HFMA Executive Roundtable: Optimizing the Revenue Cycle IT Investment

Executives from Penn Medicine, Sutter Health, Partners Healthcare, and Guidehouse

Healthcare providers are increasingly turning to technology to improve revenue cycle efficiency — leveraging integrated electronic health record (EHR) solutions to streamline workflow, accelerate cash flow, optimize revenue integrity, and lower the cost to collect. Unfortunately, many providers still struggle to fully realize the benefits of this technology. In this roundtable, sponsored by Guidehouse, several healthcare leaders discuss how they are working to get the most from their automated solutions, particularly with regard to revenue integrity and preparing for value-based payment models.

When describing your organization's EHR platform conversion, what was the driving market catalyst?

Tim Kinney: Among our clients, I would say the main market catalysts are the shift to value and the desire to connect the clinical and financial sides of the house in a way that they never have before. Providers are looking for greater transparency between the two areas in terms of clinical documentation, coding, and billing to ensure the correct financial reimbursement.

If you peel the onion a little more, another driver that emerges is the need to consistently foster best practice performance, which can enable comprehensive revenue capture while reducing expenses. There is also a desire for greater efficiency. Historically, the revenue cycle has involved multiple handoffs and rework. With denials, for example, there are many manual tasks when following up on rejections, underpayments, and so on. With technology, providers can embrace a more proactive approach that reduces back-end work.

What steps did your organization take to achieve a positive ROI through the process, and what are some examples of the successes you achieved?

Tim Kinney: If you look thematically at the differences between a strong go-live and one that has faltered, there are a couple of things that emerge. The first is engagement. Overall, an implementation must be operationally driven. Those organizations that have the best outcomes are the ones where the operations team leads design and workflow decisions, and IT comes to the table to support them in the decision-making process. There is also a need for regular clinical involvement with physicians and other providers weighing in on what works and what doesn't. This strategy is something that should be established from the beginning. If your revenue cycle and clinical leaders work together with your CIO, you will set yourself up for success.

Providers also should focus on some leading indicators like charge capture, revenue, and whether bills are going out timely and clean. Both revenue cycle and clinical staff need to know and appreciate their roles in ensuring these metrics improve with the implementation of a next-generation EHR. Our experience is that organizations that focus on those larger, leading indicators are able to minimize revenue misses and cash disruptions, as well as ensure they enhance revenue integrity. There is a change-management component to this work, and the more upfront rigor you can put around it, the better off you are going to be.

What is your structure for implementing long-term EHR optimizations and keeping up with the latest functionality and code set for your platform?

Tim Kinney: The guiding principle that we see as we look across the industry is to revert to the implementation mindset. Every year that an upgrade becomes available, providers should gather their operational, clinical, and IT teams and determine what system functionalities will deliver value to the organization. Hospitals and health systems also should consider upgrades that will foster a more patient-friendly experience — things like generating a single patient bill, enabling smoother registration and easier scheduling, and leveraging mobile solutions. Keep in mind that it all comes back to having your operational leadership in the driver's seat.

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