In this episode, Kathy Ruggieri, Senior Director and Mary Devine, Senior Manager of the Revenue Cycle team at BESLER Consulting, discuss hospitals’ biggest concerns and best practices related to Epic conversions gathered from discussions with providers nationally.
Michael Passanante: Hi, this Mike Passanante and welcome back to the Hospital Finance Podcast. Today, I’m joined by Kathy Ruggieri who’s a Senior Director on the Revenue Cycle Services Team here at BESLER as well as Mary Devine who is a Senior Manager on our Revenue Cycle Services Team at BESLER.
Kathy and Mary recently presented at the New Jersey HFMA Annual Institute on a topic entitled Epic Conversion Revenue Cycle Lessons Learned. And we thought it’d be great to have them on the podcast and talk about some of the findings that they presented at that meeting. So Mary and Kathy, welcome to the podcast.
Kathy Ruggieri: Thank you, Mike.
Michael: So why did you choose to explore this topic?
Kathy: So the reason we chose to explore this topic is that we felt that it was very industry-relevant. We work with a lot of providers across the country and it just seems in the last two to three years, we constantly hear we are converting to Epic.
So even though we didn’t have firsthand experience in terms of actually going through an Epic conversion, we thought it would be a good idea to really tap into our clients and really get some industry relevant experience from them in terms of how their conversion went and their lesson learned.
We also did a lot of research and watched some other webcasts as well. So we just thought it would be something that would be very relevant, especially when we embarked in the New Jersey area because so many providers are converting in the next year or two.
Michael: Kathy, thanks for setting that up for us. So let’s dive right into some of the things that you did find. One of the things that comes up with Epic conversions is the term big bang. Can you explain to us what big bang means?
Kathy: Sure. So, big bang really means that when hospitals are embarking on the conversion, they’re implementing all the modules at once. So there’s no real—it’s not a transition conversion as some people may have experienced in the past.
Also they are embarking on the conversion. There really is a philosophy with Epic of really limiting the bolt on technology. There’s bolt on technology that you do have to bring over, but the bottom line is they’re really looking to reduce as much bolt on technology as possible.
Another thing with regard to just the big bang is as hospitals are really evaluating the systems that they’re going to be using. Sometimes there is an effort to convert for the hospital, but also the physician environment as well, which is very new to a lot of organizations. And they’re moving towards a single billing office.
And in conjunction with this, often there is a movement towards a combined statement. And the combined statement gives you opportunity where it’s really more patient-friendly. And so this is just a lot of change, but the philosophy really is to embark on it really all at once and do a cut-over to the new way.
Mary Devine: And Kathy, if I could just interject for one second, one of the big things that we heard about the big bang is the whole paperless. And we have been talking about going paperless for 20 plus years now. I think as long as I’ve been in healthcare, we’ve been talking about going paperless.
And Epic really means paperless. They do not want you printing paper, keeping paper, any piece of paper that you have, it is immediately scanned into Epic and then you shred that piece of paper or hopefully you’re not even generating paper. So that is a big piece of the big bang because you’re really just eliminating any processes that require you to have paper.
I’m sorry, Kathy. Go ahead.
Kathy: No, I think I’m good. I think we can move on, Mike.
Michael: Wow. So another term, that comes up when people are speaking about Epic conversions is the black hole. Can you explain a little bit about that and how you can avoid the black hole?
Mary: Sure, Mike. I’ll take that. So the black hole, Epic is infamous for creating these black holes. When we talk about the black hole, it’s really the work cues and the way that you design your work cues that you risk a black hole being created.
The intent of the work cue is to trigger your team to work and account timely. And that is somewhat of a science, but also you need to understand your payers. So you don’t want any of your staff working an account that pays in 16 days. You don’t want them working it on the 15th day. You want to work it on the 18th or the 20th day because that’s when you should begin following up on it because they haven’t paid.
