.”

Revenue cycle staff are integral to the successful adoption of RPA technology. Therefore, their leaders have the responsibility to explain the benefits of automation and the opportunities it presents for meaningful work.

“If the organization takes those easier rote tasks away without discussing how metrics and goals will change, like AR days, initial denial rate, clean claim rate, etc., it will come face to face with skeptical staff,” Jarvis emphasizes. “The other piece of the puzzle is looking at all the productivity metrics used for evaluating the human workforce to determine that RPA is doing what it is supposed to.”

Truly measuring the success of RPA adoption requires a wide set of metrics to avoid disappointment.  “We always talk about measuring labor benefits by touches and work avoided,” Hildreth points out. “For example, a bot might check something 15 times a day which a person would only do once, with a single touch. That does not translate to 15 times the value. That’s where we’ve just seen a lot of criticism around ROI growing in RPA.”

This confusion around measuring how RPA technology benefits a healthcare organization highlights the value of working with a strategic automation partner with revenue cycle expertise and the ability to guide the organization on where to look for value and track progress toward goals.

“There’s a perception among vendors who do not work every day with revenue cycle teams that staff just want to show up, do their job, and go home and have little concern for the work in front of them,” Jarvis observes. “But I’ve worked in organizations that have MBAs working on denials who want to spend their time identifying trends and solving more complicated problems. This kind of job satisfaction goes a long way toward staff retention and improves quality in those more complex workflows. There’s huge value in that, but it may be harder to quantify than the more ‘obvious’ benefits of automation.”

When making the business case for RPA technology, revenue cycle leaders need to bring a few essential bits of information to the table. They begin with baseline data against which the organization will be able to set realistic expectations for automation and its impact and finally turn to the effect of improvements on staff performance, quality of work, value of data, and reduced compliance risks. By focusing the conversation about the benefits of RPA implementation across three categories — quantitative, operational, and qualitative — revenue cycle leaders can garner support for leveraging powerful technology that improves efficiency, quality, and revenue.

__________________________________________

Cloudmed, a leading provider of Revenue Intelligence™ solutions, partners with over 3,100 healthcare providers in the United States and recovers over $1.7 billion of underpaid or unidentified revenue for its clients annually. We are unique in our ability to utilize industry-leading expertise and the powerful CloudmedAI™ Platform to help providers boost productivity and increase revenue. Cloudmed was awarded 2022/2021 Best In KLAS: Robotic Process Automation and 2021 Best in KLAS: Revenue Integrity/Underpayment Services. Our solution suites have HFMA Peer Review status and are HITRUST certified. To learn more about where healthcare leaders are on their automation journey, visit https://go.cloudmed.com/rpa-infographic-2022. For more information about Cloudmed, visit www.cloudmed.com.