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The California Sutter Health Approach
In 2006, Sutter Health, one of Northern California's largest providers, committed to giving its patient financial services (PFS) staff the necessary tools to improve patient collections. After reading the details of the financial approach, it showed that the staff began working towards the registration staff with its aim at transferring back end functions to the front end so they would make the norm. This paper will show the reasons, discussions, meetings, steps taken, and the results that ended successfully in making the Sutter Health Approach one of the most effective in the United States of America.
Sutter Health is a non- for-profit community based healthcare and hospital system based in Sacramento, CA. Sutter Health faced several problems, but the key problem was, "Within our Sutter Health family, 48,000 physicians, employees and volunteers care for patients in more than 100 Northern California cities and towns" (The Sutter Health Story, 20). Souza and McCarty wrote an article, "From Bottom to Top: How One Provider Retooled its Collections," that provided data from research indicating how this healthcare system reputed to be on the list of the largest health care providers in Northern California maneuvered into implementing a whole new strategy on how to increase collections. When collecting payments from new patients, services provided, comes from the need to implement new strategies on how and when to collect the payments. The successful program used by Sutter Health has aided the accounts receivable (AR) department in developing solutions to their problems and allowed them to recognize that even though the program is successful, the need to ensure the program remains open to better improvement (Souza, & McCarty, href="http://www.justanswer.com/homework/5hu1j-written-8-10-page-case-study-analysis-sutter-health.html1). "One of the key problems that Sutter Health was experiencing was that each facility acted as an independent "island" of information. Due to the numerous operating and accounting systems it was impossible to obtain data and reports in the same format from every location. There were no common practices within the organization" (Hummel, J., 2004).
The following paragraphs of this paper show the research done by Souza, and McCarty in order to write an article entitled, From bottom to top: how one provider retooled its collections, on the strategy taken by Sutter Health. This organization started a project in 2006 to work on the problem of "island" information with intentions to conclude with a solution with the patient account representatives, collectors, and other members of the central business office of its Sacramento/Sierra region. Sutter's health system worked forward to the registration staff, ultimately reduced accounts receivable (A/R days) for the nine hospitals in the region from 65 to 59. Given that each one of those days equals $13 million that means the health system collected an additional $78 million. Sutter Health identified the following problems that occurred when analyzing its revenue management cycle prior to implementing the new program:
* Gross A/R days (less capitation and credit balance accounts)
* Cash collections
* Unbilled A/R days
* Billed A/R days
* Percentage of A/R over 90, 180, and 360 days
* Major payer A/R days
Empowering PFS Staff used Sutter's strategy for increasing collections and reducing A/R days focused on empowering individual PFS staff members to assume responsibility for each account they deal with. In effect, each person in the CBO owns his or her own business, complete with a customized dashboard to track progress in meeting individual and team targets. To help PFS staff manage their businesses effectively, Sutter has provided them with a set of tools that allows them to:
* Prioritize and automate account work lists
* Sort accounts in various ways, such as by dollar amounts, oldest previous work date, and payer
* See at a glance their ranking within their work group and office wide, based on their performance as a percentage of the target achieved.
The tools tell staff members not only how they are doing, but also where and how they could improve, pointing out which accounts, if worked successfully, will have the greatest impact on their A/R days and cash collection goals. Managers have their own receivables dashboard and tools, enabling them to:
* Query all aspects of receivables for trending purposes and identify problem areas
* Drill down to the patient account level
* Monitor revenue, payments, adjustments, receivables, and days for periods from the previous day and week to the previous 18 months
* Calculate average daily revenue by day and 30-day period
* Assess their performance for the month to date, and estimate likely results at the month end
* View all receivables or select any segment for quick analysis
* Generate timely reports on demand, including aging analysis, A/R stratification, discharged not final billed (DNFB) analysis, credit balance analysis, and analysis of problem payers" (Souza, & McCarty, 2007).
"A denials management component was implemented in late summer. When registration staff went online at the end of the year, the cycle was complete, with all parts having access to all the data they needed to produce clean claims. Half of the required billing elements on a UB92/04 originate at the point of access. As a result, this point in the revenue cycle presents the greatest opportunity to reduce claims denials. To help ensure optimum performance at this crucial juncture, Sutter's new process requires that each registration be analyzed by a rules engine before the patient leaves the registration desk to identify potential problems. Examples of problems or errors that can be identified at this stage include the following:
* Workers' compensation or liability financial class lacks accident information.
* Workers' compensation is filed with an occurrence code other than 04.
* The patient's guarantor is under 18 years old.
* The patient's marital status is widowed, but the relative is listed as husband, wife, or spouse.
* The patient type is not valid for hospital service.
* The patient is age 65 or older, but the Medicare insurance plan is missing.
* The patient had Medicare in any plan code, but the Medicare secondary payer questionnaire is missing.
* The health insurance claim number or policy ID number is XXXXX
* The patient address includes errors in format, punctuation, and/or abbreviations.
* The patient has duplicate medical record numbers.
