Jake Morris is a managing director with McKinnis Consulting Services (MCS) and was a founding member of the firm in 2009. MCS provides revenue cycle assessment, strategy, and optimization assistance to health care providers. HCB News spoke to him about the benefits of upgrading to a hospital information system (HIS) platform – and the importance of a clear game plan and unified approach to implementing change.

HCB News: In your experience, what are the benefits to a health system converting to a next generation HIS platform?

Jake Morris: When health systems adopt a HIS platform, they hope to bring in the revenues they’ve already earned as quickly as possible and also uncover new opportunities to reduce costs.



By establishing a system-wide patient medical record integrated with revenue cycle functions, organizations hope to realize benefits through improved quality of service, streamlined flow of patient information, reduction of bolt-on and third-party technology, efficient resource utilization, and increased management transparency. They expect that adopting an integrated HIS platform will ultimately lead to cost reduction opportunities and enhanced revenue realization.

HCB News: But we’ve heard that the conversion to a next generation HIS platform can actually present a significant risk to an organization’s revenue cycle. What do you attribute this to?

JM: During an initial roll-out, any number of problems can disrupt revenue cycle operations—charge entry challenges, revenue capture and reconciliation issues, unbilled backlogs, claims processing delays, remittance posting issues, etc. Regardless which of these problems is the most acute, the risk of an increase in accounts receivable and customer service volume is almost a given, at least initially.

HCB News: Why, do you think?

JM: In our experience, revenue cycle performance issues are typically traceable to gaps in strategic thinking. Some organizations don’t have an implementation strategy focused on operational outcomes. Others didn’t coordinate their operational and their technical resources. This includes defining areas of responsibility, and leveraging technology to improve revenue cycle processes.

Some of these gaps seem simple, but they really require a broad perspective on the organization’s power structure. Who is the most natural fit for a given task? Deciding who owns what and assigning clear areas of responsibility are crucial steps that are often mismanaged during implementation.

HCB News: Any other problems you tend to see in those conversions?

JM: Unfortunately, yes. Organizations often fall into the trap of building their system workflow without enough context. Think about switching systems and having to build a new charge description master (CDM), which is the comprehensive list of charges for all billable items in the hospital.

When done right, the revenue cycle team can use this forced migration to a new CDM as a catalyst to re-engage the clinical departments into reviewing their charge codes, revenue performance, and workflow rationale. They can take time to correct past charge failures and lay the groundwork for the enhancements that the new charging workflows make possible. By revisiting the CDM early, often, and consistently, an organization can build a culture of transparency, collaboration, and trust around revenue capture. Without it, charging errors and workflow obstacles become more and more ingrained.

HCB News: What are some of the underlying causes of those problems?

JM: Sometimes the causes are cultural; those are the tough cases. But others can be managed relatively easily. Many organizations are taking on much longer conversion timelines than they should be to migrate to next generation HIS platforms. If the timeline is too long, they may start to see a lack of engagement from revenue cycle operational staff. Reasons for this include the frustration of serving competing priorities when you have to both effectively manage legacy environments and foster newly live platforms. Staff may also disengage from the stress of keeping up with maintenance issues just as they have to prepare for upcoming facility conversions.

HCB News: What can institutions do upfront in the HIS planning stages to get ahead of these issues?

JM: As a foundation, they need to identify key stakeholder groups, create a collaborative communication structure, and determine key performance metrics prior to implementation. If they take care of those basic requirements, they position the organization to deal with the inevitable obstacles that arise even in a best-case scenario.

HCB News: Can you say more?

JM: Certainly. Much like how the HIS platform is integrated, the people and structure in hospital systems need to be unified as well. During the planning stages, organizations need to develop a results-driven and holistic approach—to their people, their process, and their technology—across several areas. And then they need to execute that approach.

Achieving true operational engagement means involving all stakeholders, and refraining from an over-focus on the back office staff. The largest breakdown areas during the conversion process are in the areas that have shared responsibility between clinical departments, finance, and the revenue cycle.

HCB News: For those institutions that are already on a next generation HIS platform, what steps should their revenue cycle team take to realize the full ROI of the platform?

JM: Right now we’re seeing trends within the post-implementation environment where organizations attack process improvement with a break/fix ticket model, a patchwork approach that does not promote higher-level decision-making.

That higher-level decision-making is crucial to post-implementation results, though. The foundation for achieving all aspects of continuous revenue cycle improvement begins with a dedicated focus to several core initiatives. To reduce system inefficiencies and bottlenecks, organizations need a well-defined “ownership” of responsibilities among disparate teams and exception-based workload management. Just as important are clearly defined productivity standards in the new paradigm, user and management reporting independence, and the empowerment of operations to drive ongoing system improvement.