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You might not think that a simple move like changing the medical records department’s reporting structure would pay big dividends, but Steven A. Fellows begs to differ. As executive vice president and chief operating officer of Santa Barbara, Calif.-based Cottage Health System, Fellows made that change several years ago at another hospital, and he made it at Cottage back in December.

In many institutions, medical records are seen almost exclusively as a resource to the clinical staff, Fellows says. “While it is the clinical documentation, it is ultimately a financial document because there’s only one department that can code that chart and generate a bill,” he says. Without direct financial department supervision, numerous delays in obtaining payment can creep into the process. Cottage Health’s medical records department now reports to one vice president, rather than a multitude of people. “We have admitting, medical records and patient accounting under a single chain of command from when the patient enters, through care to discharge, to coding and initiating a bill, to collecting on that bill,” Fellows says.

It helps that Cottage, a three-hospital system, is a leader in technology adoption. “All three campuses will be completely wireless by the end of the year,” says Fellows. To boot, the system has been completely filmless for the past 12 years. Not to be left out, Fellows and his colleagues made some changes to technology in the finance suite, installing financial software in the business office from Boca Raton, Fla.-based Eclipsys Corp. that redesigned processes for collecting patient information and generating bills from medical records. Part of the benefit of using a “best of breed” philosophy when choosing technology is that it allows the hospitals to parse out only the information they need—for example, exporting test results from an integrated electronic medical record to clinicians while allowing financial office people to do their billing and coding work nearly simultaneously.

That interoperability has made the change in reporting structure easy to make, Fellows says. And despite some initial resistance from clinical staff, his results from a prior engagement were tough to deny.

San Gabriel Valley Medical Center, where Fellows worked as president prior to coming to Cottage Health, once had accounts receivable days at an astronomical 110. Its discharged-not-final-billed was running over 24 days, “which was just horrible,” says Fellows. “We completely restructured that chain of command and took days AR to 52 in six months,” he says. Discharged-not-final-billed in medical records went from 24 days to one.

“I attribute that exclusively to the change in command.”

—Philip Betbeze