The Path to Unification

Trinity's base platform for the unified revenue organization is McKesson's HealthQuest system, "but we've got a whole number of best-in-class bolt-ons," he says. Trinity is using a Cerner clinical system, a McKesson's HealthQuest revenue system, and Lawson's enterprise resource planning system.

In implementation, Trinity goes live with the revenue and clinical functions on the same day sequentially, hospital by hospital. "We've now turned on half our hospitals—half our revenue base," he says, adding, "We've all seen botched revenue conversions. With all the hospitals we've taken live so far, our days in accounts receivable never went up more than 10 days, and within 45 days we get them down to below pre-go-live statistics."

Getting CFOs on board
Naturally, some local hospital CFOs were skeptical of the program, both Sahney and Chadwick acknowledge. But in anticipation of that feeling, they have spent a lot of prep time with local CFOs to outline what the URO concept means to them in terms of how their responsibilities will change. The transition team has engaged the CFOs at a number of seven-day meetings over the course of an entire year before implementation began to define how the URO works.

"Local hospital CFOs have been central to our dialogue because it's a big change in their roles locally," says Chadwick. "We're doing this in part to free up them to support their organization strategically and operationally and get them out of the process functions."

He admits that the transition might not free up a large number of hours for the CFOs, but as the healthcare business environment has gotten more competitive, local hospital CFOs need to be strong business and strategic partners with their CEO and operating team. "We're helping them live into their roles," he says. "A good CFO should be focused on the strategic side, and now we're letting them do that."

Ed Chadwick, Trinity Health's senior vice president and CFO, offers his thoughts on the four objectives of his system's revenue unification initiative.

Ensure full compliance with regulations. Regulations are getting more onerous. In transitioning from ICD-9 to ICD-10, we're going from 13,000 codes to 150,000. How would you ever manage that many codes in a freestanding hospital? We can do it in a systematic way instead of each hospital figuring out how to respond.

Create economic value. It's less about reducing staff and more about making sure we get paid every dollar that's owed to us. From our analytics, we believe there's about $500 million in value over the next five years.

Provide a new patient experience. Everyone I've talked to has had a bad personal experience with the revenue systems at hospitals. There's a lot of press about the lack of transparency. The reality is that our revenue cycle is the first and last part of our health system to touch a patient. How well we manage that interaction significantly affects patient's perception of us.

Improve physician relationships.The billing process directly impacts physicians by the data requests we put on them through documentation and coding and indirectly affects how they treat the patients. We'll require less of that in this model.