SYS-CON MEDIA Authors: Liz McMillan, Zakia Bouachraoui, Elizabeth White, Pat Romanski, Yeshim Deniz

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CGH Medical Center Makes Speedy Revenue Cycle Gains with the Implementation of Cerner Patient Accounting Supported by S&P InTegrity℠

A creative and cooperative recasting of responsibilities helped CGH Medical Center stay 100% on-track and on-budget in the face of a potential snafu during their migration to Cerner Patient Accounting.

In the fall of 2015, CGH's management decided they were ready to upgrade their 1997 interfaced patient accounting system (Allegra) to try and integrate revenue functions more directly with their Cerner EHR solution. The hospital's leadership was eager to improve their revenue cycle management capabilities and the IT team sought to escape the pitfalls of maintaining two separate systems.

"We had dual chargemasters comprising 12,000 lines of code," explains Ken Koerner, CGH's Director of Revenue Cycle.

The hospital's CFO, Ben Schaab, was also looking for ways to eliminate the re-keying of data, reduce errors, and improve their performance in areas like denials management. "As we moved to an integrated system we wanted to be sure and retain our good performance in key performance indicators (KPIs) of revenue cycle management like cash flow, 'Days in AR,' and DNFB. In fact, we hoped we might see some gains," Schaab says.

After visiting with several hospitals who had implemented CPA, the CGH team was convinced of the value of adding a third-party consultant to the project. They hired S&P Consultants on the strength of their reputation for deep Cerner experience—and their candid approach to communication.

"S&P would tell us what we needed to hear--even if it wasn't always what we wanted to hear," says Koerner. "We appreciated that."

S&P introduced the project team to their InTegrity™ framework for complex implementations, which included an extensive "Phase Zero" element, designed to prepare all projectstakeholders to efficiently deliver vital contributions.

A few months into the project, CGH discovered that Cerner was planning to put their project "on pause," due to a staffing crunch. After quickly assembling the project team, it was agreed that S&P could assume leadership of the implementation and avoid any delays. According to Zach Johnson, S&P's Chief Strategy Officer, Cerner had never before agreed to cede control of revenue cycle project in-process, but the longstanding relationship between the two companies helped make a smooth transition—and preserved their mutual client's original go-live date.

A combination of experienced consultants and the InTegrity process made for a positive experience—even for clinical staff who were integral to the success of the project, according to CGH's Director of Health Informatics, Teresa Kikuts, RN.

"When you start cutting away at areas of unnecessary complexity, you can really start to focus on issues of value, improving workflows, maximizing returns," says Kikuts. CGH examined nearly 80 workflows in-depth to uncover new efficiencies—to great effect. "All of a sudden [clinical] activity and revenue capture are working together and you've really set yourself up for success," says Kikuts. "Here we are, a small rural hospital that has jumped from a 1990s-era system to being ahead of where many of today's largest hospitals are."

Everyone involved in the process agreed that the robust communication facilitated by InTegrity was a critical component to success.

Koerner singled out InTegrity’s "8-4-2-1" approach—whereby stakeholders are alerted to needed contributions eight weeks ahead of time and then reminded at increasingly frequent intervals—as a great aid to engagement. "We were able to get our clinical folks involved in integration testing because we gave them enough notice. And having actual clinicians involved made a huge difference," Koerner explains. "We would never have caught the things we did without them. IT people don't do things the same way clinical folks do."

Another result of this level of communication was S&P's discovery that CGH had sidelined a previous effort to support their 340B drug program. The S&P team was able to automate this reporting and include that new capability as part of the overall CPA engagement.

"InTegrity allowed us to optimize everyone's time--especially the clinicians," says Schaab. "People knew that if we called them into a meeting it was because we really needed them. So, they would attend. Questions got answered in real time, and [because the framework was so clear] we could also say to people, 'You can skip this meeting,' which they appreciate—which maintains your credibility as a project leader—and which helps maintain a high level of engagement from people over the whole process."

CGH's level of commitment was a critical element to success, according to Angie Fosnough, a Project Executive for S&P: "I haven't seen many clients step up the way Ken and the CGH team did. They maintained a daily focus on facilitating our efforts; 'What do you need?' 'How can we help?' and always kept the right stakeholders engaged—all the way up to their CFO."

Approaching 60 days post-go-live, CGH is very satisfied with their early results—and the process that got them there.

"After go-live we started seeing payments coming back within 14 days, which surprised us so soon after conversion," says Schaab. "Our 'clean claim rate' has improved from prior benchmarks and we've gotten rid of a lot of extra 'touches' in the process, which helps our clinical people stay focused on what they want to be doing: providing great care."

Strong evidence of the CGH team's confidence in the new system is offered by Koerner: "Our Manager of Patient Accounts was in danger of having a bunch of her earned time off expire. But things are going so well we are letting her take a week off so she doesn’t lose it. Never in my wildest dreams did I think it would be okay for our Manager of Patient Accounts to take a week off 38 days after go-live!”

S&P's Johnson puts the success down to InTegrity: "This is a great validation of our InTegrity framework. We didn't miss a single milestone by a minute and we are meeting or exceeding all of the KPI’s we set out to achieve, and I’m serious when I say we set the bar higher than many were comfortable with and we still achieved them The framework helps draw upon the strengths of all parties; the great Cerner solutions; the institutional and operational/clinical knowledge held by the client's team; and S&P's experience in managing clinically-driven revenue cycle implementations across a wide variety of clients. In the end, everyone agreed that it was a win-win-win situation, all the way down to the community of Sterling seeing their top-class facility gain new capabilities that put it on-par with major metropolitan systems and ensure its success in the future."

About S&P Consultants:
S&P Consultants enjoys a 20-year reputation for “doing the right thing” in healthcare IT, facilitating realistic interactions among all parties in HIS implementations. Their InTegrity℠ approach provides a solid “genetic roadmap” and adaptive framework to organizations looking to assure the success of complex projects. Learn more about InTegrity HERE.

About CGH Medical Center:
CGH Medical Center is a progressive acute care facility located in the heart of the Sauk Valley, in Northern Illinois. Since opening in 1909, CGH has consistently received high ratings for delivering quality care to their community, positive public awareness, safety, and high patient satisfaction. CGH Medical Center employs over 1500 individuals, with a medical staff consisting of 115 physicians specializing in 35 areas of medicine.

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