Combined Business Office: greater scale, efficiency and insight into revenue operations

Mike Mast

The HFMA ANI annual conference always promises to be one of the premier events in the healthcare finance industry, and this year didn’t disappoint.  When not withstanding the Orlando humidity, some of the brightest minds in the industry came together to share ideas, network, collaborate and discuss opportunities to help solve some of the most pressing challenges facing healthcare. On everyone’s mind is the turmoil in Washington D.C. centered around the future of healthcare, a topic that made its way into almost every conversation.

Regardless of what happens in Washington, the rapid adoption of value-based care models is moving forward with unwavering focus. It’s widely acknowledged that these models aren’t going anywhere and therefore it is incumbent on financial leaders to focus on putting their organization in the best position possible for the future.  

With all of that as the backdrop, I had the distinct pleasure of sitting in on a roundtable discussion that was focused on the challenges of implementing a Combined Business Office (CBO) approach to managing both hospital and physician billing operations. This roundtable featured leaders from some of the most prestigious organizations from around the country. 

Here are a few of the observations that were shared in this discussion:

  • High deductible healthcare plans (HDHPs) are here to stay. Consumerism will continue to drive the need for greater efficiency and transparency. Conversely, there is more cost pressure than ever before and organizations will need to seek out and capture every opportunity to reduce costs and create greater efficiency.
  • The old business model that centered on fee-for-service is rapidly becoming obsolete and revenue sources are evolving which is driving the need for new and improved approaches to managing revenue operations.
  • The universal position of the panel was that a CBO approach enables greater scale, efficiency and greater insight into revenue operations. Most importantly, it offers the opportunity to improve the patient experience by simplifying the billing process, giving customer service complete information and achieving the revenue cycle holy grail: a single bill that contains all charges from across the enterprise.

Now, achieving the benefits of a CBO approach to revenue cycle management isn’t easy.  Here are a few things I learned from the discussion that might help you if you’re considering implementing a CBO:

  • Organizations should continue to spend a significant amount of time (more than half) on the front-end to improve patient collections AND improve the information downstream.
  • Be thoughtful about how you structure the leadership team. Common leadership over a CBO is important, but recognize that physician billing and hospital billing have significant differences.
  • Carefully think through the deployment of your human resources. Align resources based on  talent and skills as it relates to different payers or type of claim. Make sure that incentives and goals are clearly communicated. 
  • A CBO can’t be implemented without paying attention to culture. Transparency and employee engagement (revenue cycle management team to physicians) are critical. It’s not just an IT project.

Implementing  a CBO presents unique challenges.  While the desired benefits – scale, improved performance, lower cost to collect, greater insight into your revenue picture – are achievable, it is critical to think through the process and engage all participants in an open and honest manner.


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