St. Luke’s Health System Relies on CTG for Implementation Leadership
Founded as a six-bed frontier hospital in 1902, St. Luke’s Health System (St. Luke’s) has evolved to become Idaho’s largest healthcare provider. At the time of this project, St. Luke’s had a network of six hospitals and more than 100 outpatient centers and clinics. St. Luke’s hospitals have been nationally recognized for excellence in patient care with numerous prestigious awards and designations.
Challenges and Objectives
Managing an environment with multiple interfaced best-of-breed clinical systems is not a sustainable model in today’s clinical environment. Upgrading one system often results in unintended downstream effects that further exacerbate support issues. Due to the disparate clinical application landscape, information security is a challenge, and lack of integration and medical information sharing creates a fragmented patient-care environment. Organizations like St. Luke’s Health System choose to adopt a single system centered on a single patient record with a core set of integrated applications designed to function for different clinicians. Significant organizational growth, including the addition of multiple provider-based practices and acute care facilities and the joining of southern Idaho regional hospitals, had resulted in many disparate IT systems for St. Luke’s, including 16 practice management systems and five electronic health records (EHRs). Data was duplicated and stored in multiple locations and gaps existed in information between the different systems. Multiple patient access processes were in place and patient information was not shared between organizations. St. Luke’s executives, physicians, business owners, and nursing leadership undertook an IT strategic planning process including the development of a comprehensive business case. Planning efforts culminated in board approval for the implementation of Epic for the enterprise. Implementation was broken into two phases.
St. Luke’s leadership recognized the challenges ahead of them and the need to bring in outside expertise to achieve the expected operational and financial savings. CTG was chosen to augment St. Luke’s management capabilities and to ensure organizational adherence to project scope, budget, and timelines. CTG provided implementation leadership and program management, operational impact assessments, application builds, staffing, and project management skills for the Epic Implementation.
CTG initiated the St. Luke’s project with an implementation kick-off meeting that set the stage for project governance, team structures, communication, and accountability. Epic implementation efforts represented a major strategic transformation for St. Luke’s and had strong support of the organization’s physicians, board of directors, CEO, and executive leadership. CTG worked with St. Luke’s to develop a governance model that allowed leadership to actively participate in the successful realization of the program vision.
Once governance was established, the planning process began with the development of a future-state vision of the revenue cycle workflows and processes in the new Epic environment, including defining the impact of those changes.
Implementation of Epic Systems’ Patient Access (Cadence and Prelude/ADT) and Revenue Cycle Resolute Suite (PB, HB, and SBO) had significant impact on existing patient and revenue cycle workflows and organizational structure. The resulting process redesign changes required thoughtful analysis of all of the organization’s patient-access activities.
A few examples of the workflow and process impacts identified by CTG included:
- Hospital coding (inpatient and outpatient) changes, as related to charge entry and a reduction in minimum days prior to billing;
- Defining and enforcing co-pay collection policies in the clinics and hospital outpatient departments (often resulting in a significant boost to revenue);
- Advance Beneficiary Notices (ABN) for all Medicare-eligible patients to mitigate the write-off on non-reimbursable claims;
- Cash handling changes (use of cash drawer and detailed balancing), netting down contractual charges, payment posting, and follow up; and
- Planning validation including the development of key performance indicators, such as revenue cycle performance baseline metrics.
CTG then partnered with the St. Luke’s project team, operational leaders, and staff to develop a project plan that was both attainable and ensured the maximum capture of Meaningful Use (MU) dollars for eligible providers.
Under the program director’s (a role filled by CTG) leadership, the project team established an approach based on accountability and execution that enabled them to continue to set and meet deadlines. This team set the bar for delivery within the organization and became a model for other programs and projects. The templates, methodologies, processes, and metrics were woven into the fabric of the organization for both program management and process redesign.
CTG’s healthcare industry knowledge, technical strength, proven approach, and methodologies resulted in streamlined billing and collection processes post go-live, reduced payer denials, and minimized accounts receivable (A/R).
Results at three months post implementation included:
- PB claims dropped four days after first PB go-live (97 percent clean claim rate on average)
- HB claims dropped within first week of go-live (more than 95 percent clean claim rate on average)
- Remits posted successfully in week two with no errors
- A/R 6.5 percent favorable compared to baseline
- Mitigated spike in A/R days; metrics stayed relatively flat post go-live
- Charges 3.1 percent under baseline with some errors in the CFB queues
- Current payments are 4.8 percent favorable against baseline
- Approximate registration times in the hospitals down from nine minutes to four minutes
- Approximate registration times in the clinics down from eight minutes to three and a half minutes
- Physicians from prior waves are at, or above, their pre-live visit volumes
- Command Center closed well ahead of schedule—just 18 days after go-live for pilot, 15 days for Wave 1 and hospital revenue cycle, and 10 days for Wave 2 clinics (both Waves are part of Phase 1)
- Epic’s implementation pulse rate was consistently a four to four and a half out of five, indicating a go-live with minimal issues and problems
- For ambulatory providers eligible for MU attestation, approximately 86 percent qualify at the 60-day mark