Beyond optimization: A revenue cycle “post-live” story


How does a large academic medical center and health system integrate its EMR and various revenue systems without decreasing patient satisfaction or losing gross revenue? And how does it plan for long-term continuous improvement rather than optimizing once and moving on?

The University of Michigan Health System (UMHS), a multi-site academic medical center and health system that handles 2.1 million outpatient visits and 47,000 hospital stays yearly, grappled with these questions in the late 2000s when a rise in self-pay prompted reconsideration of existing revenue cycle management practices. It underwent an EMR implementation in 2012, and then sought a partner to optimize its post-live revenue cycle management. Recently, UMHS reconfigured that partnership to help inform and sustain the energy around continuous improvement.

Reasons for Integration

According to a 2013 J. P. Morgan Healthcare Banking report, from 2004 to 2011 the U.S. market experienced a 10-fold increase in the number of covered lives under High Deductible Health Plans (to more than 11.4 million people). The Commonwealth Fund found that premiums for family coverage increased 62% across states over nearly the same period (from 2003 to 2011). Acknowledging this dramatic increase in out-of-pocket payments, UMHS leadership sought to adapt revenue cycle operations to better fit the shift in financial accountability from employers to individuals.

Collaboration vs. Prescription

UMHS had brought on a consultant to help with the initial EMR implementation, but was looking for a different type of assistance for its post-live optimization. In 2012, UMHS engaged McKinnis Consulting Services (MCS) to perform a revenue cycle assessment and optimization of the newly implemented EHR. While the resources of a larger consulting company were attractive, the complexity of optimization across several revenue cycle systems required flexibility and a genuinely collaborative ethos. The engagement began with MCS getting to understand the culture and existing practices of UMHS, and then working in partnership to identify areas for improvement and the organizational structure and resources necessary to achieve best practice metrics.

What the UMHS revenue cycle management operations did not need was another group telling them what to do. MCS earned organizational buy-in by delivering real collaboration, not prescription — they helped form a bona fide team by rolling up their respective sleeves to get the hard work done. This meant sharing their post implementation experience, skills, and expertise.

Written by Benjie Johnson, Chief Officer, Integrated Revenue Cycle – University of Michigan Health

See the original publication in Becker’s Health.