Community Hospital of the Monterey Peninsula Achieving Strategic Goals with Eclipsys

The financial performance of Community Hospital of the Monterey Peninsula (Community Hospital) improved substantially in 2005 after the hospital implemented a new financial system, enhanced business processes and collected some overdue bills. The resulting outcome improvements have enhanced the bottom line.

"Cash collections have been fairly phenomenal. We set out in 2005 to collect about 107 percent of net revenue and, in fact, we ended up collecting about 111 percent of net revenue," said Joseph Haney, director of Patient Business Services. "And that left us about a $13 million dollar cushion, which was very much appreciated by the board of trustees."

The increase in collections followed the activation of Sunrise Access Management™ and Sunrise Patient Financials™ in July 2004. This integrated revenue cycle management solution from Eclipsys enabled Community Hospital to streamline workflows around the capture of patient charges and generate statements more accurately.

With a variety of new automated functions, the Patient Business Services office is now able to manage patient billing and collections far more effectively. For example, when a bill is requested, staff can run the Billing Edits function to automatically check an account for errors and flag any errors found. "As a result, cleaner bills are going out," said Jean Liebermann, Application Support supervisor.

Fully Digital Hospital
Prior to the implementation of Sunrise Access Management and Sunrise Patient Financials, the hospital relied on a standalone health information system that required a considerable amount of manual processing between the admitting and billing departments. Errors at the front end of the patient process and inadequate eligibility checking made it difficult to comply with HIPAA 837/835 electronic claim submission and remittance requirements. The hospital's clean-claim submission rate was only 65 percent, which brought complaints from patients and payors alike.

Nowadays, Sunrise Access Management integrates the insurance eligibility checks during the registration process, and provides tracking of eligibility submissions and responses. The Eclipsys system is the only one in the industry that integrates these front-end processes with back-end billing operations. "The amount of time it takes to register the patient has been streamlined and we have been able to identify potential insurance issues before the patient visit is qualified for billing. Patient complaints are way down as a result," said Daisy Noguera, assistant director of Patient Business Services.

While the Sunrise solution is satisfying a near-term goal of streamlining patient financial workflow, it's also an important part of Community Hospital's strategic goal of having a fully digital hospital. This goal corresponds with the new $150-million, two-building expansion of the hospital's main campus, which includes 120 patient rooms, a 20-bed intensive care unit, and state-of-the-art Surgery and Emergency departments.

"Our selection of the new financial system was driven by our choice of Eclipsys (Sunrise Clinical Manager™) for the clinical system," said Thomas McNamara, Community Hospital's chief information officer. "Having a single vendor for both allows us to have an integrated information system that supports clinical and strategic operational decisions by providing the right information to the right people, in the right place, and at the right time."

The Benefits
Since the activation of Sunrise Access Management and Sunrise Patient Financials, the hospital has significantly improved the quality of its electronic transactions, raising the clean-claim submission rate to more than 90 percent. "We expect to get to the high 90s with some new billing edits procedures we're developing," said Haney. Patient satisfaction has also steadily improved because staff can capture more patient demographic information when the patient registers, reducing billing errors.

These improvements have also led to a substantial reduction in accounts receivable (A/R) days from an average of 69 to 52. "A huge reason we could do this is the ability within the Eclipsys system to move financial classes and use worklists effectively to assign our resources to the right accounts," said Haney. "These features help us to manage and get better results from our outsourced collection activities, as well."

The hospital also has seen a reduction in Discharged Not Final Billed (DNFB) days from a range of 9 to 11, to currently 7 days, resulting in better cash flow. "DNFB can now be managed more efficiently because all unbilled and billed accounts are managed within the system," said Haney.