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

1. Defining Potential Improvements: the Opportunity Evaluation Process
Adding the horizontal viewpoint to identify systemic opportunities for financial and operations improvement

2. 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
During Services
Following Services
Portfolio
Optimization
Patient Access
Design
Denial
Management
Charge Capture and Pricing
Clinical
Integration
Documentation and Coding
Billing
Process
Accounts
Receivable
Cash
Collections
Svc Line Growth
Capacity Management
Referral Management
New Venture Partnerships
Clinical Process Improvement
POC Med Admin
Bar Coding
Electronic ICU
Clinical Alerting
Scheduling
Pre-registration
Insurance Verification
Point-of-Service Collections
Call Center Technology
Registration Points
Prior Balance
Adjudication
Case Management
Denials and Appeals Tracking
Physician Alignment
Appeals Process
Electronic Charge Capture / Reconciliation
Market-based Pricing / Fee Screen Review
Operational Pricing
Managed Care Pricing & Contracting
Strategic Pricing
Standardization & Consolidation of Charge Description Master (CDM)
Medical Management Infrastructure
Service Line Redesign
Clinical Technologies and Process Improvement
CDMP**
Bed Management
Resource Management
DNFB* Reduction
Outpatient Documentation
APC Process Improvement
APC Financial Impact Assessment
HIPAA
Medical Records Redesign
Claim production work flow analysis
CDM Review & Update
Late Charge Analysis
EDI Editing & Claims management
DNFB Reduction*
Days Revenue
% > 90 Days
Hold Days
Bad Debts & Collection Policies
Contractual Modeling
Third Party Payor Analysis
Cash Acceleration
Denial Management
Self-Pay Collections Management
Follow- Up/Collector Workstations
Electronic Remittance Enablement/ Payment Posting
Agency Management
Using Technology to Support Improved Processes
* Discharge Not Final Billed ** Clinical Documentation Management Program

3. Quantifying Potential Improvements: the Opportunity Evaluation Process
It is no longer sufficient to describe potential improvements – today’s buyers need quantifiable targets and benchmarks to measure accomplishments and sustain progress

4. 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.

5. Financial Performance, Operations Improvement and the Technology Connection
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.

6. LEVEL OF TECHNOLOGY ADOPTED
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
DERIVED BENEFIT
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
LEVEL OF TECHNOLOGY ADOPTED

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

8. 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

9. Summary Questions and Answers