Upending revenue cycle first step toward success

Mention combining departments and reorganizing functions, and health care consultant Bobette Gustafson quickly informs you of a key philosophy of her company: "We never talk about who should do anything until after the process is defined."

The plan by ScrippsHealth in San Diego to bring together patient access services, health care information management, and case management into one department suggests the following question, she says: "What’s the process that seems to demand this?"

"That process is the revenue cycle turned upside down," explains Gustafson, president of Gustafson & Associates Inc., a health care management consulting firm based in Port Washington, WI.

In today’s managed care environment, a pro vider must have completed several functions before committing to schedule patients without life-threatening problems for future service, she points out. "That includes gathering comprehensive data sets, searching for and resolving managed care requirements, and educating patients about insurance. Couple that with a demanding customer who traditionally has been upset by all the multiple contacts and repeated requests for the same information."

The only way to upend the proccess adequately while providing customer service is by consoli dation, or at least coordination, of the activities being combined by Scripps Health, Gustafson says. "That doesn’t necessarily imply an organizational change. I don’t think it matters who reports to whom or where functions are located, because reporting relationships don’t make people do what they’re supposed to do. You just have to bring the functions into coordination."

The ultimate effect of such a re-engineering must be that the people responsible for the upfront activities become the "owners" of those activities, she says. "In a traditional arrangement, upfront staff do the best they can, and the business office cleans up after them. There are so many employees involved in editing and cleaning up. In the new model, that goes away. The traditional back-end business office becomes very small. With providers where we have facilitated re-engineering efforts, typically 40% to 60% of the FTEs [full-time equivalents] need to move out of the back end into the upfront activities."

It’s also crucial to recognize, she points out, that the various departments or functions are "interlaterally dependent. All are absolute stakeholders — none can function without the other.

As health care providers move away from the inpatient setting and serve more and more outpatients, they are increasingly bound by managed care requirements and the changing nature of contracts, she adds. "Part and parcel of this is case management.

"The only way to handle the volume plus the constant change is through technology," explains Gustafson. "We have added so many systems to try and support, with few solutions from one vendor. Information systems becomes almost the central core in trying to integrate and interface all these systems."