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Why Technology Alone Doesn't Promise SBO Success

By Alexandra Wilson Pecci  
   February 11, 2020

The system patient revenue cycle director for UC San Diego Health explains why SBO success depends on "the connectivity of the people, the process, and the technology."

Since going live with its single billing office (SBO) on June 1, 2017, UC San Diego Health's revenue cycle has increased its self-pay cash flow by almost 10% year-over-year, Terri Meier, CHFP, CRCR, CSMC, CSBI, director of system patient revenue cycle for UC San Diego Health, tells HealthLeaders.

But UC San Diego Health isn't just successful compared to its own past performance. Meier says that the Epic SBO the healthcare organization uses compares metrics from its other users, and UC San Diego Health is a high performer there, too.

For example, from a professional billing perspective, UC San Diego Health was compared with 1,738 service areas in other healthcare organizations. For fiscal year 2019, its self-pay days in AR were just 2.5, compared to 5 for top performers (i.e., the top 25% of the total service areas), and 7.1 for the median among all users, Meier says.

Also on the professional billing side, it sent just 0.4% to bad debt, compared to 0.7% for top performers and 1.3% for the median.

On the hospital side, UC San Diego Health was compared in Epic to 536 service areas and logged similar success: Its self-pay days in AR ended at 1.9, compared to 3.5 for top performers and a median of 5.6 days. Its bad debt on the hospital side was 0.5%, whereas for top performers it was 0.9% and the median was 1.6%.

Technology isn't the only reason for UC San Diego Health's success. Meier's leadership style combines a revenue cycle strategy that emphasizes people and process as much as technology and it has resulted in what she hopes is just the beginning of SBO success for UC San Diego Health.

"I think the most important thing is the connectivity of the people, the process, and the technology," says Meier. "We've got to put emphasis on all three."

Below, Meier shares UC San Diego's SBO strategy with HealthLeaders and executive peers who want to achieve similar results.

A differentiating factor

High-deductible health plans and high out-of-pocket costs mean that patients aren't just patients anymore; they're also consumers who are deciding how to spend their money, Meier says.

"Why would they pick San Diego as opposed to a competitor who's literally across the parking lot from us?" she says. "We've got to continue to think of ways that we can make ourselves different, provide a better service."

For UC San Diego Health, one of those differentiating factors is customer service.

Meier says the "exclusive reason" she was hired at UC San Diego Health was to build the SBO, which she did from scratch. But before she came onboard, she says the organization outsourced its customer service on the hospital side and had about seven in-house FTEs on the physician/professional side.

Meier not only combined the two customer service departments, but insourced everything, and hired an additional 30 people. They all were cross trained in both functionalities and can all "navigate end-to-end revenue cycle in Epic."

Good customer service also extends to a simpler and clearer patient statement, which was redesigned with input from patient and family focus groups. Meier says that only 21.41% of statements that they send result in a customer service call, which she believes is lower than the industry average. In addition, only 3.58% of statements result in a complaint.

The people and the process

Because of those new statements, patients clearly understand the service they received, how much they owe, and why, Meier says.

But when billing questions do arise, patients need to get them answered as quickly and competently as possible. That's why the people Meier hired were different, too.

"I didn't hire typical customer service reps. I hired knowledge workers," she says. "We had a high expectation that they had at least five years' experience in hospital revenue cycle."

While customer service experience was a requirement, "we really tried to hire folks that were seasoned within the revenue cycle that would have the answer to the question for the patient."

Hiring highly skilled people also calls for excellent compensation.

"San Diego allowed me to build the highest pay grade in the revenue cycle here at UC San Diego, so customer service is where people would want to transition to instead of transition out of," she says.

Indeed, Meier says her turnover has been zero, and the people who've moved on from the department have retired or been promoted to leadership roles in different areas.

As would be expected after consolidating customer service operations, UC San Diego's call volume and talk time both increased, which Meier views as a success, especially in light of other metrics: Its customer service reps are answering calls within nine seconds, and its call abandonment rate is just 0.29%, making its service level 99.71%.

"Now we're servicing that patient holistically, not just a piece of it," Meier says. "They're talking to a person who is listening and really cares about their problem and is here to help them."

And because they're able to help patients resolve their billing issues, cash flow is up and bad debt and self-pay days in AR is low.

"The process really works," Meier says. "We're able to actually help those patients pay their bills."

The business case

For UC San Diego Health, customer service is not only a differentiating factor for patient choice but also for revenue cycle metrics. Meier says there's a clear business case for hospital leadership to revamp its customer service team into the most highly paid and desirable positions within the revenue cycle.

She says that because of high-deductible health plans, patients "are a payer in a sense, just like Blue Cross and Blue Shield, because they're responsible for a lot of that bill."

In fact, she says patient self-pay—including both patients without insurance and balance after insurance—accounts for about 12% of the organization's cash flow.

"Well, with the patient being a payer now, I think the same strategy holds true with self-pay," she says. "I want to hire the best and the brightest because self-pay is a big part of my cash flow these days."

She continues, "If you want to make … the patient financial experience part of your differentiating factor, having staff that are dedicated to your organization personally is the way to make that difference," she says.

Meier presented some of this information at the December HealthLeaders Revenue Cycle Exchange, an event where revenue cycle vice presidents and directors from around the country gather to share ideas and best practices. To inquire about attending the next HealthLeaders Exchange program April 20-22, in Carlsbad, California, email us at

Alexandra Wilson Pecci is an editor for HealthLeaders.


Design billing statements clearly, simply, and with patient input.

Hire 'knowledge workers' and pay them well.

Revamp the customer service team into a highly paid position within the revenue cycle.

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