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Intermountain's Innovative Work to Orchestrate Revenue Cycle Management

July 23, 2012
by Mark Hagland
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The vast Utah integrated health system moves forward to optimize system-wide RCM

Intermountain Healthcare has long been nationally famous for its many patient care delivery, clinical information technology, and other innovations. But of course its very size—23 hospitals, 105 physician clinicians, 33,000 employees, over $5 billion in annual gross patient revenues—means that coordinating certain types of activities is by definition challenging. Certainly, that is the case when it comes to revenue cycle management.

Fortunately, the leaders at Intermountain have recognized for some time the necessity to coordinate its revenue cycle management (RCM) activities in a system-wide fashion. As part of this careful orchestration of activity, Intermountain business office professionals have been using the Chargemaster Toolkit® solution from the Atlanta-based Craneware, in an effort to optimize charge capture, along with a self-developed overall financial information system. Meanwhile, the ultimate responsibility for orchestrating the health system’s RCM activities falls to Todd Craghead, vice president of revenue cycle, who four years ago, was the first executive to be named to that position. Craghead spoke recently with HCI Editor-in-Chief Mark Hagland regarding all the activity taking place at Intermountain Healthcare these days in this critical area. Below are excerpts from that interview.

You were the first executive in this position, correct?

Yes, that’s correct. I’ve been at Intermountain for nine years; about four years ago, the position of vice president of revenue cycle was created, and I’ve been the first and only person in that position. The position was created to better managed revenue cycle as a whole. We’re a health system with over $5 billion in gross patient revenue, with over 1,000 employed physicians, and more than that many affiliated physicians, and a health plan that covers over a half-million lives in the state of Utah. And there was a lot of exposure in revenue cycle from a compliance perspective. Meanwhile, from the revenue cycle perspective, most of the hospitals had been operating somewhat independently. So the idea was to create some common characteristics in this area.

Todd Craghead

So the core issue at the outset was that the hospitals were operating somewhat independently in this area?

Yes, and we were trying to organize towards a consistency of approach. For the most part, all of the front end, and the middle of the revenue cycle processes,  with health information management, were managed by individual hospitals. There was some consistency of process, but there was enough variation that patients were getting confused; and the other part of it was, we weren’t really leveraging our technology.

What kinds of steps did you build in order to innovate in this area?

I created a management team, including a revenue integrity unit; and then I went out into our regional structure and we identified the technology deficiencies we had, as well as process variations. And then we realigned our staff. At each geographic location, we had people responsible for each element. And we said, we’ll have one person responsible for about three functions for all hospitals. So we identified what those were: pre-registration and registration; we have an individual who manages eligibility counseling and financial assistance; then patient financial services and patient follow-up; and then central appeals, including payer relations and contract management. So there’s one executive with accountability for all the hospitals for each of those areas.

So essentially, there are five broad areas?

Yes, those are all within patient account services. And then we also have a revenue integrity unit, a separate arm, and they manage charge practices, audits, billing-based audits; and then we have a strategy team that helps us deploy the technology and also helps deploy the processes. So, patient account services; revenue integrity; strategy team, which is project-management-oriented; and then health information management, which is a separate arm.

How long did it take to do the reorganization?

It’s taken us about two-and-a-half years to really stabilize it, and so the first two and two-and-a-half years was a time of change for everybody.

So the individuals in hospitals A and B report up through the same corporate people?

That’s right. And there may be other reporting relationships.

So people in the individual hospitals are reporting up through and to different streams, correct?

Yes, that’s correct.

You’ve been using the Craneware solution, correct?

Yes, that’s the tool we used to help us in the charge practices, charge capture, and charge master areas.

Is there a core financial system?

Our patient accounting system was self-developed at Intermountain, by our IT folks. On the medial group side, we leverage GE Centricity, but on the hospital side, it’s an internally constructed application.