Improve Processes: Refuse to Accept the Status Quo

Any of us with a reasonable amount of experience in the healthcare revenue cycle space realize management systems (PM, EHR, EMR) all have their strengths, but also have their weaknesses.

Many systems do not readily lend themselves to satisfactory modeling existing business processes that, albeit fairly manual, are deemed effective and best practices. Other systems may effectively model some processes but are found to be lacking flexibility in other key areas. The bottom line is that, based on its own merits, NO ONE SYSTEM seems to be a “perfect fit” for any medical provider or facility.
Quite often, when a major system is implemented the users find that a key process has not improved to the degree hoped. In fact, in some cases, a key process has actually been rendered less efficient at the cost of other important process improvements. It’s not a rare occurrence to hear something like “the new system works great - except for the collection module.”

Many organizations find themselves in a scenario like this: they now have a fantastic system for managing clinical information but find it lacking in the key area of revenue cycle management. This is unfortunate since effective RCM helps insure the financial vitality of the organization moving forward, thus allowing the continued provision of services in pursuit of the mission I.E. such as healing the sick and improving the wellness of the community.

So, what do you do when (for example) you find yourself with a new system which excels in all other areas but lacks the tools to help you manage your self-pay A/R as effectively as you’d planned? The old adage “where there’s a will there’s a way” comes to mind.

First, understand that a fully integrated and optimized world within the healthcare industry in terms of Information Technology is an unreachable panacea. “Locked-down” systems frequently play significant roles in the financial and billing functions of major healthcare institutions and organizations across the nation. Vendors who lock down their systems and attempt to convince clients they are best served by using only a select set of vendors are clearly not acting in the best interest of their clients, prospects or the industry as a whole. Customers and prospects that accept such a position as the status quo may be doing themselves a huge disservice by not challenging, or possibly even firing, such a vendor. They may be sacrificing significant productivity gains or other efficiency gains in the near term. Furthermore, they may find that future updates to their “new” system will not adequately address their needs. Therefore, where once they enjoyed a balanced and efficient workflow between powerful, yet discrete systems, they now have an imbalance (I.E. productivity gains in one area and losses in another).

Finding ways to get actionable data from one of these systems in order that another system or service provider may be able to perform a truly valuable service may appear on the surface like a futile endeavor. But with the right mind-set and the right resources, mission critical business processes can still be automated and optimized. If you have “the will” you can frequently find “the way.”

For example, the data contained in a self-pay statement output file (I.E. the file typically used for printing the statements) from even the most “locked down” PM system may contain rich, actionable data despite the fact that it often comes in the form of a CSV file rather than an integrated SQL database or other data structure internal to and used for the system’s intended functions.

Innovative thinking in this case requires consideration of questions such as:

1) What problem are we trying to address?
2) Does the data contained in this simple format lend itself to transactional evaluation, in order to make proper decisions related to workflows and desired outcomes to solve the problem?
3) Are we willing to accept “better” over “perfect”?

Here is an example that Etacticsroutinely addresses:

Problem: “Our PM system lacks the ability to easily, if at all, assign accounts meeting certain criteria in appropriate workflows.”

Methodology for finding a solution:

  1. Determine what data is required to evaluate Ex. Ending balance on previous statement.
  2. Determine if those data points are found in the statement file (Statement files inherently contain previous balances and ending balances).
  3. If the data is available, how can it be properly evaluated. Ex. Can you store the account number and balance from month to month and determine if the balance has been reduced due to a payment made by the guarantor? Ex. Does the string “Patient Payment” followed by a dollar amount, consistently appear in the statement file?
  4. If yes, enhance the message in the statement file to reflect that either a) a sufficient patient payment has been made or b) has not been made and that the guarantor should act accordingly.

In this example, the lack of flexibility within the PM, EMR, EHR system to produce the proper messaging on a statement based on the guarantor’s recent payment history did not act as a barrier to creating a solution. The initiative and inquisitive nature of the stakeholders led to a process improvement in spite of the obstacles. In the end, communication was enhanced between provider and patient/guarantor and self-pay A/R was greatly enhanced.

To summarize:
Software vendors with a large installed base may be able to solve a lot of problems, but can also become known as very inflexible and even restrictive toward existing or desired ways of conducting business with best practices in the area of collections. Combat this risk by looking at the data you have available to you. Consider what it’s capable of telling you and how you can consistently evaluate it to your advantage. Then plan out and implement a solution that (at a minimum) will not sacrifice quality, efficiency and/or end-user satisfaction at the cost of major enhancements elsewhere.