How can RCM help the healthcare industry grow and prosper; a tip for Survivability, Continuity & Sustainability of the KSA healthcare sector
We had a discussion Dr. Ayham Refaat, CEO and Founder of Accumed to talk about the importance of patient’s care, digitized economy and its affect on the healthcare industry. In addition, we also ndiscussed how Revenue Cycle Management, a very niche yet the most effective industry launched by Dr. Ayham has created a signicant impact on the country’s healthcare sector due to its contribution in helping healthcare institutions manage the finances better. The initiatives of Dr. Ayham in the Kingdom of Saudi Arabia positively showcases his contribution towards objectives of the Saudi Vision 2030.
Talking about the Healthcare Revenue Cycle Management, Dr. Ayham Refaat, CEO and founder of Accumed said: Simply speaking, Healthcare Revenue Cycle Management is the financial function performed by Healthcare Providers to ensure they receive the appropriate and fair revenue for a patient’s treatment. It is the sum of all the activities surrounding a patient’s encounter from when their appointment is first booked through when the balance of their treatment is paid. Healthcare Revenue Cycle Management is the lifeline of any healthcare provider, and what ensures their survivability, continuity and sustainability.
We all as patients have experienced RCM whenever we visited a hospital and used our insurance policy for treatment coverage. Whether that was at the appointment booking point, or whether when our doctor requested diagnostic tests for us and insurance approval was required, or whether when we were prescribed some medications and were asked to pay for it from our pocket because it is not covered by our policy; all of these are RCM related processes experienced by patients on daily basis, and forms a vital part in their treatment experience.
RCM extends beyond a patient visit because even after a healthcare provider has followed all the protocols mandated by the insurance company, and obtained the necessary approvals from them, there are still two issues for a healthcare provider to tackle; the first issue is the fact that healthcare provider hasn’t got paid at that point. Their services are provided on credit basis and there is still lots of work to do, and lots of time to wait, before the services provided are reflected as cash in the healthcare provider’s bank account.
The second issue is the other fact that healthcare providers do not have any guarantee of payment despite all approvals obtained, and the chances that their services could turn from expected receivables into bad debts do exist and are substantial.
Dr. Ayham also stated: In the past few years, and when the Saudi Vision 2030 was launched, the Kingdom witnessed a great transformation in many sectors, and the healthcare industry topped the list. The Ministry of Health in Saudi is ensuring that the objectives of the Saudi Vision 2030 are being accomplished, those objectives include: increasing the total adequate capacity, applicable geographical distribution, timely access to services and individuals’ ability to afford healthcare services. And the MOH is ensuring the accomplishment of the objectives by launching a number of initiatives and projects. Moreover, the Council of Cooperative Health Insurance (CCHI) under its visionary leadership is playing a paramount role in regulating the private health insurance industry, digitalizing the market and transforming the healthcare sector into value based driven care. Now given the impact RCM created globally on the healthcare industry, we believe that the RCM services would further advance the overall operations of the healthcare institutions and also support the government with achieving Saudi Vision 2030 in addition to serving Saudi citizens with quality services.
Healthcare providers partnering with RCM companies can be a great tactic for providers to manage their revenues while contribute to achieving the objectives of Saudi Vision 2030.
Speaking about the main growth factors for the industry in the KSA, Dr. Ayam said: As mentioned earlier, the healthcare sector in KSA is undergoing a major transformation. However, providers in the healthcare industry need to cope with the evolution, whereby patient care is about quality and clinical outcomes rather than service delivery. In addition to the growing need of adapting global trends such as the amassing vast & accurate clinical data, the adaptation of technology and the advancement of research & development; this transformation offers a great opportunity for investors and service providers to consider the KSA as one of the important markets for growth.
Dr. Ayham also shed the light on how will the RCM industry impact the investments and the attractivesness of the healthcare sector in the KSA.
“RCM is a crucial factor in facilitating, supporting and increasing the investment attractiveness of the healthcare sector in KSA. Unfortunately, it’s simultaneously the most underrated factor”. Dr. Ayham said
And he added: Investors in Healthcare services will be looking at the return on their investment as a key factor, among others of course, in deciding on investing in a certain country/sector. The ROI on investing in providing healthcare services is purely judged by the RCM since it’s the process by which investors realize revenue and profits. RCM can play a vital role in encouraging investments in healthcare by helping investors establish the needed business relations with healthcare insurance companies, and then by helping them manage their RCM function effectively so their investments are realized positively from day one. There have been several investors (both locally and internationally) who have been turned away by the high-risk prospect of not being able to generate revenue when opening a new facility due to the complications imposed by health insurers on contracting with these facilities. Also by the high-risk possibility of incurring losses due to loss of revenue as a result from their lack of knowledge, or from the poor management of the RCM function by the healthcare providers. RCM companies can directly solve those problem and smooth the way for interested investors, thus adding to the many attractive factors KSA has as an investment destination to further motivate such investments and facilitate their deployment in KSA.
Speaking about Accumed’s partners in KSA, Dr. Ayham stated: “We are working closely with the Ministry of Health on one of their key strategic initiatives related to privatization (which is currently undergoing in 27 public hospitals) and aimed at preparing public hospitals to be able to generate revenue from the private insurance patients as part of 2030 vision.
We are also proud to have worked closely with the Cooperative Council of Health Insurance and its visionary leadership where we had a chance to help them in developing a comprehensive and Saudi-bespoke Billing and Coding classification (named the Saudi Billing System for Private Health Insurance SBSPHI) that will be used to unify the medical language in the kingdom, facilitate the electronic exchange of data between all stakeholders, and be one of the enablers in the transformation towards Value Based Healthcare.
Finally, I worked closely with the Saudi Health Council on developing a pool of local manpower in the domain of Clinical coding, and help creating a path to recruitment for thousands of those young Saudi graduates from different medical fields; a vision the leadership of the SHC is very passionate about and dedicated to.”