Revenue Management During a Clinical System Implementation
DIVURGENT was engaged by BayCare Health System (BayCare), a large healthcare integrated delivery system, to support the Revenue Management and Charge Services teams during Phase II of a three phase clinical transformation project using Cerner Millennium® as the electronic medical record (EMR).
BayCare is comprised of 11 not-for-profit hospitals in Hillsborough, Pasco and Pinellas counties. With 17,000 employees and a wide array of healthcare services, BayCare is the largest community-based healthcare system in the Tampa Bay region.
Phase II of the project replaced Siemen’s Invision® clinical applications with Cerner PowerChart®. All hospital clinical personnel, including nurses, patient care technicians and ancillary support, documented patient care in the EMR. The paper chart was virtually eliminated. Charges are no longer entered directly into a system or batched for data entry; they are a by-product of clinical documentation and virtually invisible to the clinical provider. As a result, there was a need for monitoring tools that had not been used previously by BayCare to ensure minimal impact on the revenue stream during activation and beyond.
DIVURGENT was responsible for developing reports and monitoring mechanisms to be used to identify potential revenue issues that included:
- A report for nurse managers and department directors to run at the end of each shift that identifies incomplete or unsigned charts that drive charging in the background.
- A report of incomplete tasks that have built-in charges on discharged patients to identify potential late charges.
- Daily detailed interfaced charge reports to help nurse managers and department directors balance patient load against charges.
- Charges that did not qualify for the financial system interface (suspended) to identify issues with unprocessed charges or revenue mapping by department.
The following metrics were used during clinical systems activation to monitor revenue and identify issues:
- Gross inpatient revenue per patient day compared to budget and similar day of the week revenue from the previous month.
- Gross outpatient revenue per encounter compared to budget and similar day of the week revenue from the previous month.
- Number of unsigned clinical documents per day.
- Number of overdue clinical tasks per day.
- % of total charges that were suspended.
400-bed academic acute-care hospital client located in the Northeast
Three years ago, this organization decided to take advantage of cost savings and the open source benefits offered by Medsphere, a company that created an EMR product from the VA’s VISTA code. DIVURGENT began working with this client in June 2009 in a process redesign role. Today, DIVURGENT team members hold key roles in leading overall clinical transformation initiatives, including:
- Project Manager: Responsible for coordination of the project plan and working closely with the client’s ancillary areas (i.e., Radiology, Pharmacy, HIM, and Nutrition) to prepare for the replacement of legacy systems.
- Clinical Transformation Lead: Responsible for working closely with nursing and ancillary clinical leadership, is addressing the process redesign and system adoption needs.
- Project Executive: Responsible for overall project reporting to the client’s Executive Committee, order set validation, communication planning, change management, and physician adoption.
This three-phase implementation will begin with CPOE and basic clinical documentation implementation. Phase 2 will address bedside bar-code medication administration. The third, and final, phase will result in a nearly paperless environment with the implementation of clinical documentation for all clinicians and physicians. Metrics for Success in Phase 3 will include compliance with the ARRA meaningful use requirements.
New business development strategy
Our team led the development of a business strategy for a large integrated delivery network interested in commercializing intellectual property developed in the areas of technology implementation, clinician integration, project management and vendor selection.
Total Cost of Ownership
Our consultant led the development of a Cerner Total Cost of Ownership (TCO) model for a nine hospital IDN in the Southeast. DIVURGENT partnered with all major client and vendor stakeholders in order to outline a six year total cost of ownership for a suite of applications to be implemented throughout the IDN.
DIVURGENT was engaged to develop a project culture that was built on PMI principles that would improve project outcomes, provide timely project information and the necessary guidance, support that would frame projects to be completed within scope, on time and within budget. In this engagement, our client recognized that a disciplined change agent was required to carry their Information Technology initiatives forward.
DIVURGENT provided various roles in the organization including: Senior Project Manager, Project Managers and the Project Management Office Director. During the engagement DIVURGENT guidance to the organization in the following areas:
- pro-actively follow-up with vendors or other stakeholders to resolve outstanding issues.
- escalate issues at the appropriate time to maintain project momentum.
- successfully communicate and consult with all key stakeholders.
- sufficiently track all project issues, ensuring that critical issues do not slip through the cracks.
- manage deadlines and budget effectively.