Revenue Cycle Management Automation

So in March, we're going live with the Epic revenue cycle solution, and we're now in the process of improving workflows, and in that regard, we're bringing together a number of systems-health information management, physician and nursing documentation, and the OR information system, which is notoriously separate-in order that the workflows in those areas will drive efficiencies, not only in the clinical process, but also in the revenue cycle process. And that's because we realize that the clinical process really drives the revenue cycle process.

Looking forward, consider the national healthcare reform scenario, with ACOs [accountable care organizations], and bundled payments, and the medical home. How do you do bundled payments without integrated information systems? And how do you share referrals without a community-type system? And what's driving all this is all the Baby Boomers not being followed by the same people, which is causing our healthcare system, and the nation, to blow up. And a true driver of reform, in many ways, is the payment model.

So 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. And at the end of the day, the incentive model is going to be more about keeping people healthy and not spending money. Right now, the sicker you are, the more money we make.

HCI: Are you actively thinking about participating in ACOs and bundled payments?

Conocenti: We're actively thinking about them, though, like everyone else, we don't yet know exactly where all of that is going. So we need to figure out where we fit into that, whether we want to be a member of an ACO or lead one, for example. But what's clear from a technology point of view is that the foundation for such participation will involve having an enterprise clinical information system that's tethered to the revenue cycle piece; having a very, very robust business decision support system, as well as a robust clinical decision support system, to drive decisions within community models; and, at the heart of it, health information exchange, because other [participants in the same collaborative groups] will have other platforms. So you have to have a health information exchange that's robust enough to deal with these new models. And you can wait for the National Health Information Network or the state health information network, or you can take a bold step. And some are creating their own health information exchanges within their own communities; and that's something we're piloting. And you combine that with meaningful use, which people will say is all about clinical, but at the end of the day, it's also about revenue cycle.

HCI: So you're seeing the interrelatedness of all this?

REVENUE CYCLE AND QUALITY AND CLINICAL CARE ARE CONVERGING. AND YOU KIND OF NEED TO THINK ABOUT BOTH.

Conocenti: Yes. And revenue cycle and quality and clinical care are converging. And you kind of need to think about both, when we all know that what's coming down the road is, you need to make a profit on Medicare and Medicaid, and that's not an easy thing, so you need to put these systems in place. And what I like as a CIO is that the technologies we put into place for one, enable three other things. And then you add your clinical analytics report writing system, and combine that with your business report writing system and revenue cycle management system, and then you've got a pretty powerful set of tools. So from the CIO's point of view, it's really about bundling those tools together across your entity, and even the community.

HCI: So from your viewpoint, best-of-breed is simply going to have to go away, because of the complexity of interfacing?

Conocenti: Yes. I think there will be two approaches. What happened with Allscripts and Eclipsys, and why? Eclipsys had a great inpatient system, and nothing in outpatient, and with Allscripts, the reverse. The big question is, is it going to be truly integrated when they piece it together, or will it be two different systems, interfaced, with lots of workarounds?

HCI: So you believe in the same vision that Epic and the most integrated vendors are pursuing?