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Southeast Alaska Regional Health Consortium

Transforming Ambulatory and Inpatient Revenue Cycle Operations Using the Cerner EHR

Overview

SouthEast Alaska Regional Health Consortium (SEARHC) is a nonprofit Tribal health consortium serving 28 communities throughout Southeast Alaska. In 2017, SEARHC joined the Alaska Native Tribal Health Consortium, and other local Tribal health partners in implementing a shared Cerner electronic health record (EHR) system to improve communication between the organizations serving Alaska’s Native population and to enhance the quality of care provided.

the challenge

The aggressive implementation timeline, coupled with limited deployment assistance and training from Cerner experts, caused a decline in SEARHC’s financial performance. The lack of a formal training program for an influx of new employees intensified these negative effects.

the process

Nine months after go-live, SEARHC engaged ECG to evaluate the design, use, and performance of the revenue cycle system at two SEARHC facilities: Ethel Lund Medical Center and Mt. Edgecumbe Hospital. The goal of this assessment was to help SEARHC identify and quickly resolve the operational and technical issues negatively affecting its revenue cycle, which in turn would allow SEARHC to achieve positive financial results, realize operational efficiencies, and successfully adopt the new Cerner EHR.

Key findings from the assessment identified three main areas of opportunity: revenue cycle, utilization review (UR), and ambulatory operations. With a mandate by SEARHC leadership to provide quick wins, ECG created performance improvement solutions for these three areas by developing specific, focused recommendations intended to enhance Cerner training and system design; we then helped SEARHC implement them. The key recommendations developed by ECG are listed below.

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A comprehensive work plan that tracked immediate (two months), short-term (six months), and long-term (over six months) activities against organizational goals guided the development of the recommendations. The recommendations centered on the following objectives:

  • Ensuring EHR system build decisions were in line with best practices and supported an efficient revenue cycle
  • Implementing the tools, processes, and training necessary to establish optimal Cerner workflows and support continuous optimization
  • Establishing baseline revenue cycle performance indicators and measurement tools to monitor improvement and opportunity
  • Providing a biweekly status report of accomplishments, planned activities, and appropriate performance benchmarks to relevant stakeholders

Upon completion of the assessment and correction of high-priority issues, ECG coordinated and facilitated a revenue cycle boot camp and presented it to SEARHC’s 12 revenue cycle and clinic operations leaders. With a holistic view of the patient care process, this helped the group gain an understanding of each department’s unique needs, competing priorities, and role within the revenue cycle. In addition to developing process improvement recommendations, ECG completed a staffing analysis to ensure appropriate staffing of revenue cycle departments. EGG also provided SEARHC with a comprehensive training plan detailing a revised process for onboarding new hires and communicating system and workflow changes.

I just want to say thank you again for all the great work and support. Many times we take our consultant friends for granted, but I very much recognize the talent, effort, and results you provide. With your help, SEARHC just had the best cash month in its history. I look forward to the future with a process and system we can trust, and I know you will help us get there.

Dan Harris, Chief Financial Officer, SEARHC Executive Offices

the outcome

Over the course of six months, the ECG team and SEARHC’s revenue cycle leaders collaborated to identify and rectify system design and workflow issues across all revenue cycle departments. The revenue cycle department leaders now have a deeper understanding of how the Cerner system functions and the tools needed to maintain the system and ensure it is fully supported moving forward. Other notable achievements included the following:

  • Eliminated the need to manually update each evaluation and management code and saved the coders two minutes per account on average.
  • Developed the ability to understand and build Cerner Discern Analytics 2 (DA2) reports to aid in the analysis of financial metrics.
  • Achieved compliance with Centers for Medicare & Medicaid Services UR-related regulations.
  • Reduced nursing administration time by two hours every day through the creation of a DA2 custom clinical census report.
  • Conducted a comprehensive staffing analysis and identified gaps affecting revenue cycle performance in the resource model that demonstrated the need to add or redistribute 12 full-time equivalents across revenue cycle functions.
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