Vanderbilt Health harnesses data to improve revenue cycle management

Close to half of healthcare finance professionals say in a survey that their organizations are experiencing a severe shortage of revenue cycle management (RCM) talent — and many are exploring automation as a way to keep RCM operations working properly. It’s a move that Vanderbilt Health in Nashville, Tennessee, made just prior to the pandemic — and one that has paid big dividends throughout the pandemic and positions the academic medical center well for the future.

Since 2017, the move toward data-driven processes in revenue cycle, supported by automation, has enabled Vanderbilt to rack up the following results:

• 116,000 staff hours of automation, amounting to 63 full-time equivalents s for FY22
• 43 automation initiatives (bots) currently live
• Roughly 1.8 million records automated

While adding hospitals and clinics and seeing net patient service revenue climb to $5.4 billion in 2022 from $3.3 billion in 2017, no increase in revenue cycle staff was needed.

“I think that in eight years, our organization will be able to use the data within each of our institutions to inform the way accounts are worked, with processes that are much more automated than they are today,” said Heather Dunn, vice president and chief revenue cycle officer in revenue cycle services for Vanderbilt “We need to move away from the processes that have been in place for more than 20 years — like ‘High-dollar account outstanding Monday’ and ‘Aged-account Tuesday’ — toward a more intelligent approach.”

For Vanderbilt, the decision to use data intelligence to transform work in revenue cycle comes down to payment.

 “If I’m consistently doing something that is not leading to my end goal of payment, do I want to continue to do that process, or do I want to do something different?” Dunn said.

“At the end of the day, we all want to get paid for the work our organizations do,” she added.

Data helps Vanderbilt’s RCM leadership to distribute work in three ways:

1. Determining which activities do not require a human touch and can be automated
2. Identifying the claims that require staff intervention, such as complex denials
3. Pinpointing opportunities to work directly with a payer to adopt a more strategic approach

At Vanderbilt, efforts to distribute work into those three buckets are still a work in progress, but ensure folks are doing meaningful work.

A new way of looking at RCM

The shift toward allowing data to dictate revenue cycle process design, which began in 2017, required a change in mindset for Vanderbilt’s revenue cycle team.

“The first step was acknowledging that we were doing the same things over and over again and expecting a different outcome,” Dunn said. “The second was realizing that we are not a victim of our own fate. We can make a difference by being more thoughtful in how we use our human capital to work accounts.”

Next, Vanderbilt laid the infrastructure for analytics-driven improvement and automation. Throughout this process, Vanderbilt revenue cycle leaders presented the vision for change to revenue cycle team members, encouraging them to conceptualize the impact they could have on their performance and their quality of work by maintaining the momentum for transformation. Over time, employees shared ideas for applying automation to aspects of their work where redundances exist so they could focus on higher-level tasks.

Bots are about

When the pandemic hit and human capital became more stretched than ever, the work Vanderbilt had already undertaken to optimize efficiency put Vanderbilt in a better position to stay on top of claims, even as team members switched to a remote environment and adjusted to rapid-fire changes in claim payment and processes.

Today, 43 process automation bots are running throughout Vanderbilt’s revenue cycle. Staff remain energized about their efforts to build the revenue cycle of the future, which has helped attract high-caliber talent when revenue cycle vacancies arise.

“I believe Vanderbilt will have a revenue cycle that looks completely different in three years, and we’ll be a much higher-functioning shop than we would be if we weren’t following this path,” Dunn said. “Think about the cash flow that you could increase and the wasteful processes that you could eliminate by taking a similar approach. At Vanderbilt, the work we’ve done to clean up our internal infrastructure and produce better, cleaner claims, strengthens our position with payers. Now, we expect the same level of commitment from payers — and that’s a different conversation than we’ve had in the past.”