The California Sutter Health Approach - Essay Example

? A Case Analysis for the California Sutter Health Approach Introduction Currently most health care organizations face theproblem of being incapable to collect their debts the uninsured, self-paid and under insured patients due to the increased recession rate in the economy. A number of reasons exist that explain this common problem occurrence with the working families recording the highest number of uninsured patients (Souza, 2007). They have the means to pay the hospital but remain ignorant on the need to have a medical insurance scheme for them. Sutter Health located in North California is one of such organization that suffer from this predicament; considering that they are a not-for- profit health system expending their services to over a hundred towns and cities in the Northern California region (Souza & Mc Carty, 2007). The Sutter Health system provides quality health care through with the help of physician organizations, hospitals and other health service providers who share the same resource and knowledge. They have gradually expanded from a small facility in Sacramento to one of the largest health care providers in the California region (McMurray, 2006). However with their expansion came the increased bill and costs that have made payments collections futile; but the system has attempted severally to improve their budgeting and patients accounts. In such an attempt, they committed to providing the patients financial services (PSF) staff with the valuable tools to improve the patients’ collections. In reference to their financial approach, the Sutter Health care staff had already embarked on staff registration; aimed at transferring back end functions to the front end in an effort to make the norm. Evidently, the Sutter Health held continuous meetings and discussed reasons, steps to take and results oriented approaches to improve the effectiveness of their health care service in the United States; which builds the basis for this case analysis paper on the California Sutter Health approach (McMurray, 2006). Discussion Sutter Health faced several conflicting problems, but the main problem emerged from the expansive patient base that Sutter Health served the Sutter Health family complete with 48,000 physicians, volunteers and employees cared for patients in more than hundred towns and cities in the Northern California region (The Sutter Health Story). According to (Souza & Mc Carty, 2007), the article provides research data indicating how the Sutter Health care system regarded itself the best among the largest health care service providers in the Northern California region who successfully implemented a totally new strategy of on ways of increasing the patients collections. This strategy prompted the need to focus on collecting payments from new patients, monitoring services and implementing strategy precisely targeting how and when to collect payments from patients. The successful program has positively promoted the accounts aided (AR) department in Sutter Health established to develop solutions and allow the system time to recognize; that, despite the success of this program, there is still need to maintain and open the program to further, future improvement (Souza & McCarty, 2007). One of the leading problems observed at Sutter Health involved the fact that each facility acted independently when it came to dispersing information. Considering the numerous accounting and operating systems they had it became impossible for them to obtain reports and data in a synchronized format from every location; therefore this broke down the organization's practice uniformity (Hummel, 2004). In 2006, the Sutter organization embarked on a project to work on the independent information problem with intentions of sourcing out lasting solutions with the patients’ accounts representatives, collectors and other members of their central office branch in Sacramento. The Sutter Health system has worked quite fast on the registration of its staff, ultimately reducing the receivable accounts (A/R) days for nine of their hospitals in the region from a large number off 65 to 59. Directly estimating the days to accounts, the days equal up to thirteen million U.S. dollars; meaning that the institution benefitted from an additional financial collection of 78 million U.S. dollars. However, analyzing the systems revenue management cycle before the implementation of the new program the Sutter Health discovered the following problems. First, their PSF staff could not access information on time regarding the principal financial and operational indicators such as the accounts receivable days and the cash collections. Hence, the management and the staff had to rely on the end-month data to set new benchmarks and track progress or ultimately formulate valuable business decisions. Secondly, the complex hospital accounting system did not allow for any data isolation and analysis or regeneration of demanding reports to the level of desired detail. Instead, the region relied on the services of meticulously trained programmers to develop the reports for them; leading to increased costs in dealing with identification delays and problem correcting. The third problem leaned on the central business office which suffered the inability to access the right information on time, accessing only the list of outstanding accounts assigned to them; therefore the accounts representatives could not monitor progress of the system effectively or prioritize on key issues affecting the collections. As a remedy, to this problem, the Sutter health strategists laid down benchmarks to focus on improving their current situation and the patients. This involved collecting of cash, analyzing the billed and unbilled A/R days, investing in less capital and concentrating on more crediting of the balance accounts, targeting on achieving the highest quarterly, mid year and annual A/R percentage and majoring on the payer A/R days often. The Sutter staff in return applied the laid out benchmarks to cut down on the A/R days and increase patient collection; aimed at motivating the individual members of the PSF staff in taking responsibility for each account they handled. As a result, each of the Central Business Office (CBO) members took the role of the business ownership in order to keep up the track progress; in accomplishing individual goals and meeting the set team targets. Additionally in an effort to increase the system's effectiveness, the Sutter Health formulated tools of business such as sorting out the accounts; this involved the analysis of accounts by amounts in dollars, the work date of collection and the payer who handled the cash. The organization also changed its focus by prioritizing on automatic lists of work accounts instead of waiting for the end month reports. Lastly, they put someone in charge to oversee for them on organization ranking from the group to the cooperate level based on the analysis of individual performance against the targeted achievable percentage. These tools effectively directed the staff’s actions and highlighted areas and accounts which still needed improvement; which if carefully rectified would positively affect the A/R days and the overall goals for cash collection. However, the management had their independent tools for business that enabled them to scrutinize down to the account level of the patients, calculate the daily average revenue collected and tally it with the thirty days time frame, adequately monitor the payments, account receivables and adjustments made to the period of days from the last account records. These tools also contributed