And with that, providers tend to get real specific in their work cues and where they want an account to go or when they want it to show up and who’s going to work it. And they get these accounts go off on to these black holes and you really can’t get to them. Or worse yet, you get so specific that there are pockets of AR that really never hit a work cue and the accounts end up never getting worked.
So although we say you want to be somewhat general, you certainly want to again consider when accounts get paid and how the payer works and so on and so forth as you design these work cues.
The other thing to consider is if you have work cues set up for—you have 30 staff members and you have 30 work cues or 60 work cues and these two work cues are for Suzy and these two work cues are Johnny and Johnny quits and you forget to get Johnny’s work cue worked until it’s replaced a month and a half later. Again, there’s that black hole that exists.
And just as a final note, remember that as you’re creating these work flows and these work cues that you’re not just looking at the hospital, but you’re looking at the physician accounts as well and those certainly have different timely billing and payment restrictions around them. So you want to watch that as well.
Kathy: And one other thing I just wanted to mention, one of the common themes that we heard from a number of providers was that just because you set it up a certain way at the conversion doesn’t mean that you can’t re-evaluate it and make changes to it post-conversion.
And actually a number of providers that we did speak with, that’s exactly what they did six, nine months into it. They were making changes because they felt that maybe they just were over-ambitious or they created too many or too few. And they were used to—they got through the learning curve and all that and there was just an opportunity to really do some refinement.
So just because you set it up a certain way doesn’t mean that you can’t make those changes and to keep an open mind and constantly re-evaluate.
Mary: And just one more point. Kathy, that’s a good point. As you’re going into the Epic conversion and you’re setting up work cues and you’re thinking about your work flows, this is the time where you’re really looking at your AR vendors and you’re outsourcing. And as you set up those work cues, that’s the other thing you really need to consider – what vendors are going to be working what population of accounts so that you tag them to them and that you create work cues for them as well.
Michael: So speaking of vendors, when you were talking to the providers as you put the presentation together, did any of them recommend the use of consultants for any part of the conversion process?
Mary: That’s a good question. And the number one place where everybody stressed the importance of using a consultant was around the revenue cycle assessment. And they really, really, really stress to us the importance of doing a full-blown revenue cycle assessment.
And we’re not talking just a quick look under the hood. We’re talking peeling back the layers of the onion and having a consulting firm that really specializes in revenue cycle assessments.
And as you interview consultants, we realized that this may be cost-prohibitive, but I think as you look at the Epic conversion, I think you could probably cost-justify doing this type of assessment, hundred thousand, $150,000. I’m not exactly sure what the cost is.
And this is in a space that BESLER is in, but we heard all our providers say this was so important in helping them establish that roadmap and understanding where they are today and thinking about where they want to go as they consider the work cues and the paperless and having staff that specializes in physician billing and specializes in hospital billing. So I think really looking under the hood and understanding where you’re at in doing that deep dive with the consultant that specializes in that is key to moving forward. This is the roadmap.
Kathy: Yeah. And one just other point with regards to this, one of the things, whether you have your consulting partner or something that you handle internally, but really make an effort in terms of metrics.
One of the things that Epic is really known for is their exceptional dashboard. And everyone we spoke with just raved about just how great it was. But that’s great because you’re cutting over and you’re bringing over your new AR with the conversion. But what you don’t have is the picture before.
So it’s really, really important to understand what your baseline metrics were, pre-conversion so that you really have the ability to do that comparative. So you can really see if there is disconnect. So once you’re doing the system cut over, are there really things? Are there charges not coming over? Are there disconnects from a DNFB perspective?
But if you are only really monitoring the new and not comparing to the old—actually I went to one full presentation on just the baseline metrics and having it in that comparison. So there’s been a lot of just emphasis on the importance of that.
Michael: Epic has something called a playground. Can you tell us what the playground is and how important that might be?
Kathy: Sure, the playground really essentially is the testing environment within Epic. And it’s really an opportunity where you and your team can go and really spend a lot of time and just in terms of learning how to use Epic.
It’s really critical to your long term success. And almost everyone we spoke with felt that there was just not enough time with regards to the testing and being able to spend the time in the playground, so to speak.