This front-end claims editing enables PFS staff to quickly identify problem areas where corrective action and/or further training is needed. In the same way, computer interfaces allow the system to flag accounts that require special handling. The admitting clerk receives an alert that may include a description of specific action he or she should take. Examples of such alerts include "Patient has other accounts with returned mail; please check for valid address," and "Patient has other accounts in bad debt; please request payment" (Souza, & McCarty, 2007).
Further research by Souza and McCarty showed that Sutter Health had a simple prompt to the registrar to collect the amount preregistration had established with the patient could make all the difference. The health facility tested a tool to track how much money each staff person collects up front, hoping eventually to link that tool to estimating and contract management systems so that registrars can be evaluated as well on percentages of contracted rates and established targets collected. Sutter's system is designed to support the existing PFS and registration staff without the need to hire a more formally educated staff or to increase wages beyond the current average of $10 to $20 an hour. The system does, however, require that staff receive comprehensive training. The focus of the training differs with different staff areas. For example, registration staff, who are not accustomed to asking people for money, receive training that focuses largely on effective patient communications and includes role-playing and script rehearsal. By contrast, CBO staff are more used to asking people for money, but they are not used to taking stewardship of their assigned accounts. So in addition to time spent learning to use the tools and perform the functions, the first hour of the CBO staff's three-hour group training session focuses on the concepts and principles of effective receivables management--e.g., how to take ownership of problems and make autonomous decisions about how to solve them, how to identify trends and use that information to boost performance, and how to use performance feedback-based results rather than just activity. In order to resolve these issues, Sutter Health chose MedAssets' Receivables Manager and MyMentorTM applications to not only give managers and staff access to the real time information they need to do their jobs, but also the intelligence they need to work smarter and make more informed and more profitable decisions. With Receivables Manager, the region's nine facilities' managers now have information about key performance indicators, such as A/R days and cash collections, at their fingertips. The application's digital dashboard enables managers to identify and analyze potential issues and trends on a daily basis. Managers also have the ability to create detailed reports on the spot. Using a series of simple drop-down boxes, Receivables Manager allows users to isolate and analyze data for each payor or staff member, enabling faster problem resolution and increased leverage in negotiations (Souza, 2007).
The results that Souza and McCarty found showed that MedAssets' software helped the region's central billing office detect an error in a major payor's contracted rate, which could have resulted in thousands of dollars in underpayments. The error was detected within days rather than weeks, allowing Sutter Health to proactively improve its cash position. Equally as impressive are the results generated by MyMentor, a complementary application that empowers business office personnel by prioritizing and automating account worklists and analyzing productivity trends. As a result, Sutter Health's business office staff is increasing efficiencies and reaching individual and team goals faster. Designed specifically for patient account representatives, collectors and other business office staff, MyMentor provides each user with a customized dashboard that tracks his or her progress in meeting targets - allowing users to analyze their performance and compare it with others in the department. "MyMentor is the most effective piece of software I have seen in my 32-year career," said Margie Souza, Sutter Health's regional central business office director. "By giving all employees the tools they need to run what is essentially their own business, we've seen a renewed sense of ownership and competitive spirit within the department.." In fact, 100 percent of respondents in a recent survey of Sutter Health's business office staff provided positive feedback on the software, and the department earned Sutter Health's Department of the Year Award in 2006. "Taken together, the results we have seen from MedAssets' Receivables Manager and MyMentor over a very short period of time have been nothing short of incredible. With the intelligence provided by these products, we reduced A/R days from 65 to 59 over a three-month period. One day in A/R equals $13 million for the nine hospitals in our region. Multiply $13 million a day by six fewer A/R days, and that's a $78 million impact." "We don't think this story is finished yet," said Souza, noting that her region is still in the process of implementing and integrating MedAssets' Denials Manager and UpFront software. "Once this process is complete, we believe we will see similar successes in the denials management and patient registration areas" (Case Studies, href="http://www.justanswer.com/homework/5hu1j-written-8-10-page-case-study-analysis-sutter-health.html1).
This paper showed the reasons, discussions, meetings, steps taken, and the results that ended successfully in making the Sutter Health Approach one of the most effective in the United States of America. An alternative would be to take the opposite approach and begin from the top and proceed downwards, and perhaps there might be a few flaws that the original approach did not catch, however, the first approach seems to have covered everything.
Case Studies. (href="http://www.justanswer.com/homework/5hu1j-written-8-10-page-case-study-analysis-sutter-health.html1). Retrieved from
Hummel, J., (2004). Sutter Health. Retrieved from www.healthdatamanagement.com/issues
Souza, M., & McCarty, B., (2007, September). from bottom to top: how one provider retooled its
collections. Healthcare Financial Management, 61(9), 66-73. Retrieved August 22, href="http://www.justanswer.com/homework/5hu1j-written-8-10-page-case-study-analysis-sutter-health.html1, from ProQuest Health and Medical Complete. (Document ID: XXXXXXXXXX .
The Sutter Health Story. (href="http://www.justanswer.com/homework/5hu1j-written-8-10-page-case-study-analysis-sutter-health.html0). Retrieved from