in probing into the A/R accounts chart and identifying problems prior to their occurrence, reviewing the accounts to pick segments for analysis and assessing monthly performance in estimating the monthly turnovers. Additionally they assisted in generating demand reports on time for timely analysis of credit balances, payers’ problems, aging, A/R revenues and non discharged bills (Souza & McCarty, 2007). The implementation of the component of denial management saw all parts access the real-time data that they required for clean reports the billing system reorganized and the debt from patient collections recollected by half. This is because the entire billing elements relied solely on access to information and as a result, the revenue cycle for Sutter Health doubled significantly reducing the denial claims reported to the hospitals. However, in ensuring quality performance the management had to register the new strategic process afresh and analyze the system by rules governing the discharging of patient’s before they leave the registrars desk in order to point out problems prior to their effect. For example, the problems that possibly identified at this implementation stage would include the age of the patient’s guarantor, the validity of the patient to qualify for hospital service, the patients’ age in connection to the Medicare insurance scheme, the patients plan code as stipulated by Medicare payer and the workers compensation based on the accidents information (Hummel, 2004). Additional problems might occur after this stage such as the workers filed compensation on occurrence code different from code 04, the patient’s insurance claim policy, and errors in the patients’ address and duplicated patients’ medical numbers. Subsequently, the editing of front-end claims enables the PSF staff in quick problem identification so that the necessary actions and further application of training on time. An added advantage since the innovation of the computer technology allows prior account flagging that fosters shading light on the specified accounts that need reviewing. The reviewing process operates in a way that the accounts clerk receives notification, and detailed description of action to take on an individual account. For example, such accounts include patients with returned mails; check the validity of the patients' address and in instances that the patients’ accounts carrying serious debt amounts the request for payments ought immediate effect (Souza &McCarty, 2007). According to further research done into Sutter’s Health system, the data showed that if the registrar received occasional prompts on the preregistration amounts this would help in improving the revenue received from the collected debts. Therefore, the alternative solutions to the Sutter Health problems would involve putting one tool to test in order to deduce the amount, collected per staff; with an intention of linking the tool to the estimation and system’s management; to ensure transparent evaluation of the registrars handling the cash (Coddington, Moore & Fischer, 1996). The Sutter system should then design a support plan to improve the well-being of their PSF and registration staff members without the option of rehiring, educating, retraining or increasing their wages averaging beyond the 20hour dollar mark. However, the system still calls for further advanced training of its staff focusing on the different health service departments. For example, the registration department needs more training on patient communication that includes role-play and repetitive rehearsal of the communication script (Coddington, Moore & Fischer, 1996). On the other hand, the CBO staff needs additional training on principles of A/R management on top of the tool implementation strategy applied in the past. In an attempt of solving the above predicament, Sutter Health, can reach on decision and pick out the MedAssets’ Receivables Manager and application on MyMentorTM to assist the management and staff access information in real time for increased effectiveness and commit to sound judgment in their jobs. This will also avail necessary information to the nine hospitals in the region on key indicators affecting performance such as the collected cash and A/R days. This application also will contribute in aiding the managers in daily identifying and analyzing possible threats; and business trends and influence their ability to draft conclusive reports on the ground. The receivable’s manager application will also give the users avenues to isolate and analyze data of each staff member, aiding faster resolution of problems and increased negotiation leverages (Souza & McCarty, 2007). In conclusion, the billing system utilized by Sutter Health accounts for several of their contacted payers’ rate which highlighted the existence of underpayment in the dollar billing system. The detection of errors on time did significantly aid Sutter in improving their cash position; therefore the new applied strategies should aim at accomplishing this aspect of management, as well. Through giving the employees of Sutter Health the necessary tools of business to accomplish their tasks according to the target margins, the organization renewed its competition culture and ownership ensured each department contributed equally to the system quality service dispensation. Hence, in favor of this benchmark approach it is to my opinion that the system needs to incorporate this tools more often and at an advanced level; to guarantee future business renewal. Noting that the Med Asset’s approach earned the Sutter Health an award in the year 2006, the manipulation of this approach at an advanced level is significantly necessary; in establishing a profitable ground for positive receivable results in the shortest time possible. Although, the Denial Management approach has never undergone implementation in the Sutter Health care system, the attempt to try something new would not wound the performance in the health care context but will instead open new areas for further study in the identification and problem analysis, which will in return develop the organization’s disaster preparedness. This paper addressed the reasons for this the Sutter Health approach, the discussion on the problems, steps taken to remedy the current Sutter situation, the possible alternatives to solve such problems and the achievable results (Hummel, 2004). These aspects collectively contributed into making Sutter Health one of the leading largest health care service providers in the U.S. Alternatively, this the organization could effect this remedies in the opposite manner; starting from the top and gradually moving downwards and this might consequently limit the flaws observed in the system that approaches in the past never captured (Sutter Case Study, 1998). However, the first approach used by the organization stands out as workable throughout the Sutter Health’s history and a repeated application of the same will not hurt as long they do fresh reviews on it and add a few elements to improve its quality. References A case study in corporate compliance: how Sutter Health developed and initiated its standards of business conduct. (1998). Marblehead, Mass.: Opus Communications. Coddington, D. C., Moore, K. D., & Fischer, E. A. (1996). Making integrated health care work. Englewood, Colo. (102 Inverness Terrace East, CO 80112-5306): Center for Research in Ambulatory Health Care Administration. Hummel, J., (2004). Sutter Health. Retrieved from McMurray, S. (2006). Building a system: the history of Sutter health. Sacramento, Calif.: Sutter Health. 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, Read More