One of the major issues in transitioning EHRs and Revenue Cycle Management systems is the risk in transitioning RCM processes between the old and new systems. Often, the ability to collect A/R is severely impacted, as there is a learning curve in every aspect of the collections process, from registering patients, to posting payments. If managed properly, the dip can be quickly overcome, within one to two posting periods. However, as soon as the learning curve hits 3 months, billing begins to run into timely filing, and enhanced scrutiny from many payers.
The solution that many hospitals turn to – outsourcing their A/R during and beyond the transition period comes with its own risks. Just as the internal team would have had a learning curve, it can often take a few quarters for a new outsource company to ramp up their process, and for back and forth around denials, missing claim information, scrubbing results, and more to settle down.
Where many hospitals fail in this process is trying to do too much with too little. If you try to transition your systems and your A/R at the same time, it is very easy for staff to become overwhelmed by change. A better solution is to stage the process, first outsourcing A/R, and managing that new relationship and dynamic. Then, once that change has occurred, staff can focus on implementing a new system with dedicated attention. This can help make sure that the transition to a new technology stack is handled with finesse and minimize the disruption to both patient care and business operations. It also helps decouple the risk of having an issue with one vendor impact the large transformation project.
It can help to look at the Kubler-Ross Model of change. Developed in the 1960’s originally to help explain human reactions to death and dying, modern organizational psychology successfully uses it to explain how change impacts companies. The stages, for reference, are Denial, Anger, Bargaining, Depression, and Acceptance. Let’s take a look at how that transforms into management advice.
At Stage 1, employees are still in shock from the proposed change. In general, people are not able to absorb the change, which means that they don’t yet realize that they need to change and adapt to the new process and technology. Communication is the key here, and it cannot be “drinking from the firehose.” People need time to adjust to change.
At Stage 2, fear sets into employee’s minds. This can also set in with customers and market perception drops precipitously during this stage. Reality of the change and the understanding the scope of the change are what generates the fear, or worse anger. From a market perspective, the community may push back against a perceived comfort level with the status quo. Patient complaints will go up, as they were comfortable with how the local hospital operated before. The same happens with employees, with anger and fear coming out as gossip, self-selection, and negative feedback loops within peer groups of employees. Managed appropriately, venting is controlled and external messaging is focused on truth and damage control.
At Stage 3, employees try to negotiate what their new role will be during and after the change. This will distract from ongoing development, normal operations, and more. It is an essential part of moving towards acceptance and is the time when management must be focused on either ability matching (such as Strengths-based leadership), or personality fits (such as Myers-Briggs) to make sure that critical resources feel that they have a place. Training and retraining are an essential part of this stage. From an external perspective, patients try to use new offerings, such as portals, and may complain or focus on breakdowns in registration or scheduling. If they have difficulty accessing care or medical records, patients may push back.
Stage 4 is the most difficult phase for most organizations to go through. At this point, morale is at its lowest, and emotional energy and excitement are at their nadir. It will seem very bleak as employees realize that there is no way to go backwards, the comfort zone is gone for good, and it is the new way or time to self-select. Patients or allied caregivers that have stuck it out will be waiting for more bad news, so positive PR is important at this stage. Focusing on positive messaging, and especially training and culture boosts are critical in this stage to successfully move to Stage 5, acceptance. Some employees will find this difficult to move past, and depending on their mental fortitude, may not be able to move beyond this stage without assistance.
Stage 5 is what everyone was sold on before the change – the new, improved reality. Culturally, the change is embraced fully, and people have settled into their new roles that were determined in Stage 3. New goals, hopes, and aspirations take hold. Now, employees and patients start to see the benefits and a wave of excitement and energy can carry the hospital forward. Key performance indicators (KPIs) are starting to show results, and in people’s minds, the project seems to be heading in the right direction.
Too often, when one project stall or failure compounds another, it can lead to severe cashflow problems. Separating the tasks can help manage this. If each major change isn’t allowed to progress through the stages, it is all too easy to get stuck on a stage before acceptance. That will kill a hospital.
By separating major changes like outsourcing and system changes, it also becomes possible to make sure that the system/outsource vendor that is best suited for patient care is the best system/outsource vendor to manage business operations or not. The focus of the software or service provider may be too different, both in desired workflow and user interface.
As we move closer and closer to a new payment model, and the end of an era in hospital business operations, maybe it’s time to consider a new set of systems and service providers designed for this new era. As care shifts outside the four walls, hospitals will need integrated supply chain, RCM, HR, and patient access software that can help manage costs and cashflow. This will allow them to focus on delivering the best patient care in a sustainable cost model.