Interfacing Revenue Cycle IT Across a Health System
Increased complexity of payer rules, the growing influence of consumerism, and pressures on the bottom line are just a few of the factors that have triggered providers such as Partners HealthCare system to reexamine financial data use. Partners is engaged in an enterprisewide initiative to implement a single set of patient administrative systems and revenue cycle processes across its organization of academic medical centers, community health centers, and physician practices.
Technology will eventually support standardization of processes as well as information sharing from facility to facility in relation to patient scheduling, registration, bed management, and inpatient and outpatient billing. “To operate most effectively as a system, you have to ensure a patient’s information will be the same wherever the patient goes,” explained Peter Markell, the system’s vice president of finance.
Looking ahead, the organization hopes to interface its systems directly with those of insurance companies so as to improve eligibility verification processes. Such connectivity has the opportunity to improve financial performance as well as the patient experience, noted Markell. “As an industry, we leave too much money on the table,” he said. “There are too many denials and losses of payment that are the result of missing or inaccurate patient data. And frankly, a common source of dissatisfaction for patients when dealing with the healthcare industry is the whole administrative flow of information.”
Partners HealthCare also is focusing on technology use to improve clinical operations. The system already is fairly advanced with use of electronic medical records in inpatient and outpatient settings. “Our main focus now is two-fold: one is to improve clinical decision support and the other is integration of the inpatient and outpatient medical records,” says Markell.
The overriding goal for the revenue cycle project and its eventual tie to clinical improvements is more effective and safe clinical practice and an improved patient experience.
Efforts to better engage patients in data sharing support the organization’s vision for the healthcare experience of tomorrow. Noted Markell: “People want different portals that will allow them to interact with us as their convenience—whether by phone, face-to-face communication, or computer. We’re really trying to make it easier to exchange information with us and to make healthcare administrative processes more service-focused and easier to navigate.”
This case study is excerpted from HFMA’s Healthcare Finance Outlook, March 2009. Click here to access this full report.