Presented for MCOL by Nancy Chapman
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Presented for MCOL by Nancy Chapman Superior Consultant Company, Inc. [email protected] Financial Performance and Operations Improvement: Integrating Revenue Cycle Improvement and Clinical Process Change to Accomplish Greater Financial Results.

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Presented for MCOL by Nancy Chapman Superior Consultant Company, Inc.

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Presented for MCOL by Nancy Chapman

Superior Consultant Company, Inc.

[email protected]

Financial Performance and Operations Improvement:Integrating Revenue Cycle Improvement and Clinical Process Change to Accomplish Greater Financial Results

Adding the horizontal viewpoint to identify systemic opportunities for financial and operations improvement

Defining Potential Improvements:the Opportunity Evaluation Process

Using Technology to Support Improved Processes

Financial Performance and Operations Improvement are goals for every process and department in the organization. The traditional, vertical focus of revenue cycle improvement falls short of exploiting all possible opportunities for financial improvement and positive change. When the horizontal focus is added, exponential results can be achieved.

Prior To Services

Following Services

During Services

* Discharge Not Final Billed ** Clinical Documentation Management Program

It is no longer sufficient to describe potential improvements – today’s buyers need quantifiable targets and benchmarks to measure accomplishments and sustain progress

Quantifying Potential Improvements:the Opportunity Evaluation Process

Value Proposition – Sample Hospital $(000)

Note: This estimate of revenue improvement is based upon information believed to be reliable, however, the estimate is provided for discussion purposes only and is subject to material and substantial changes. Additional validation and confirmation of the major assumptions and related revenue potential will be required.

While information systems have been expected to solve problems for years, the buying market largely missed the boat regarding the critical need to change operations and processes that new technologies could support. This phenomena is changing rapidly and returns on investments are being realized.

Financial Performance, Operations Improvement and the Technology Connection

Traditional Approach

Cash acceleration

Back-end process improvement

DNFB reduction

System calculation of allowances

Verify of automated edits

Electronic work-lists

System notes and reminders

Electronic billing folders

Electronic posting/remittance processing

Technology-enabled approaches to financial performance and operations improvement opportunities

e-Health Solutions

  • Integrated processes and technology across all departments

  • Web-enabled patient access

  • Advanced telephony systems

  • Self-serve kiosks

  • Call center technology

  • Workflow automation (from the simplest (automating eligibility checking) to the most complex (CPOE)

  • A core patient record with elements of the electronic medical record (EMR) which leverages current legacy systems

  • Longitudinal patient EMR

  • Personalized web pages for physicians with links and alerts to IDN – physician portals

  • Real-time claims adjudication

  • Appeal & dispute resolution with payors

Technology Enabled Redesign

  • Front and back end process improvement

  • Denial management

  • Charge capture enhancements

  • Clinical documentation and care management improvements

  • Uniform policies and procedures throughout departments

  • Electronic schedule (with access notification of service)

  • On-line access to multiple payors for verification

  • On-line access to past balances

  • Physician alignments

  • Outsourcing opportunities

  • Consolidated/shared services opportunities



The value statement

Key Results Of The Opportunity Evaluation Process:Improved Definition of Prioritized Tasks, Project Teams and Achievable Budgets

Key Results of the Opportunity Evaluation Process

  • Used to quantify and serve as the value statement for the level of effort required to accomplish change.

  • Used to rapidly identify areas for financial improvement in clinical service lines and operations areas.

  • Helps to focus required resources by skill set to allow optimized configuration of multi-disciplinary project team

  • Helps to more accurately project budget requirements.

  • Projects potential future state – both from an operations and financial perspective

  • Provides key performance metrics and analytics for each major clinical and business process and related sub-processes. Such metrics and analytics include:

    • Process and sub-process benchmarks and analytics

    • Organization’s decision triggers and analytics

    • Shared risk/reward performance measurement analytics

Summary Questions and Answers

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