Becker's Hospital Review

22 Executive Briefing Sponsored by: H ospital revenue cycle efficiency is not only a cornerstone of operational excellence, but it is also essential to patient-centric care. No matter how deluxe the hospital room or how excellent the care delivery, a bad billing process will diminish an otherwise positive patient experience. Creating tomorrow's perfect billing experience in today's healthcare environment is no easy feat. National trends are driving patient out-of-pocket costs upwards, which puts financial pressure on hospitals. This pressure can become even more significant for health systems undergoing expansions. As health systems grow, via mergers or capital improvement projects, the complexity of the billing process grows along with its patient population. Farmington-based UConn Health found itself in this position in 2015, as patient volumes increased after the completion of an $864 million expansion at its John Dempsey Hospital in Farmington. The expansion added 169 single rooms, an outpatient pavilion and an ambulatory care center. System leadership wanted to elevate revenue cycle performance to take advantage of economies of scale and preserve the first- rate care experience created by the modernization project. "The patient could have the best experience with the physician, have surgery in our hospital and leave, but then get a bill that's upsetting at the end," UConn Health CFO Jeffrey Geoghegan said. "We can ruin that whole patient experience just on the revenue cycle side." UConn Health coupled its revenue cycle initiative with an EMR upgrade and was able to improve operations, making billing more patient-centric. It accomplished this without incurring new costs or adding more staff. The following article examines the process UConn Health used to streamline and update its revenue cycle, as well as the challenges the system faced and lessons it learned. Background In 2011, state lawmakers approved a plan called "Bioscience Connecticut," which earmarked $864 million to renovate and expand the medical and dental schools at UConn Health; offer medical, dental and urgent care services at a town center in Mansfield, Conn.; and add 169 rooms, an ambulatory care center and an outpatient pavilion to John Dempsey Hospital. The approval marked the beginning of a period of unprecedented growth for the health system. After completing this project in 2015, the health system saw a 10 percent increase in inpatient discharges and a 2 percent increase in overall outpatient volume. This major growth presented a new administrative challenge. The hospital was on a different billing system than the health system's 325-physician University Medical Group, and each department within the hospital sent out individual bills for various services within a single stay. If a patient accidentally called the hospital about a bill from a physician's office visit, the hospital was unable to look up their bill to answer questions. "In the past, we had 34 different sub-systems across our revenue cycle," Mr. Geoghegan said. "These systems did not communicate with one another, and it made for a frustrating patient experience. This EMR upgrade was our opportunity to shift to a single billing office. We wanted patients to have one number to call where all their questions could be answered." As part of their "Big Bang" Epic go-live in April 2018, UConn Health decided to focus on creating a more efficient and patient-centric revenue cycle. The health system did this by moving to a single billing office with a centralized management structure. It enlisted Optum Advisory Services for interim leadership of the revenue cycle and insight on best practices for process improvement. Through this transition, they were able to accommodate the growth in patient volume without adding overhead. Here are three lessons UConn Health learned throughout the billing office centralization process: 3 lessons from UConn Health's journey to patient-centric billing Jeffrey Geoghegan CFO, UConn Health

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