Revenue Cycle Management Automation

As part of our ongoing series of in-depth, one-on-one interviews with CIOs regarding their experiences with revenue cycle management automation, HCI Editor-in-Chief Mark Hagland this month interviews Paul Conocenti, senior vice president, vice dean, and CIO at the three-hospital, 1,069-bed NYU Langone Medical Center in New York City, regarding his experiences in this important area.

Healthcare Informatics: Your revenue cycle management strategy is part of a much broader overall strategy. Please tell us how those strategies have evolved forward.

Paul Conocenti: As many who are moving from best-of-breed to enterprise-wide solutions, we're undergoing a transition in the revenue cycle management area, as well as more generally. NYU has had over the past five to seven years ago a history in which we've had a governance committee and weekly meetings around revenue cycle management. Historically, revenue cycle management activity had really focused around patient scheduling and the billing folks. But over time, the conversation began to focus around capturing charges accurately, and looking at the whole revenue cycle from a financial point of view-where we were dropping charges, where we were not charging enough appropriately, and how we could use business decision support systems to bring all the data together and look at the variables around contracting, with the ability to compare types of cases. Suddenly, we were realizing that, whoops, we haven't been charging for implantables; or, whoops, some of our supplies from yet a different [information] system aren't documenting charges. And we've done very well, actually, in terms of the basic blocking and tackling in terms of charges. So we've been very successful in that area.

WE REALIZED THAT CLINICAL DOCUMENTATION IS AN AREA WHERE WE WEREN'T DOCUMENTING THINGS WE WERE IN FACT DOING, IN ORDER TO OPTIMIZE CHARGES.

Then we moved into a different phase of this, saying, we think we've got the charges not erroring out for various reasons, now. But we then asked ourselves, what can we do to optimize revenue? And we realized that clinical documentation is an area where we weren't documenting things we were in fact doing, in order to optimize charges. And looking at documentation that tells us if a patient is coming in, in a very critical condition, we're not documenting that; and all of a sudden, because we didn't document all that in a discrete format, we're losing on the coding of those things. So we brought some consultant help in during the early phase of looking at charge capture. And we also brought consultants in for that second phase we're now in, around optimizing clinical documentation. So we actually changed our clinical ordering system, to be able to capture those necessary elements, in terms of the orders we're placing, within the workflow.

WHAT WE'RE LOOKING TO DO IS TO HAVE REVENUE CYCLE AND THE CLINICAL PROCESSES ONE AND THE SAME, BECAUSE THEY FEED EACH OTHER, ESPECIALLY AS WE MOVE INTO A MORE NETWORKED SYSTEM.

HCI: In other words, as a result of this ongoing analytical process, you've been changing aspects of your CPOE [computerized physician order entry]?

Conocenti: Yes. We started with a real charge-capture orientation; now we're focusing on clinical documentation, and we're looking at how physicians and clinicians order things. And by the way, that also helps to support clinical care, because you're documenting to a greater degree of granularity. We began this about two years ago, and have had great success with it. Then we began applying our lean management process to this, and we're now looking at our operational processes around the whole clinical process, which includes the documentation element around clinical care. We came to recognize that we had gone as far as we could go with our old, fragmented system, one that had a different patient access system, a different inpatient CPOE system, a different billing system, and a different inventory management system. So we're putting in an enterprise-wide Epic system [from the Verona, Wis.-based Epic Systems Corp.], including the revenue cycle piece as well as the clinical. And that's where you're really driving workflow, because when you start doing the Lean management work, you realize you're constrained by the lack of integration of your information technology.