Mid-sized healthcare providers face unique challenges in today’s competitive healthcare landscape: pressures from reimbursement cuts, operational complexity, and the push toward value-based care. SolisRx is dedicated to helping these providers not only survive, but thrive by offering tailored health data and analytics solutions that address these challenges.
Mid-Size Health Care Providers Defined:
We classify mid-size healthcare providers as organizations that are larger than small, independent practices but smaller than large hospital systems, typically with a few dozen to hundreds of providers. These include outpatient clinics, specialty practices, and ambulatory care centers, such as infusion therapy centers, behavioral health clinics, chronic care management services, and ambulatory surgery centers. Mid-size healthcare providers typically operate with narrow margins and encounter challenges that are specific to their size and scope, all while pursuing aggressive growth goals fueled by private equity. As more providers transition to value-based care, the ability to manage costs, improve care quality, and navigate reimbursement pressures becomes even more crucial. Our team recognizes the unique challenges these organizations face and is committed to delivering data-driven solutions that optimize operations, strengthen financial performance, and simplify reimbursement processes.
Challenges Faced by Mid-Sized Healthcare Providers
Reimbursement Pressures:
- The ability to reinvest in care, staff, and infrastructure is hindered by reimbursement cuts and payment delays, which strain cash flow.
- A recent report from Physicians Practice revealed that 66% of survey participants consider low reimbursement rates to be their biggest challenge with payers.
- Financial pressure makes it challenging for providers to sustain operations while maintaining high-quality services.
- Prior Authorization: The administrative workload involved in managing prior authorizations places a strain on healthcare practices, such as mid-size practices with limited staff. This strain can also have negative impacts to patients. A survey from the AMA reported that 79% of physicians believe that delays or denials in the prior authorization process occasionally result in patients paying out-of-pocket for medications.
Operational Complexity:
- The burden of navigating lower complexity in getting paid while dealing with increasing regulatory and administrative requirements.
- The struggle of balancing cost control with maintaining quality care.
- Scheduling in a mid-sized healthcare practice, such as infusion centers, presents several challenges that can affect both patient care and daily operations. Common issues like cancellations, no-shows, and staff shortages can disrupt patient flow, cause delays in treatment, and result in lost revenue. Infusion centers face the challenge of maintaining an adequate drug inventory especially when factoring in recent complexities related to White Bagging and Brown Bagging , as any shortages or delays can interfere with patient care and treatment timelines.
- In mid-sized healthcare practices, the intake process requires careful attention to accuracy, especially when dealing with complex referrals and treatment plans. While clinical staff can manage most tasks independently, delays often arise when waiting for external factors like insurance verification or provider approvals. Streamlining workflows and improving communication with external partners can help reduce these delays and ensure smoother intake processing.
Operational Costs:
- Effectively managing a practice and controlling costs requires careful planning and optimization, which can be challenging without the appropriate tools and strategies.
- A medical practice's overhead expenses can account for 60% to 70% of its revenue.
Front-Line Provider Retention:
- Provider burnout is on the rise, and many practices struggle to retain staff. As the demands on healthcare providers grow, it’s crucial to create a supportive work environment to prevent burnout and retain top talent.
The Journey to Value-Based Care:
- As the healthcare industry moves from a fee-for-service model to value-based care, mid-sized providers must enhance their data and analytics capabilities to manage risk, improve patient outcomes, and demonstrate cost-efficiency. While this shift is essential for long-term success, it can be a challenging transition without the proper infrastructure in place.
Providers can adopt a more data-driven approach by aggregating data across the EHR and Practice Management systems into a data warehouse. Once the data warehouse is implemented, here are the key metrics that are readily accessible, particularly for mid-sized providers.
Essential KPIs for Operational Enhancement
Mid-sized healthcare providers, such as outpatient centers, face balancing quality patient care with financial sustainability. To navigate this balance, they must track key performance indicators (KPIs) that provide insights into operational efficiency, care quality, patient satisfaction, and financial health.
1) Operational efficiency directly influences the cost-effectiveness and profitability of healthcare providers.
KPIs to Track:
- Room and Equipment Utilization
By identifying bottlenecks and inefficiencies, SolisRx enables mid-sized providers to make data-driven decisions that improve operational workflows, reduce costs, and enhance value-based care.
2) Effective management of the reimbursement process ensures timely payments for services rendered and helps avoid cash flow disruptions. Delays in reimbursement can lead to financial strain, especially for mid-sized providers.
KPIs to Track:
- First-pass Claim Resolution Rate
With SolisRx claim tracking and analytics features, SolisRx helps providers identify patterns in claim denials, reduce rejection rates, and accelerate overall healthcare reimbursement optimization.
3) Providers must manage operational costs, optimize revenue cycle management, and ensure they are reimbursed appropriately for services provided.
KPIs to Track:
- Days in Accounts Receivable (AR)
- Cost per Procedure or Patient Visit
SolisRx’s financial tools enable healthcare providers to monitor their reimbursement cycles, track insurance claim processing times, and ensure timely and accurate payments. By offering real-time visibility into outstanding claims and payer performance, SolisRx helps providers optimize cash flow and reduce the risk of revenue leakage.
Navigating the complexities of reimbursement, operational efficiency, and the shift to value-based care can be daunting for mid-sized healthcare providers. SolisRx offers the expertise and tailored data solutions needed to tackle these challenges head-on, enabling providers to streamline their operations, enhance patient outcomes, and drive revenue. Ready to take the next step toward optimizing your healthcare practice? Contact SolisRx today for a 30-min consultation.
