Meet­ing Chal­lenges – Old and New

Health Data Management - - SUCCESS STORIES + STRATEGIES -

Health­care or­ga­ni­za­tions have their work cut out for them when it comes to op­ti­miz­ing their rev­enue cy­cle man­age­ment func­tions to pro­vide the ef­fi­ciency and cus­tomer ser­vice needed to suc­ceed to­day while also forg­ing ahead to add the capabilities re­quired to sup­port emerg­ing value-based care mod­els. The jour­ney is a for­mi­da­ble one – and could re­quire sig­nif­i­cant tech­nol­ogy in­vest­ments.

Part of the chal­lenge could em­anate from the fact that health­care or­ga­ni­za­tions are still strug­gling to reign in rev­enue cy­cle costs, even af­ter im­ple­ment­ing elec­tronic health records. A study pub­lished in the Fe­bru­ary 20, 2018 is­sue of the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion showed that even though a large aca­demic med­i­cal cen­ter was us­ing a cer­ti­fied elec­tronic health records sys­tem, the es­ti­mated costs of billing and in­sur­ance-re­lated ac­tiv­i­ties were still sub­stan­tial. In fact, the es­ti­mated costs of billing and in­sur­ance-re­lated ac­tiv­i­ties ranged from about 3% to 25% of pro­fes­sional rev­enue. More specif­i­cally, es­ti­mated pro­cess­ing time and to­tal costs for billing and in­sur­ance-re­lated ac­tiv­i­ties were 13 min­utes and $20.49 for a pri­mary care visit; 32 min­utes and $61.54 for a dis­charged emer­gency de­part­ment visit; 73 min­utes and $124.26 for a gen­eral in­pa­tient stay; 75 min­utes and $170.40 for an am­bu­la­tory sur­gi­cal procedure; and 100 min­utes and $215.10 for an in­pa­tient sur­gi­cal procedure.

For many years, Min­nie Hamil­ton Health Sys­tem, a fed­er­ally qual­i­fied health cen­ter that owns and op­er­ates a crit­i­cal ac­cess hos­pi­tal and ru­ral health cen­ter in Grantsville, West Vir­ginia, out­sourced its rev­enue cy­cle man­age­ment re­spon­si­bil­i­ties to a third party – be­cause the staff at the hos­pi­tal couldn’t ef­fi­ciently lever­age its EHR to suc­cess­fully man­age rev­enue cy­cle man­age­ment. When the health­care provider re­cently tran­si­tioned to a new EHR with more ro­bust func­tion­al­ity, it brought the rev­enue cy­cle man­age­ment func­tion­al­ity back in house. The EHR makes it pos­si­ble to put rel­e­vant in­for­ma­tion in front of the hos­pi­tal’s billing and cod­ing staff mem­bers – mak­ing it easy for them to take ac­tion and move the rev­enue cy­cle man­age­ment process along.

“We’re a small ru­ral, crit­i­cal ac­cess hos­pi­tal, so tal­ent ac­qui­si­tion is quite a bit of a chal­lenge for us. That’s why we orig­i­nally went with the third-party out­sourc­ing,” said Eric Ritchie, COO. The new EHR, how­ever, “al­lowed us to bridge that gap a lit­tle bit by putting the knowl­edge right on the com­puter screen. So, all staff mem­bers have to do is read it, in­ter­pret it, and then take ac­tion on it.”

Bring­ing the rev­enue cy­cle in-house has en­abled Min­nie Hamil­ton to re­duce days in ac­counts re­ceiv­able by about 30% within about fourth months. In ad­di­tion, “by bring­ing rev­enue cy­cle man­age­ment back in house, you elim­i­nate the over­heard of the third party ven­dor,” Ritchie said.

Per­haps more im­por­tant, Min­nie Hamil­ton has been able to im­prove its cus­tomer ser­vice by re­ly­ing on its own em­ploy­ees to pro­vide rev­enue cy­cle man­age­ment ser­vices. “Our rev­enue cy­cle staff mem­bers are from the area. So, they are more fa­mil­iar with who qual­i­fies for ben­e­fits un­der our slid­ing fee pro­gram. They can have a more mean­ing­ful conversation with a pa­tient when set­ting up pay­ment plans. Pa­tients just have an in­stilled trust when they are deal­ing with some­one that they rec­og­nize as being from the area,” Ritchie said.

The value propo­si­tion

In ad­di­tion to mak­ing the billing process more cost ef­fi­cient and pa­tient friendly, health­care or­ga­ni­za­tions are also tasked with strate­gi­cally rein­vent­ing their rev­enue

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