Many providers are looking at a new revenue cycle management (RCM) system in terms of how it fits in with a single-source enterprise strategy, often driven by the clinical vendor. Enter Ellis Medicine, a Schenectady, N.Y.-based 438-bed community and teaching healthcare system, was able to connect three hospitals, including about 25 physician groups, on a single-enterprise revenue cycle solution from Siemens, the Malvern, Penn.-based vendor that has developed its Soarian Enterprise Revenue Cycle Management, a solution designed specifically to drive down costs and improve operational efficiencies across all venues of care.

In doing so, Ellis minimized disruption to their cash flow and have been able to keep the days that accounts stay in accounts receivable (AR) far lower than their pre-implementation baseline. Ellis CIO David Snyder and director of information technology Veronica Ziac spoke with HCI Assistant Editor Rajiv Leventhal about the benefits of a single-enterprise solution, partnering with Siemens, and challenges and trends in the RCM market. Below are excerpts from that interview.

What prompted Ellis to become a Siemens’ customer and how is its RCM solution benefiting you?

Snyder: We are using Siemens’ Soarian Enterprise Revenue Cycle Management product, and it is running across the acute and ambulatory suite of products. We are also using it for our physician billing component. Years ago, we had a number of different billing products. The idea behind the search for an enterprise-wide product was that we wanted a single-source product for all of our clinical information, financial information, as well as the implementation of a centralized business office. As part of that implementation, it was key for us to have a single enterprise revenue management solution, so there is one call-in point for our customers. This allows them to get all of the data about any of the stays/services that were performed throughout the entity.

And that was really one of the big things, because with that single point of reference and single call center for patients to call in to, they can readily contact us. Say I was there for a visit on the 1^st of the month and then had some follow up visits soon after. Now you can tell me what the remaining balance on my bill is and what has been paid by the insurance carriers. Also, if they have been referred to a primary care provider in our network, we can see details on those visits. We also have access across the entity; we have one patient access point in and we have that data across the entire entity once a patient accesses our system. So if you do come into the emergency room (ER) department, you’re registered once, and now we have all of your demographic and insurance data for when you come back in for a follow-up lab visit. There is no re-entry involved.

Similarly, if you see one of our primary care providers in our network, all of your information is there.  They can look back at your longitudinal history and say, for example, “I see you were here three months ago for an ER visit. It looks like there was incident with your blood sugar levels—what has happened since? Have you been taking your insulin?”  The follow up is a lot more complete. We also have the ability to do e-payments and e-statements. These were some of the things our customers were looking for that we couldn’t provide before going with this centralized tool.

What are some of the most pressing issues you experience in RCM? Has this solution helped resolve them?

Ziac: One of the big things related to system change that we dealt with was the cultural shift from how we had conducted our revenue cycle operations. The system drove some of those changes—previously we had a lot of fixes going on at back end. For instance, the business office would adjust charges and would change things on a visit to produce clean bills, but a lot of those problems were caused by front end staff (registration error, charge error), and it all ended up back in the business office. It was a poor model, it was hard to manage, and it did not put the right work to the right person at the right time. The way the system works, it pushes much of the responsibility to the right place, so you can fix your own errors. That’s been a huge shift for us, in thinking and in culture. And we have added staff up front to handle those workloads.

RCM becomes more challenging every single day. More recently, one example is the increase in high deductible plans. That is something we have now started to understand the implications of, as we are seeing a downturn in some of our volumes for voluntary admissions and procedures. People are putting off care because they have to pay out of pocket. How do you mitigate that? Your volumes are down but these are people who need service. How do you work that in your business plan? We are also dealing with alignment with physicians. We’re approaching groups and vice versa to employ more physicians. There is a whole shift to employ physicians rather than have their own private practices.

How has Siemens’ RCM solution helped you keep up with market trends?

Ziac: As far as revenue cycle in general, having the physician and hospital together on one system is fairly innovative. I can’t think of too many places across the country that have done this on a large scale. It will position us very well for some of the new payment models that are coming out, such as accountable care organizations (ACOs).

Snyder: We are positioning ourselves for bundled payments and ACOs, because that’s where the industry is going. Without the data aggregated, it’s really impossible for a business like ours to tell what the true expense and the true return on the care that you’re giving is. It’s been a real benefit there. While some of our practices are getting used to the different flow and the mixed data model, it provides such a great benefit to our customers to see everyone in one place, and it really limits the confusion.

What we’re seeing on the horizon are ACOs directing many of our customers towards plans that they will carry, which will mostly be under a bundled payment model. At the federal and state level, that’s where the guidance is towards. It’s only logical when you look at the percent of the federal and state budget. Economically, when you look at the consumption curve, it’s unsustainable going into the future. We have started a couple pilot tests asking the question, “If we are to bundle your customers into some type of collaborative, can we effectively manage care and reduce cost for both the customer and the insurer? We need to determine what we need to be proactive rather than reactive, and that’s where healthcare is going.

What advice can you offer other health systems when looking for an RCM partner?

Snyder: You need stability, as well as the ability to deliver within the marketplace that we deal with, but also to deal with the regulatory needs. There a number of rules and regulations that can be difficult to deal with. It is imperative to have someone who is working hand and hand with you to improve issues as they arise. Obviously, you need someone who knows the healthcare landscape as well. And you want someone who is truly dedicated to being a business partner to the organization on all levels, not just a vendor. We think Siemens fits that description pretty well.