Hospitals shopping for end-to-end revenue cycle suites
As the healthcare industry moves from volume to value, tech vendors are working working with hospitals to integrate their systems.
Photo of Florida Hospital Alamonte from Facebook.
While others were out vacationing, Florida Hospital finance vice president Jeffrey Hurst worked overtime to launch one of the biggest technological changeovers the hospital has seen -- all of its revenue cycle management tools are being moved to one unified system.
The changeover of its back-office management to a new Cerner system will be a two- to three-year process for Florida Hospital. Hurst said a combination of things led to the initiative, but a major reason is integration and alignment of the clinical and revenue sides of the organization.
The hospital has eight campuses, 2,500 beds and provides services including free-standing imaging, home care, hospice and retail pharmacy. Its clinical care was moved to one system from Cerner Corp. in 2007, but its billing is spread among five different systems including a "home-grown" one it built for acute care.
As the healthcare industry moves from volume to value, hospitals like Hurst's are trying to manage patients in a new way. IT providers including Cerner, Craneware, Premier Revenue Solutions LLC and ZirMed Inc. are attempting to fill the need in the market by working with hospitals to integrate their revenue, clinical and operational systems.
[Also: 2015 a year of changes in revenue cycle with population health, ICD-10]
Craneware is another organization offering integrated IT systems to hospitals. Coined as the "value cycle," the provider is working with hospitals to produce systems that help determine the best outcome for the best cost, said Mark Montgomery, the organization's chief marketing officer.
"We are creating not just data sets and analytics, but insights for decision support and enablement to allow different people across the value cycle to do what they need," he said.
The systems allow providers to take cost outcomes and financial data to understand the profitability of a particular service line or treatment. The data can be managed to anticipate and predict how to care for a certain population.
For example, Montgomery said an organization can track purchase data from supplies or pharmacies and attach clinical distribution and claims to show the value cycle of all of the elements. It could also be used to track if a post-transition care plan is monitored and invested in to reduce readmission rates, he said.
[Also: What CFOs think about revenue cycle]
"The industry is struggling to move to a value-based world," Montgomery said. "It is organized for the old way they did it … components that drive a value model are in front of us today, we just need to take advantage of them."
The industry, on the whole, is farther along than it thinks, he said. The data is there, it just needs to be aggregated and combined in a way that is meaningful.
Much like Florida Hospital, organizations that have data spread among five or six providers have created a logistical challenge. Having everything on one system will improve data integrity, operations and workflow, Hurst said.
It will also allow providers to log into the same system and get clinical and revenue data. From a consumer perspective, the changeover will allow them to have one billing system for all of their business units. Instead of receiving a bill from three or four areas, it will now be rolled into one.
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Hurst said providers are no longer going to be paid for the services they provide, but those they document they provide. Integration of clinical and revenue aspects are becoming requisite.
"We can document in the EMR and send it out in billing," said Hurst. "Having clinical documentation and everyone on a single platform makes sense."
With all of the potential benefits of integration, Florida Hospital is just now making the move because the IT industry is catching up to the healthcare market, Hurst said. They were on a system they built for acute care services because many companies didn't have the "sophisticated revenue cycle solutions we felt we needed," he said. At the end of the day, however, Hurst said the organization wanted to focus its time on healthcare, not IT.
"As solution providers are evolving to meet the market needs, we want to get out of the business of being an IT developer and focus on healthcare delivery," he said.
And its partnership with Cerner has been a mutually beneficial one.
"In our relationship with Cerner we are a co-development partner," Hurst said. "They bring the IT and we bring the clinical."
Working together, Cerner is able to build its clinical functionality and Florida Hospital is able to integrate systems to better enable it to take part in things like bundled payment contracts. The partnership with Cerner has allowed IT providers to create solutions and spread the cost of development across various providers. It would be more expensive for one hospital to build a system on its own, Hurst said.
Working with a national organization has afforded Florida Hospital insight into what other organizations are doing. Hurst sat in on a council Cerner organized with other major hospital systems across the country where he was able to interact with peers and find out the direction their organizations are moving. This kind of gathering also gives a unified voice, allowing providers to offer input to Cerner on their needs as health care moves forward, he said.
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