This month, HCI begins what will be an ongoing, series of in-depth, one-on-one interviews with CIOs, regarding their experiences with revenue cycle management automation. In this first interview, HCI Editor-in-Chief Mark Hagland interviews Charles (Chuck) E. Christian, CIO of the 232-bed Good Samaritan Hospital in Vincennes, Ind., regarding his experiences in this important area.
Healthcare Informatics: Tell me about your organization's journey with regard to revenue cycle management (RCM) automation?
Chuck Christian: We've actually been doing revenue cycle redesign for a long time. Our current CEO, who started out as an internal auditor, was CFO for eight years, and recently became CEO. And he and I have a great working relationship (I reported to him), and we're always looking to maximize our effort to get appropriate levels of reimbursement. A few years ago, we installed a new patient accounting system. But we had terrible days in AR (accounts receivable), and terrible cash flow, and I said, in response to our now-CEO who was then internal auditor, in 1995, well, let's do some analysis. And during the analysis, we learned that we were actually trying to use the new system the way we had used the old system, and not taking advantage of any of the new functionalities.
THE REALITY IS THAT IT'S ABOUT WORKFLOW, AND MAKING SURE PEOPLE ARE DOING THE APPROPRIATE THINGS.
HCI: So, clearly, success means more than simply automating old processes?
Christian: The reality is that it's about workflow, and making sure people are doing the appropriate things. It's easy to collect $10, but let's focus on accounts involving $12,000. So in 1996, we began a CQI [continuous quality improvement] process in the revenue cycle area, and we've never stopped. It truly is continuous improvement, using a plan-do-check-act cycle. As part of that initiative, we initiated a series of processes, and have continued to refine those processes over time. First, we educated the staff on everything, and not just on the software that they used every day. So basically, we did comprehensive training. We actually put the billers and the follow-up staff in a room and mapped our processes.
And what we found was that we had had no standard practices until that time. Each biller had their own process, and each follow-up person had their own process; so we created opportunities for those standard processes to be created. And we gave the staff ownership of it, which was extremely powerful, because they had this “aha” moment around that experience. And once that awareness was created, we were able to begin to streamline processes. Among the key advances was that we figured out how to use some of the workflow capabilities in the system to improve their day. And on the AR side, that meant that we were working those accounts much earlier in the cycle, thus directly impacting days in AR. And lastly, we took a look at billers' workspace. When we looked at their workspace, we found that, at any given time, we had between 80,000 and 100,000 file folders at some point in process; and each day, we were producing an absolute tsunami of paper, and that was nuts. So we bought and implemented a document imaging system, even before it was the cool thing to do. And we imaged the documents at their point of origin.
Then we moved all the patient accounting department out of their space and into a new workspace, with new lighting, new ceilings, new PCs, new cubes, everything. And it was amazing to watch the transformation. Rather than having the piles of paper and the misfiles and the hunting down of paper, it was all at their fingertips. And the good thing is, through attrition, we eliminated four FTEs right off the bat. And over the course of time, we've actually eliminated seven positions out of about 35. And so we were able to reduce overhead and at the same time increase volume and decrease our days outstanding in AR. And so once we were able to create those best practices and standards, and we've been honing the process ever since. What's more, we were doing this before it was a cliché thing to do.
HCI: There is a broader context here, too, in that your organization is a county hospital.