Revenue Cycle Management – Discovering the New World…. of Value Based Care

Much like Christopher Columbus during his voyages of discovery in the 15th century, revenue cycle departments are discovering that their world may indeed be round and sense that the new world of value based healthcare services is where they will soon land, if not already there. Both the regulatory environment and the newly engaged patient community are more educated than ever before as to what is available to them as consumers of health. Education coming from their payers as well as organizations such as Healthgrades and with apps on each person’s smart devices, these capabilities are literally at their fingertips.

Much of the provider ecosystem has completed their EHR implementations over the last 4 years and  some of these organizations are looking to update their financials or ERP/RCM applications which have been postponed over the years. Now  that there is more pressure from systems to focus on concepts such as “pay for performance”, the movement to new methodologies of care are being assessed.  Solution vendors are seeing an uptick in their sales cycles to provider systems, leveraging the recent merger between two of the large healthcare vendors last year. I’ve heard the phrase “2 wrongs don’t make a right” mentioned in this context.

The HFMA provides the MAP award for revenue cycle and the process as to how to win that award. On the HFMA site, it states that the “MAP Award for High Performance in Revenue Cycle recognizes hospitals, health systems, and physician practices whose innovative and effective strategies have enabled them to achieve excellence in revenue cycle performance”. How many days outstanding Net AR do they have and if you are in the low 30s (days), its understood that you are doing exceptionally well. Reporting is becoming an all important focus in this regard and expect to see that area of analytics to come more into focus in the coming months and years as payment reform occurs.

The “For Profit” healthcare organizations are acquiring healthcare providers that are currently “not for profit organizations and now have had layoffs in the healthcare ecosystem, that was previously unheard of due to the need for those individuals and their years of domain experience and knowledge.


The driver for the future will be around analytics and data that will help in the decision making to drive patient care and outcomes as well as the effect of physician engagement and it’s relationship with these positive outcomes with the hopes of increasing quality and reducing the cost of care.  The hope is to effectively create a model and hopefully, the foundation for better patient care through process, people and technology.

Patience with patients! A CEO that gets it!

At a recent meeting of the local Indian American Chamber of Commerce this past January, the new President & CEO of Mercy Health Partners, Dr. Yousuf Ahmad (who was the keynote speaker for the evening) spoke about his journey to the CEO spot at Mercy; from arriving in the United States in his teens and adapting culturally through the years in Kentucky and south western Ohio, to his focus on being able to leverage data during his time as CIO, and move Mercy Health deftly through the challenges of MU 1 and now navigate through MU Stage 2; the topic of patient engagement arose and how Mercy has towards being an ACO and how he places a high degree of value on physician empathy towards their patients in today’s continuum of care.

Listening to his keynote, I realized how now, more than ever it was even more important to share clinical and operational best practices across the healthcare community and for care provider leaders to share their experiences on implementing different elements of technology necessary for their initiatives, such as building and supporting a successful ACO. I was recently privileged to have that opportunity during the ICD-10 project I managed last year and have seen our care provider IT departments collaborating to help make sure that they can assist their fellow care delivery organizations meet their project and regulatory objectives.

Yousuf spoke about the need to understand the data requirements needed to support care, such as the 91% patient experience quality metric he mentioned that Mercy Health is able to derive from their physicians showing empathy towards their patients and the success he mentioned to a question I posed of his patient engagement initiatives for MU Stage 2. In short, he is able to tie his metrics with the quality of care the patient population his organization serves. What are the challenges they have with interoperability, especially with other care provider organizations, both urban & rural and health information exchanges in order to better and more efficiently coordinate care?

The role of, and need for empathy within the care delivery environment was described was evident to all during his talk and he was an amazing evangelist for his organization’s mission, both operationally and for information technology and the positive initiatives he has spearheaded over the short time he has been it’s operational leader.

During the Q&A session afterward, I made a comment that I applauded the fact that he had tied bonus incentives for Mercy’s physicians and making sure they focused on a better patient experience for the organization meeting it’s regulatory MU goals even though they would have had challenges in culturally changing the way in which some physicians may be working and relating to their patients now, but ultimately, through great patient care and compassion, his organization will march on towards their plans of expansion and as an excellent regional healthcare provider. I had the chance later that evening, to take a poll from some of the physicians that were present during the keynote and they all concurred that while they were inundated with all of the regulatory challenges currently, their ability to interact and positively connect with their patients was paramount for their initiatives to succeed.

With the news coming out over the last few days that interoperability will be the focus for the newly appointed national coordinator for health information technology, Karen DeSalvo, MD, the focus on better health through information technology assumes so much more significance as we transition towards a technology prevalent care provider environment where the patient is, and will remain, the center of attention.

Accountable Transitions for Accountable Care

As we venture further into 2014, we start to see healthcare delivery organizations investigate their care delivery capabilities and costs associated with delivering high quality care to their patient population, and they may do this at a cost that is higher than they have seen in the past. Now more than ever, healthcare organizations would have to understand and change the way in which they deliver care and improve their processes greatly in order to cut out redundant processes and improve their operational workflow.

Some of the innovations that may already be prevalent in many other industries, but may be appropriate to adopt within care delivery providers are solutions around the visibility to organizational projects through an executive dashboard that would give operational, clinical and information technology leadership opportunities to transparently collaborate on initiatives like the ICD-10 transition, EMR implementations and optimizations and of course Meaningful Use initiatives organization wide.

Politically and culturally within the industry, these kind of initiatives are not easy to implement as it would require a cultural shift in the way the organizational environment operates. Can you influence your clinical leadership to understand that a “red” status may not always be a bad thing, depending on how you look at it. The ability to shift resources towards mission critical initiatives in an agile way will give a provider organization the nimbleness to move at the speed that the new paradigm requires of them.

The organization that can implement this in a well thought out way, will need to bear in mind the lessons of the past of things such as in-network and out of network costs to the member of a payer organization and keeping in mind what’s best for the patient might not always be what’s best for the care delivery provider organization.

Utilizing technology for such things are multidisciplinary clinic meetings to track progress through teleconferencing and be able to treat patients only with certain health concerns may be a first step in the process improvement arena before rolling out much more exhaustive improvement list.

The question to ask is where does the continuum of care end for an Accountable Care Organization? As we develop a models for payers and providers collaborating for both theirs and the patient’s benefit. An example of a great collaborative initiative is last week’s announcement in Healthcare IT News that Sutter Health joined Heritage Group and Kayne Anderson Capital Advisors (both VC firms) to collaborate in a $23.6 million deal with the telehealth software company MDLIVE, which touts itself as a cloud based, HIPAA compliant platform. Such innovations and development of out of the box thinking is the future of healthcare and will help healthcare organizations contain costs and build the collaborative tools that healthcare in the United States can finally regain the leadership in the information technology arena that was needed for many years.