The Exec: CFO Shares Tips on Creating a Clinically Driven Revenue Cycle

As more hospitals face financial uncertainty, revenue cycle leaders need to work to help improve the bottom line, and sometimes that means reworking your revenue cycle.

This article appears in the November/December 2022 edition of HealthLeaders magazine.

Over the past several years, many health systems have run into underperforming metrics, insufficient workflows, and undefined roles within the revenue cycle.

Hawaii Health Systems Corporation (HHSC) Kauai Region was running into these same challenges, so it began tackling these issues in 2019 by focusing its efforts on creating a clinically driven revenue cycle, meaning Kauai Region aligned its clinical and financial information with a twofold goal in mind: improve clinical outcomes and reduce costs.  

"We had become burdened by our EHR system because we didn't understand it. But now, we're not. When we got our system to work more efficiently for us, it freed up staff time so we could focus on other things like bringing self-pay in-house," said Christine Asato, regional CFO for HHSC Kauai Region.

Putting the focus on process and training, along with the engagement of an operational revenue cycle architect, helped HHSC Kauai Region increase its average daily revenue by 7%, Asato said.

Staff were not only able to track performances through a clinical lens, but also follow patient journeys within its facilities. This helped HHSC Kauai Region in its effort to reduce time spent on manual charge captures.

Pictured: Christine Asato is the Regional CFO of HHSC Kauai Region. Photo courtesy of HHSC Kauai Region.

"That's the beauty of having a clinically driven revenue cycle. It allows a hospital to operate more efficiently and effectively and really have the system work for you—instead of the other way around," said Asato.

Through this revenue cycle optimization, Asato says there are two main reasons for the increase in its revenue: better charge capture from its EHR system and an increase in swing bed utilization.

So how can other healthcare organizations and revenue cycle leaders do the same? Asato said HHSC Kauai Region was able to pull this off with help from the third-party vendor Cerner.

After implementing an EHR platform that supported its clinical, financial, and operational needs, HHSC Kauai Region was able to drop its gross accounts receivable days by 8.8%, decrease accounts receivable greater than 90 days by 12.6%, and increase payments by 61.7%^.

To fully benefit from revenue cycle optimization, it's important to understand the revenue cycle puzzle pieces and how those pieces connect to each other and the bigger picture, Asato said.

"Patient financial services is responsible for getting the claim out the door and the payment in our bank; registration is responsible for getting accurate demographic information from the patient; coding is responsible for assigning codes based on the documentation provided in the chart; and our clinicians and providers are responsible for making sure all services performed are documented in the chart in a complete and timely manner. When all these moving pieces are working as designed, it becomes the glue that holds us all together," Asato said.

Because of the success in creating a clinically driven revenue cycle, Asato had much to say when asked what tips she had for other revenue cycle leaders looking to optimize their revenue cycle in the same way:

Asato: I think the biggest tip that I can give is to, first, engage with your revenue cycle architecture team because they understand the system and can help address workflows. Unless you understand the design and flow of the EHR you are implementing, you cannot begin to optimize your workflow or even capture the revenue in real time. 

Looking back on our experience at Kauai Region, I share this mantra: If you document it, the charges will come. What was instrumental in the growth of our charge capture wasn't that our teams weren't taking great care of our patients; it's that we weren't able to bill for every service performed.

As revenue cycle leaders, it's important to think about these projects, not from a financial standpoint, but from a clinical documentation standpoint using the EHR as a tool and not a check the box exercise. You need to tell the story of the care provided to the patient that can be shared across their continuum of care in a meaningful and timely manner. When you place your emphasis on documentation, the charges will come. That's how the system is built.

Finally, I think the beauty of having a clinically driven revenue cycle is that it allows a hospital to operate more efficiently and effectively. But if you don't get it right, you become enslaved to your system, and end up spending valuable time and resources cleaning up the mess.  

If you're in the clean-up phase it's easy to blame the system, but this is the time to take a break and really dive into your workflows to figure out how to get the system to work for you. It all starts with the order and flow of capturing information and when done properly–and in the right sequence–you will create a win/win in the clinical and financial aspects of the revenue cycle.