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Avoiding Revenue Crunches During EMR Transitions

Posted on May 23, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most healthcare leaders know, well before their EMR rollouts, that clinical productivity and billings may fall for a while as the implementation proceeds. That being said, it seems a surprising number are caught off guard by the extent to which payments can be lost or delayed due to technical issues during the transition. This is particularly alarming as more and more hospitals are looking at switching EHR.

Far too often, those responsible for revenue cycle issues live in a silo that doesn’t communicate well with hospital IT leadership, and the results can be devastating financially. For example, consider the case of Maine Medical Center, which took a major loss after it launched its Epic EMR in 2012, due in part to substantial problems with billing for services.

But according to McKesson execs, there’s a few steps health systems and hospitals can take to reduce the impact this transition has in your revenue cycle. Their recommendations include the following:

  • Involve revenue cycle managers in your EMR migration. Doing so can help integrate RCM and EMR technologies successfully.
  • Create a revenue cycle EMR team. The team should include the CFO, revenue cycle leaders from patient access and reimbursement, vendor reps and someone familiar with revenue cycle systems. Once this team is assembled, establish a meeting schedule, team roles and goals for participants. It’s particularly important to designate a project manager for the revenue cycle portion of your EMR rollout.
  • Before the implementation, research how RCM processes will be affected by the by the rollout, particularly how the new EMR will impact claims management workflow, speed of payment and staff workloads. Check out how the implementation will affect processes such as eligibility verification, registration data quality assurance, preauthorization and medical necessity management, pre-claim editing and remittance management.
  • Pay close attention to key performance indicators throughout the transition. These include service-to-payment velocity, Days Not Final Billed, charge trends and denial rates.

The article also recommends bringing on consultants to help with the transition. Being that McKesson is a health IT vendor, I’m not at all surprised that this is the case. But there’s something to the idea nonetheless. Self-serving though such a recommendation may be, it may help to bring in a consultant who has an outside view of these issues and is not blinkered by departmental loyalties.

That being said, over the longer term healthcare leaders need to think about ways to help RCM and IT execs see eye to eye. It’s all well and good to create temporary teams to smooth the transition to EMR use. But my guess is that these teams will dissolve quickly once the worst of the rollout is over. After all, while IT and revenue cycle management departments have common interests, their jobs differ significantly.

The bottom line is that to avoid needless RCM issues, the IT department and revenue cycle leaders need to be aligned in their larger goals. This can be fostered by financial rewards, common performance goals, cultural expectations and more, but regardless of how it happens, these departments need to be interested in working together. However, unless rewards and expectations change, they have little incentive to do so. It’s about time hospital and health system leaders address problem directly.

Is An Epic Investment Bad For Health Leaders’ Job Stability?

Posted on January 28, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

For quite some time now, the buzz has been that at least one EMR vendor was a safe bet for everyone involved. “No one ever got fired for choosing Epic” has begun to seem as obvious a sentiment as “No one ever got fired for choosing IBM” in hospital C-suites. And certainly, in previous times that was probably true.

But it’s beginning to look as though at least in some cases, Epic has not been as safe a choice as health execs had hoped. In fact, while it’s not exactly a fully-fledged trend, it’s worth noting that Epic-related costs and technical issues have led to job losses for hospital CIOs, as well as other operational leaders, in recent times.

Perhaps the most recent example of Epic-related job attrition took place earlier this month, when the chief information officer and chief operating officer of Denver Health Medical Center. According to the Denver Post, the two executives left their posts in the wake of major disagreements over the medical center’s big investment in an Epic EMR.

The Denver Post story reports that former Denver Health CIO Gregory Veltri was on the outs with CEO Arthur Gonzalez from the outset where Epic was concerned. Apparently, Veltri argued from the get-go that the Epic install costs — which he estimated could hit $300 million when the $70 million cost of dumping the center’s current EMR contract and doubling of its IT staff were computed — stood a chance of bankrupting the hospital. (Gonzalez, for his part, claims that the Epic installation is under budget at $170 million, and says that the system should go live in April.)

In another example of Epic-related turnover, the chief information officer at Maine Medical Center in Portland seems to have left his job at least in part due to the financial impact of the hospital’s $160 million Epic investment. Admittedly, the departure of CIO Barry Blumenfeld may also have been related to technical problems with the rollout which slowed hospital collections. This took place back in 2013, but it still seems noteworthy.

The spring of 2013 also saw the departure of Sheila Sanders, the chief information officer for Wake Forest Baptist Medical Center, in the midst of the medical center’s struggles to implement its own Epic system. While Wake Forest Baptist had spent a comparatively modest $13.3 million on direct Epic costs during its second quarter of fiscal 2012-13, the medical center had been socked by delays in revenue resulting to Epic rollout problems, including issues with billing, coding and collections.

Wake Forest Baptist reported taking an $8 million hit that quarter due to “business-cycle disruptions (that) have had a greater-than-anticipated impact on volumes and productivity.” It also reported $26.6 million in lost margin due to reduced volume during go-live and post go-live Epic optimization.

Of course, a botched rollout can mean job insecurity no matter what EMR the hospital has chosen. For example, in May of 2014, Athens Regional Medical Center President and CEO James Thaw was apparently pressured out of office when the facility’s Cerner rollout went poorly. (After weeks of Cerner problems, the hospital’s staff voted 270-0 that they had “no confidence” in the hospital’s leadership. Gulp!) Somehow, Senior Vice President and CIO Gretchen Tegethoff kept her job, but my bet is that it was a close-run thing.

And to be fair, this is obviously a small, selected set of anecdotes about questionable Epic rollouts. They don’t prove that Epic is a CIO job killer or an ineffective EMR. But these stories do highlight the fact that while Epic investments might yield good things, rolling Epic out requires nerves of steel and flawless execution.