Iterative Process

Iterative process helps build incremental improvements during an implementation

Implementing new digital systems for healthcare organizations thrives best as an iterative process, where improvements are achieved through a series of steps that build on each other. That is particularly true for a small regional referral center located in the Central Plains of the U.S., which achieved notable improvements following recommendations from HIT advisory firm Huntzinger Management Group.

The hospital, which operates 200 beds, built on an existing implementation of a new integrated medical record system to eventually achieve significant improvements in its financial system operations. In so doing, the organization realized measurable achievements in accounting measures and bottom-line performance, including real-dollar savings.

The Journey
The downstream improvements, however, were not in the picture in 2018, when the facility was preparing to go live on a suite of Cerner systems. With only a few months before the go-live date, the organization experienced some leadership changes and, at the same time, was having trouble recruiting technical support leaders to work in its remote rural setting.

That’s when Huntzinger stepped in to assess the situation. After considering all factors, the Huntzinger team made the hard recommendation to delay the go-live date for at least half a year. To make full use of that time, Huntzinger brought in an integration expert and a health information management professional to support the transition. The delay proved well worth the additional time – preparations provided enough breathing room to support a successful transition to the Cerner system in the last few months of 2018.

But as many other organizations have found, implementing digital systems is only the start. Then, it’s crucial to find and correct deficiencies that are standing in the way of achieving full benefits from the investment.

In the spring of 2019, Huntzinger conducted a revenue cycle assessment. The consulting firm was able to bring a revenue recovery auditor and a consultant with expertise in Cerner reporting, revenue cycle data mapping and accountability to help with Cerner clinical consulting. The initial assessment by the consultants found issues with the organization’s workflow, build, implementation, and training on the new Cerner system. The initial effort helped stabilize the environment and offered guidance for the facility to follow moving into the future.

Even with that support, several months later, the healthcare organization sought help at the beginning of 2020 to achieve some very specific financial and accounting goals. These included reducing days in accounts receivable as well as the provision of executive contract support and assistance for its contract with Cerner.

To support the initiative to improve revenue cycle governance, Huntzinger focused attention on patient access processes, as well as an effort to study CDM charge assessment and maintenance. These in-depth analyses helped to uncover unproductive processes and inherent inefficiencies. This past spring, the assessment and recommendations, which included a new governance structure, were implemented remotely because of restrictions on travel caused by the COVID-19 pandemic.


The special focus on accounting and financial improvements, resulted in a string of benefits for the hospital. These include:

• Reductions in AR days to 60 days from 70 days in less than three months’ time.

• Reductions of suspended charges to 500, down from 1,900, in less than a month.

• Identification of $2.9 million in transformation charges.

• Identification of many billing delays, errors and inefficiencies, and the resolution of several critical billing issues that were inadvertently introduced when the new system went live.

• Development of several revenue cycle reports and educational efforts to support daily operational processes.

• Establishment of a management process for CDM, as well as a management policy and reconstituted committee for CDM, which helped the organization gain control of and improve CDM/charging processes.

The engagement has helped the organization solidify viable and stable work processes by putting strong governance in place, with the goal of ensuring the organization is positioned for long-term success. In addition, the EMR vendor is helping by remediating build issues, as well as providing both refresher and initial training for new staff. Reports, work plans and other documentation is intended to help the facility move forward independently with confidence in achieving positive results with its new digital systems.