From the Editor


Robert Fromberg, Editor-in-Chief

I have fond memories of going back to school each year.

Each year was an exciting new beginning. A new room (yes, a lot like the old room, but still the windows and chalkboard were in different places). A new teacher (please, not the one who shouts). New books (spines uncracked), pencils (unchewed), and notebooks (doodle-free). Even new clothes (jeans stiff enough to crackle when I walked).

The excitement of starting a new adventure was equaled only by the sense of accomplishment at the end of the school year.

Now that full-time school is no longer part of my life, I live vicariously through my kids. But I miss that sense of clearly defined new beginnings and conclusions. The workaday world has few of these. Instead, it seems we have activities that occur in cycles.

Take the revenue cycle. To some extent, day in and day out, the revenue cycle is the same. Patient access, billing, claims adjudication, management. And even attempts to change the revenue cycle often are incremental and ongoing-continuous performance improvement.

Yet once in a while, revenue cycle change is more akin to a new beginning. Saint Francis Hospital in Tulsa had that experience. "We really imploded our revenue cycle operations," reports Eric Schick, vice president of finance, in this month's special section on MAP Award winners (pages 119-126). Outcome measures showed a significant problem, and analysis pointed to the need for a new look at how front-end and back-end revenue cycle staff and processes worked together.

The solutions involved people, process, and technology. Teams were set up to enhance understanding and communication within and between the front-end and back-end staffs. Processes were shifted from the back end to the front end of the revenue cycle. A centralized scheduling and prearrival department was established. New software tools were implemented to enhance information flow and analysis, and staff receive regular training in the new tools.

The result: Days in A/R and days in total discharged not final billed decreased dramatically, improving the organization's cash position.

The spirit with which Saint Francis undertook this challenge reminds me of the first day of school: some apprehension, some things unknown. But also a sense of excitement and hope that the coming great adventure will bring great rewards. In the case of Saint Francis, those rewards were not just better performance on metrics and better cash position, but also an HFMA MAP Award for High Performance in Revenue Cycle. All those rewards taken together might convey an even more satisfying feeling of a job well done than the last day of the school year.

Publication Date: Wednesday, September 01, 2010

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