I've been having the same conversation for months now with hospital leaders: Medicare funding pressure that could amount to roughly $45 billion in FY 2026, coverage losses that could leave around 10 million more Americans uninsured by 2034, and margins that were already razor-thin getting pushed to zero or below.
For context on where my perspective comes from: I lead commercial strategy at Nym Health, and I spend my weeks with hospital CFOs and revenue cycle leaders who are trying to protect cash, access, and staffing in real operating environments, not hypotheticals.
Here's my view: RCM can't stay a standard set of processes and operations. It has to become a strategic function, a “financial intelligence infrastructure,” so provider organizations can protect access and margins instead of being reactive and always playing catch-up.
Sources for key estimates: Congressional Budget Office statutory PAYGO effects; Congressional Research Service coverage provisions summary; national policy overviews of 2026 changes.
Over the past few months, the questions I hear from health system leaders have shifted from workflow optimization to survival:
The H.R. 1 (sometimes referred to as the “One Big Beautiful Bill Act” or OBBBA) has moved from political talking point to operational risk. According to the Congressional Budget Office (CBO), the bill's budget effects would create statutory PAYGO pressure on Medicare spending, estimated at $45 billion in FY 2026, rising to $76 billion by 2034, absent congressional action to waive or offset it.
Separately, federal scoring and summaries point to a material increase in uninsurance over time, with estimates on the order of ~10.9 million more uninsured Americans by 2034.
What I hear most consistently is urgency and paralysis at the same time. Some organizations are modernizing now, while others are waiting for the policy landscape to settle.
In my view, what's happening with RCM mirrors what happened with cybersecurity. It started as a back-office function, then it became a board-level concern. And today, it's the core infrastructure that determines enterprise survival.
RCM is headed the same way.
When funding tightens and coverage patterns get less predictable, the winners aren't the organizations that simply "process faster." The winners are the ones who can see revenue risk early and respond quickly, before it shows up as runaway DNFB, denials spikes, cash acceleration requests, or service line decisions made under duress.
Put simply: RCM needs to function like financial intelligence.
Time to tell which strategies set healthcare providers up for success, but the best-run teams I'm seeing today are focused on building a simple loop:
1. SenseDetect early signals, including coding/denials trends, payer behavior shifts, eligibility changes, documentation friction, and workqueue patterns, before the lagging financials tell the story.
2. PredictTranslate signals into forecastable risk, model financial risk by payer and service line, and identify which revenue streams are becoming fragile and where leakage is rising.
3. Act + Prove:Respond fast, and measure the impact of your response. Make operational changes in weeks, not quarters, and back them up with measurement, traceability, and governance leaders can trust.
Of course, this is easier said than done. But that’s where I believe technology can turn such a model from a “pie-in-the-sky” vision to reality.
Technology is central to this shift, but not as a shiny add-on. It supports the loop in three practical ways:
I’ve seen the impact of the first bullet, automation, firsthand.
One health system we work with was facing a combination of huge emergency department (ED) volumes and workforce shortages, which led to rising Discharged Not Final Billed (DNFB) volumes.
To address this, they implemented autonomous medical coding for ED facility encounters. The impact was a 50% reduction in weekly revenue tied up in DNFB, and annual ED coding costs of ~$1.3 million.
This type of impact goes well beyond “efficiency” and directly supports liquidity protection. And in an environment where reimbursement tightens, liquidity can’t be overlooked.
Learn more about this health system’s autonomous coding story.
If I'm a hospital CFO or RCM leader, I'm asking two questions:
Most organizations can't answer yes to both, and that's the gap that needs to close.
The work of modernizing RCM starts now. The question is whether you'll build strategic capability before the crisis accelerates, or after.