Charging is probably really one of the areas where everyone talked about the importance of testing. We even have one provider who made the decision to test every single charge combination. I think it was 5000 different charges, charge routines. And they really took it to the next level and above because they just felt they were so committed to not having that disconnect.
And when you think about it, you’re making this big conversion and you really want to make sure. You can’t have revenue leakage. And as much testing as you can do in the area of charging, the better. Also, just having the buy-in, just from the leadership perspective, in terms of the emphasis on this initiative around the testing is also important.
Also I talked a lot with providers with regards to parallel revenue cycle testing. So really mapping things through your old system and then mapping things through the new system and really seeing how things pan out in terms of the final bill. Are you really able to see all your condition codes and occurrence codes and value codes and all those things coming over?
So it’s really, really, really important. Our providers couldn’t emphasize that enough.
Mary: I completely agree with you 100%. I think the common theme across all the providers we spoke with, they said that this piece was just critical to their long term success.
Michael: What did they say about training when you spoke to the providers?
Kathy: Another common response was you just can’t train enough. And in terms of just specifically within the revenue cycle, moving to the new work flows and the work cues, really a lot of the staff within business offices have been there for a number of years. So this is really a really big change and really making that investment in the training process was just so, so important.
Flipping over to a clinical side, we did hear some horror stories that some nurses and doctors didn’t even realize that they were responsible for the charging process. So just making that investment in the training was really, really important.
Do you have anything else to add on that, Mary?
Mary: The one thing I remember them talking about again across the board is that Epic requires a core team to be certified to do the training on site and that core training team will go out to Epic and they’ll get trained there and then they’ll come back and do the train the trainer thing. But they have a real strong competency around their trainers being certified.
And the other thing we found across the providers is that some of the providers required the users, before they got their user ID, to be tested and they had to get an 80% or above or they could not get their username and ID and password. So I thought that was pretty interesting.
Kathy: Yeah. And just one more thing that I had left out is just the whole training initiative and that investment. You are going to see a change with regards to your productivity and emphasis on your existing AR before you do your cut-over.
So really taking that into consideration in terms of “are you going to see that drop in productivity and how does that relate to your conversion plan related to outsourcing and those types of things”. So it’s just another thing to consider.
Michael: Is there one piece of advice you can offer to providers that are getting ready to go through an Epic conversion?
Mary: I think the one piece of advice through all this, I would definitely recommend that providers do not underestimate the implementation. Eighteen months sounds like a really long time to work on something, but it really goes fast and there’s a lot to do if you talk about your work flows and understanding, combining the complete one statement with the physicians and the hospital piece.
And there were some providers that said 18 months wasn’t long enough and they took it out to two years because they really wanted to make sure that they got this thing right. It is a conversion of a lifetime really. And you cannot underestimate that and it’s just critical that everybody is geared up and ready to go.
Kathy: Yeah. And just to add to that real quickly, I think a couple of providers even said they felt they approached this like a project at first as opposed to it being like a conversion. And just like Mary said, they just really underestimated what really this was. They got through it and all of that, but it was just very, very difficult.
Mary: Yup. And you just need to consider when you’re going to start partnering with consultants and how long do you want them involved in the process as you’re moving forward. Again, some had consultants on site for well over a year, helping them go through this.
And the other thing you can’t forget is the health and welfare of your employees. The 40-hour weeks during this conversion process, they’re over and you need to make sure that your staff is continuously motivated and ready to go.
And consider having celebrations of whatever it is. You got through training, you throw a little party. You got through…
Mary: Testing. You throw a little party. So you constantly want to be rewarding small steps and keeping the staff motivated and ready to go as you get through this conversion because again not to repeat myself, but it is a conversion of a lifetime and it’s important. It’s a lot of money that you, as a provider are investing and you want this to go right.
Michael: Kathy and Mary, thanks for stopping by and shedding some light on the insights that you found around Epic conversions.
Kathy: Thank you.
Mary: Thank you.