APRIL 2009 FEATURE ARTICLES
Revenue Cycle Management: Case History
The Advantage of Converged Systems
Standardizing registration platforms can drive financial and operational efficiencies.
By Laurie Grey, Kathleen Donnelly and Erica Waller
Results speak for themselves. Patient
registration time cut by nearly 70 percent; 25 percent saved in
department staffing costs; and hospital cash collections up a
healthy 20 percent. Those are just a few of the benefits that
University Medical Center at Princeton has realized by merging
its registration and patient accounting systems several years
ago.
While the QuadraMed solutions we implemented delivered the required technical expertise, our success was also due to a sound planning process that stressed early buy-in from key stakeholders, broad representation on implementation teams and strong internal communications.
The Challenge
Located midway between New York and Philadelphia, University Medical Center at Princeton is the 308-bed, acute-care facility of the Princeton HealthCare System (PHCS). A hospital that has always prided itself on providing the highest standard of care, it had become clear to our organization earlier in the decade that certain operational areas could be further optimized through standardization and integration of our registration process.
Laying the Groundwork
The process of transformation began in 2003, when PHCS launched a 2-year project to integrate our Affinity Registration and Patient Accounting solutions from QuadraMed into a single platform.
Employees from the patient access and patient financial services departments are now a truly cohesive and collaborative team that works together to resolve issues as soon as they occur.
As one of our initial steps, we formed a steering committee with representation from Administration, Finance, Revenue Cycle, Nursing and the medical staff. This group was charged with defining the scope of the project, raising internal awareness, obtaining key executive support and maintaining consistent communications about the value, benefits and time frame of the project.
We also formed implementation teams, dividing the project among four team leaders responsible for policy and procedure, benefit realization, and testing, building and training. Each team leader had the freedom to coordinate/manage their team and was expected to deliver results based on clearly defined goals and milestones.
An important early technical step in the
project was to analyze and standardize every registration
process. Using our existing technology and additional QuadraMed
services, we "scrubbed" our master patient index (MPI) in 2004
to ensure a clean database right out of the gate. We also
deployed Precise ID, an identity management application from
QuadraMed that enables the front end staff to identify patients
accurately and minimize duplication of patient records
during registration.
Obtaining Buy-in
There were many technical challenges; however, the biggest challenge was cultural. Because the newly integrated system would affect the workflow of nearly every department at University Medical Center at Princeton, it was important that constituencies impacted by the merged systems (e.g., administration, finance, revenue cycle, nursing and physician staff) were represented on the steering committee and project management team.
While the QuadraMed solutions we implemented delivered the required technical expertise, our success was also due to a sound planning process that stressed early buy-in.
The process also benefited enormously from
the presence of an external project manager. This neutral
outsider, who was a full-time presence at the hospital, kept the
project on track and embodied the fact that we were working for
the good of the entire organization, not just to serve one
department’s agenda. As an "outsider," the project manager also
brought a level of objectivity that allowed each stakeholder to
better understand and address each other’s concerns during the
deployment process.
Another key aspect to PHCS’ success was the organization’s consistent and clear internal communications, which ensured that employees’ concerns were rapidly addressed throughout the entire process.
Lastly, in the critical first week of activation, the health system provided 24-hour support to ensure a positive experience for new users, essentially guaranteeing faster and broader adoption. After the first week, the team reduced the around-the-clock support to standard business hours.
Team Building
For more information on
QuadraMed accounting and
patient registration solutions
The re-designed registration system and processes enhanced the accuracy of our data collected and reduced manual interventions by accurately capturing the patient information upon registration, providing that information within a unified view, and then ensuring correct patient identification via the MPI process.
Combined with the implementation of the HIPAA electronic eligibility inquiry and eligibility response transactions (e.g., 270 and 271), the process enhancements also empowered PHCS to lower the rate of claim denials and improve collections of copays and deductibles at the time of service. As a result, days in accounts receivable decreased by 30 percent and cash collections increased by 20 percent over a 3-year period ending June 1, 2008.
There were operational efficiencies as well, enabling PHCS to reduce its number of FTEs by 26 percent in the patient access services department. This was done mainly through attrition as vacancies went unfilled, and through the reassignment of personnel.
Additionally, PHCS saw a leap in patient satisfaction scores (as measured by Press Ganey) from the 32nd percentile to the 90th percentile due to a 69 percent decrease in average patient wait time and a drop in average registration time by 68 percent.
Other benefits are less measurable but no
less significant, such as improved coordination and
collaboration between our hospital’s registration and accounting
functions. It turned out that the lack of integration between
systems also fostered a silo mentality within the organization.
Integrating the data systems also leveled the silos,
strengthening a sense of teamwork and common purpose.
Encouraging this transformation, the revenue cycle departments, which are comprised of patient access services, health information management and patient financial services, implemented a "walk-in-my-shoes" program in which employees in one department "shadowed" colleagues in other areas on their jobs. For instance, a registrar would follow a biller, or a medical records employee would follow a registrar. This resulted in greater insight among employees about how the entire revenue cycle process works and how their individual actions impact others.
Employees from the patient access and patient financial services departments are now a truly cohesive and collaborative team that works together to resolve issues as soon as they occur.
The collaborative, multi-departmental approach that made this project so successful will serve as a template for upcoming projects
Next Steps
Our health system’s next step is to further optimize administrative functions by rolling out enterprisewide scheduling in 2009. Currently, scheduling at the facility is still decentralized, resulting in patients often receiving multiple reminders and insurance verification calls from different departments when they have more than one procedure scheduled.
PHCS has made tremendous strides in enabling key constituents — patients, physicians and employees — to access services and simplify interactions with our organization through the effective use of patient access and revenue cycle management technologies. The collaborative, multi-departmental approach that made this project so successful will serve as a template for upcoming projects that will continue to enhance patient care and safety, while improving patient satisfaction and workflow efficiency.
Laurie Grey, Kathleen Donnelly (not shown) and
Erica Waller are director of Revenue Cycle
Management, manager of Patient Access Services and technical
manager for Revenue Cycle (respectively) at Princeton HealthCare
System. Contact them at
npilone@princetonhcs.org.