“What’s more fun and more exciting than taking an industry that everybody hates, the economic side of healthcare … and to be able to try to at least make those steps to change it, to make people’s lives better, and to kick the biggest companies in the country’s ass doing it”
What We're Watching
Outpatient services hit 57% of hospital revenues in 2024, up from 52% in 2020, and volumes are projected to grow another 17% over the next decade. Health systems are accelerating ambulatory investments to match. But growth in volume does not automatically mean growth in revenue, and the pressure on the economics side is only increasing. Mark Cuban made that point bluntly at the Becker's Spring Chief Pharmacy Officer Summit last week, framing Cost Plus Wellness, his new direct contracting platform for self-insured employers, as the same transparency logic he applied to generic drugs now aimed at how providers get paid. Whether or not that model scales, the underlying problem it is responding to is real. This week we are looking at two places where the revenue gap tends to open up regardless: how to decode payer contracts so underpayments do not slip through unnoticed, and what to actually look for when evaluating RCM software for ASCs and outpatient practices.
This Week's Reads
Deep dives published on exactrx.ai this week. Each one is a standalone read.
M&A Activity
Health systems are not waiting to see how the ambulatory shift plays out. From new campuses and physician partnerships to multi-site acquisitions, the buildout is happening now across the country.
What to Watch Next
Before you go
“It is easy to think of denials as a billing issue that begins when a claim is submitted,” she said. “Most denials are set in motion much earlier, often during scheduling, intake or documentation.”
What are you seeing on the ground that your systems are not capturing? Whether it is a denial pattern, a payer behavior, or a cost that keeps showing up in the wrong place, hit reply. We read everything.
This newsletter goes out to a focused group of operators, finance leaders, and revenue cycle professionals working in ambulatory and outpatient settings. If someone forwarded this to you and it felt relevant, it probably was.