The initial intent of electronic health record (EHR) adoption has evolved beyond digitizing patient data, with hospitals now implementing new or upgraded systems to better integrate the clinical and revenue cycle aspects of the organization, unify the processes of a multicenter health system, and deliver more consistent service across the board. The changing goals for EHR implementations and conversions have shined a spotlight on their business risks and opportunities.
To date, the risk side of this equation has attracted the most attention. Some recent voices, however, have rightly emphasized how such large-scale projects open up new opportunities for optimization.
At this stage in the EHR evolution, it is no longer appropriate for hospitals and health systems to simply survive an implementation. Instead, they should make use of the lessons learned and best practices gleaned from past conversions. In November 2015, AnMed Health, one of South Carolina’s largest not-for-profit health systems, engaged in an EHR implementation, taking the opportunity to pursue greater efficiency and quality improvement via two main routes: by creating a centralized professional billing office and by developing a revenue integrity program that covered both the hospital and the professional services sides of the organization.
Emphasizing Opportunity
The initiative began with an assessment to identify gaps and opportunities associated with the EHR implementation. This assessment uncovered formidable obstacles to change, including decentralized ownership of professional billing and patient access processes and resistance to the project at the staff and management levels. But with ample time to carry out transformational campaigns aimed at showing staff the workings and worth of the professional billing office and revenue integrity programs, AnMed Health was able to win over its internal stakeholders—buy-in that contributed to impressive metrics for the health system.
Business office centralization. The health system started to unify billing processes and centralize control early in the conversion process, assigning staff specialized functions and consolidating roughly half of the organization’s physicians’ billing practices over five months prior to implementation. In allotting so much time to testing and practice, AnMed Health instilled individuals with confidence in their new functions and helped stabilize new departmental processes. This approach helped convince remaining practices that the centralized billing office was a benefit, not a burden.
Revenue integrity implementation. Rallying clinical focus on revenue cycle processes often is a tough sell. At AnMed Health, it was paramount for project leaders to explain to clinical operations managers the current state of charging workflows and how those would differ once the new EHR was live. Before the project, the organization’s reconciliation practices varied across departments and had no formal accountability structure or real source of education when staff had questions. To obtain and keep buy-in, AnMed Health implemented a system to communicate standard policies ahead of any changes.
Also key to the health system’s efforts was the hiring of a permanent revenue integrity manager. This hire was critical not only for bringing actual oversight and expertise to the job, but also for signaling to the broader organization the new emphasis on—and accountability around—revenue integrity.
Through these efforts, AnMed Health was able to open the centralized professional billing office and revenue integrity department in conjunction with the EHR installation and have staff successfully adopt the system and process changes—an achievement that drove effective use of the new platform.
The implementation of the professional billing office also yielded the following successes in conjunction with the initial implementation of the EHR in ambulatory settings:
- Within 30 days of implementation, the health system achieved 102 percent of its cumulative target gross revenue (compared with a goal of > 98 percent).
- By 60 days after go-live, unbilled accounts receivable (A/R) were 0.25 days (compared with a goal < 2.0 A/R days).
- Within six months, total A/R days had dropped by 12 percent relative to immediately before go-live.
- Within four months after go-live, cumulative cash returned to the baseline level from prior to go-live, and average weekly payments increased by 10 percent.
Leveraging best practices from the ambulatory implementation, AnMed achieved similar best-practice results after the acute care hospital departments went live just four months later:
- By 30 days post go-live, the health system achieved 105 percent of cumulative target revenue (compared with a goal of > 100 percent); much like the ambulatory implementation, this metric compares AnMed’s revenue captured after go-live with a baseline representing AnMed’s volume-adjusted gross revenue over a 12-week period prior to go-live.
- By 60 days post go-live, unbilled-candidate-for-bill days were 4.9 (compared with a goal of < 6.0 days).
The experience of AnMed provides a valuable lesson for other health systems, in that it exemplifies how it is possible to improve revenue cycle performance by approaching an EHR conversation as an opportunity to unify disparate processes and clarify professional roles across hospitals.
Christine Pearson is CFO, AnMed Health, Anderson, S.C.
Julianne Dreon is associate vice president of revenue cycle, AnMed Health, Anderson, S.C.
Matt Onesko is a director, Navigant, Chicago.
