"Economies of scale definitely come into it. As a physician practicing medicine it's hard to be able to be aware of what's going on in the billing side of things." Krebs' group appears to be among a growing movement toward RCM outsourcing among medical groups and hospitals. In July 2011, when EHR vendor Allscripts announced plans to launch a revenue cycle management service for physician practices, the number of larger organizations outsourcing RCM was quickly increasing, an InformationWeek story noted. Today, big practices see more reasons to outsource revenue-generation services, partly because of the increasing complexity of coding and the advent of ACOs. But while the advantages of outsourcing RCM seem to be increasing, health IT consultant Bruce Kleaveland cautions that practices should look at whether the expense of outsourcing to a service (the cost is usually calculated as a percent of revenue) truly outweighs the benefits of keeping an in-house staff.