Executive Q&A: Boston Software Exec Tackles Revenue Cycle Management


Executive vice president of Boston Software Systems, Steve Cohen, talks about controlling the revenue cycle, process automation and latest in scripting technologies. Cohen has been with Boston Software for four years; the company offers Boston WorkStation and UNISON, two products for implementing workflow automation.

DHP: What is the toughest thing about controlling the revenue cycle?

Cohen: The revenue cycle is comprised of hundreds of processes and workflows that all contribute to the cycle and ultimately the bottom line of a healthcare organization. [That’s] the difficulty, that the revenue cycle doesn’t comprise just one thing.

Because of the way healthcare organizations evolve, unique workflows typically evolve to handle information, whether it’s a clinic, department, or physician practice. These workflows often develop in response to immediate demand without consideration for how the information is ultimately used or how the process may be automated.

DHP: What are some practical examples of how streamlined business process management (BPM) can change a facility?

Cohen: The revenue cycle starts the minute the patient walks in the door, and strategic information strategies can be developed in business office, billing, and patient accounting, for example. Task automation opportunities include changing the financial class of a list of patients or writing off balances, payment and cash posting and posting notes and comments on accounts. At University of Pittsburgh Medical Center, for example, they have automated the process of going directly to payer’s Web sites to electronically obtain real-time insurance eligibility, then automatically post that information to the patient accounting portion of the hospital information system (McKesson or Meditech).

Even incorporating National Provider Identification (NPI) into provider’s tales, which can be very time-consuming, doesn’t have to be if automated.

DHP: What does it mean to add a layer of business intelligence to automation?

Cohen: Instead of simply automating tasks, organizations can use smart process automation that includes a layer of management that provides decision-making assistance for users. This watches workflow and can provide corrective action, prompt for additional or corrected data, capture and input information when appropriate, and provide automated notification and authorization.

DHP: How have scripting technologies changed?

Cohen: Scripting technologies can complement integration engines by working at the user level. They have improved dramatically, automating Web connections, capturing keystrokes or mouse clicks before they hit the screen, setting up notifications through pager or email. Simple data automation can be accomplished with inexpensive macro recording products or screen scrapers that offer a minimum of capabilities.

But not every solution fits every problem. Flexibility is the key to success, and technology needs to fit and augment the workflow you have.

DHP: How quickly can you see a Return on Investment (ROI)?

Cohen: Automating specific tasks can yield a fast return on investment and yield predictable outcomes with measurable and meaningful payoffs, but calculations vary based on how it’s used in your facility. Running a script replaces staff resources, so a simple way to calculate value is the number of full-time staff required to perform the same task. The ratio of the cost to staff and installation cost is the ROI.

The terminology of “Lean Processing”— optimizing assets, productivity, human resources and time is applicable to healthcare as well. At South Dakota’s Avera Health network, a system wide lean project was implemented three years ago, with the IT department using scripting technology to support lean projects in labs, ER, surgery, pharmacy, housekeeping, and radiology to create more efficient workflows throughout the hospital network with simple automation.

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