Black Book Survey Unveils Clearinghouse Transition Trends: 92% of Medical Practices Navigating Short-Term Fixes and Long-Term Vendor Solutions

Physician Claims Clients Endorse Four Companies That Are Excelling at Best Handling the New Customer Influx: Veradigm, Waystar, Experian, and Availity

Recent media has focused on a claims clearinghouse outage, as alternative providers in revenue cycle management seized the opportunity to step in and address the service deficiencies caused by the service disruption.

"Indeed, this ransomware situation and outage prompted a large-scale inquiry into one company's market dominance and whether its clients are exploring alternative claims and revenue cycle management solutions," said Doug Brown, President of Black Book Research, which conducted the sweeping surveys.

Black Book surveyed 30,000 practitioners to gauge how physician business office leaders and practitioners responded to the clearinghouse security breach. Notably, 13,209  practice leaders participated, achieving an impressive 44% response rate in a six-week window, reflective of the strong urge among practices to voice their sentiments of dismay.

Providers affected by the breach face a challenging situation with no easy solution. Transitioning to another clearinghouse can be lengthy and take weeks, while manual claim submission adds a significant workload to practices already burdened with administrative tasks. 

According to the polling results, smaller and mid-sized practices that rely on reimbursement cash flow are forced to make tough decisions about staying afloat. As practices have not been able to receive reimbursements from insurers for patient visits, it has become difficult for the practice to pay for operational expenses like payroll and medical supplies. When surveyed about how their practices are coping with expenses during this reimbursement disruption, 1,552 licensed U.S. physicians participating in the survey indicated:

22% - of practice owners were forced to open new lines of practice credit
27% - of practice owners chose to withdraw funds from their retirement or savings personally
 3% -  of practices applied for temporary funding assistance loans from their clearinghouse vendor
 2% -  of physicians asked their patients for temporary support payments
 9% -  of practice owners applied for personal bank loans, second mortgages, equity lines of credit, or borrowed from a third party
11% - of independent physicians are considering other employment options, retirement, or closing their practice
 5% -  of practice administrators haven’t addressed the financial impact officially, hoping for a fast resolution as they use up cash flow on hand
10% - or the surveyed practices choose not to say how they are funding their expenses or say they are funding in other ways not listed

A significant complaint from the survey respondents was that 89% of participating medical leaders reported they learned of the clearinghouse cyberattack not from the clearinghouse vendor directly but from their accountant, EHR vendor, and/or the media. Ninety-four percent revealed they were extremely dissatisfied with the communication they have received directly over the past three months. How the clearinghouse communicates with its clients about the incident and its response efforts significantly impacted client perception, according to 96% of practice business leaders. Prompt and transparent communication and effective remediation efforts could have mitigated some concerns and prevented clients from switching, 52% reported.

"Consolidation in the clearinghouse market led to one vendor's massive footprint," explains Brown, "and its outsized role may make it hard for some customers to feel they are valued during this service disruption, which often leads to a switch in vendor allegiances."

Thirty-one percent of practice leaders revealed that the incident encourages their healthcare organizations to reevaluate vendor contracts for cybersecurity incidents in the future and potentially collaborate with multiple vendors to establish redundancy in their revenue cycle processes. 

An important aspect is that clearinghouse companies often retain the right to utilize the data passing through their systems for various purposes. "During the initial digitization phase in healthcare, there was a lack of awareness among customers regarding the value of this data exhaust," said Brown. "Companies capitalized on this, negotiating data use rights in a manner that would be challenging to replicate today."

For instance, one of the largest claims clearinghouses holds secondary data use rights to over half of the claims processed through its platform. This data fuels various non-clearinghouse products such as fraud waste and abuse detection, de-identified data sales, and clinical decision support tools. These products benefit significantly from access to extensive datasets, a major selling point to payers for entrusting the clearinghouse with end-to-end operations. Interestingly, the non-clearinghouse functions appear to constitute a more significant revenue stream despite the clearinghouse business boasting better margins.

At this time, clients are also considering switching clearinghouses for other reasons, including security concerns, service quality, pricing, and the availability of additional features or functionalities.

Eighty-one percent of small practices with five or fewer practitioners and 96% of independent and solo physician practices expressed serious distrust in the large clearinghouse engines and skepticism about their ability to avoid a cyber attack in the next 24 months.

"Perhaps this signals that fee-for-service models carry risks, and adopting predictable revenue models such as a flat fee per month or yearly budgets, which don't necessitate scrutinizing every patient transaction, could streamline processes," said Brown.

Physician offices of various sizes were surveyed about customer service performance during and after the Q1-Q2 ransomware attacks. The survey focused on 18 key performance indicators for Physician Clearinghouse Services. Clientele identified the top-rated clearinghouse vendors for each category.

Solo to Four Practitioner Medical Practices: Veradigm Payerpath

Five to Ten Practitioner Groups: Waystar

Eleven to Twenty-five Practitioner Groups: Experian

Twenty-six or more Practitioner Groups and Clinics: Availity

Eighty clearinghouse vendors were included among the 13,000 physician practice respondents. Clearinghouse KPIs included reliability, trust and accountability, communications, innovation, best-of-breed technology, data security, and customer relations.

About Black Book™

As the largest survey in healthcare IT, Black Book™ has gathered over 2.5 million opinions on vendor performance in software, information technology, consultants, capital equipment, and outsourced services within the healthcare industry. With over 15 years of international recognition, Black Book™ is renowned for its customer satisfaction polling. Black Book™, along with its founder, management, and staff, does not possess any financial stake or ownership in the vendors included in this survey. There are never any participation or inclusion fees for vendors or surveyed participants.

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Source: Black Book Research