The healthcare economy has undergone tremendous change during the past three decades. As a result, healthcare organizations are demanding more from their financial systems. Today, many healthcare organizations rely on a host of task-oriented financial systems that fail to work together effectively. Historically, these types of systems have focused solely on financial transactions and have been disconnected from the clinical process, impeding workflow and leaving healthcare organizations inadequately equipped to tackle today's strategic and financial challenges.

PROBLEM

St. Joseph's Hospital Health Center in Syracuse, NY, is the 431-bed foundation of a comprehensive regional network serving the residents of 16 counties in Central New York State. In addition to the hospital, St. Joseph's Healthcare Network includes numerous outpatient services, satellite facilities and affiliated organizations.

The healthcare system has a medical staff of more than 800 physicians representing a broad spectrum of specialties and an employee team of nearly 3,000 healthcare professionals and support personnel. As a teaching facility, St. Joseph's must remain on the cutting edge of the latest medical developments as well as the newest in technology to attract "the best and the brightest."

In the late 1990s, St. Joseph's was looking for ways to prepare for Year 2000, including the selection of a new financial system. Our homegrown financial system was ill equipped to tackle looming Y2K issues as well as the pressures of everyday financial challenges. With inpatient visits averaging 20,000 annually and outpatient visits exceeding 200,000 annually, our priority was selecting a vendor that could help manage the administration of the care-delivery process across the enterprise.

With the advance of medical innovations and more complex treatments, healthcare organizations--as well as patients and payers--are left to make decisions that can have significant financial consequences. At St. Joseph's, where our, annual operating budget is more than $200 million, the hospital has debt covenants requiring that we maintain a certain number of days of cash on hand. When excessive delays in payments and reimbursements began to jeopardize that obligation, the hospital board of trustees charged the administration with significantly reducing A/R days.

We were also losing significant dollars due to process inefficiencies and inaccurate information, especially during patient registration. We needed a system that would allow us to determine eligibility and compliance, to bill accurately and to be reimbursed in a timely manner. Managing the complex relationships that govern reimbursement was a formidable challenge.

Solution

We evaluated financial systems from three different vendors before selecting Eclipsys Corporation's Sunrise[TM] Access Manager and Patient Financial Manager. The system's embedded features were a major factor in our selection, as well as its flexibility and easy-to-use navigational features, which replaced and enhanced what we already had in place.

Staff members especially liked the ability to tailor reports, such as variance and late charges, to meet their specific needs without having to engage a programmer or go back to the vendor for custom services. Furthermore, Access Manager and Patient Financial Manager are based on an integrated system, essential in providing seamless, enterprise-wide information for efficient and effective patient management.

Project implementation began in early 1998, and the system was activated in June 1999. Following a smooth implementation process, we not only sailed through Y2K with flying colors, but also began to successfully manage other important financial issues, such as reducing A/R days, streamlining processes, increasing cash flow and decreasing errors in registration. In fact, we immediately began seeing the benefits of the system and were sending out bills within 10 days from rollout.

At St. Joseph's, we rely on various components and modules of the system to manage the care-delivery process, including registration/ADT, patient accounting, medical records abstracting, managed care, reimbursement management, report processor, screen generator and superbill generator.

The system helps us resolve managed care issues. Access Manager captures critical patient information, including demographic, insurance, referral and primary-care provider data for all patients. At registration, the system tailors data collection to the requirements of the patient's insurance coverage, which helps reduce rejected claims due to noncompliance. As a result, our staff is empowered when communicating with insurance companies and health plans by having immediate access to rules, calculations and specific contract terms.

The system's billing and accounting process provides us with significant flexibility in customizing reports to suit our medical specialties and needs. Integrated real-time rules and alerts enable us to monitor clinical and financial outcomes so that we can negotiate with payers more effectively.