A transformative engagement with Nordic Consulting helps Lawrence General Hospital achieve revenue goals.
Lawrence General Hospital (LGH) faced a series of challenges with their revenue cycle operations. The private, non-profit, community hospital, which serves patients in the Merrimack Valley in Massachusetts, went live with a new electronic health record (EHR) system in May 2019. They were still adjusting to the new EHR when the COVID-19 pandemic hit. Like many organizations, LGH had to shift priorities, halt non-essential care and focus on the COVID-19 patients filling their hospital beds.
On top of everything else, LGH was struggling with persistent staff shortages. The combined factors of insufficient staffing, the new EHR, and the pandemic had a serious impact on LGH’s revenue cycle operations. Among the many pain points LGH was experiencing by 2021 were:
- decreased revenue,
- higher volumes of avoidable write-offs,
- increased numbers of claims exceeding filing time limits, and
- increased days to payments on claims (AR days).
Taking a holistic approach to revenue cycle improvement
LGH knew they needed a “whole system” approach to the problems they were having. Revenue cycle involves more than implementing the right technology or focusing on revenue cycle processes detached from other organizational processes.
LGH sought a partner who could help them assess and align the entire organization — people, processes and technology — with their revenue cycle goals.
A transformative engagement
LGH’s engagement with Nordic Consulting began with an initial assessment and analysis, conducted in Q3 2021. Nordic identified issues and presented LGH with recommendations. Nordic then worked in collaboration with LGH to implement operational and technical improvements.
The collaborative team (Nordic + LGH) implemented improvements across three broad areas impacting LGH’s revenue cycle:
1. Patient Access (Pre-admission Activity). Nordic experts optimized the technology and aligned workflows across scheduling, registration, insurance verification, fiscal clearance, and authorization management. As a result, LGH:
- decreased the number of write-offs related to patient access processes,
- improved AR days, and
- increased staff productivity.
2. Service Capture. The team addressed processes related to service capture including case management, clinical documentation integrity (CDI), and coding and revenue integrity. Workflows were redesigned and the supporting technology was optimized and enhanced. As a result, LGH saw:
- increased point-of-service (POS) charge capture,
- improved CDI,
- earlier detection and management of potential clinical denials, and
- decreased the number of write-offs related to medical necessity/clinical documentation.
3. Patient Financial Services (Billing and AR Resolution). The team reviewed patient financial services activities including billing/accounts receivable and claims and denial management. Through a combination of workflow redesign and technology optimization, LGH was able to:
- Increase the automation of routine tasks, enabling staff to focus on high-value activities such as managing claims exceptions,
- improve the collection process,
- reduce costs associated with outsourcing accounts to third-party vendors, and
- improve patient customer service related to billing.
Ongoing improvement in revenue gains
As a result of these improvements, LGH began to realize immediate revenue gains. Revenue from service capture increased and losses due to avoidable write-offs decreased. LGH was also able to reduce third-party vendor expenses as they become more efficient at managing their revenue cycle internally.
As of May 2022, LGH validated $8.5M in annualized net revenue gains, representing 3.4% of the organization’s total net revenue. LGH expects that the total annual revenue improvement resulting from their engagement with Nordic Consulting will land between $9.7 and $11.2M in recurring (year-over-year), sustainable bottom-line improvement.
The right partner
LGH wanted a partner who could deliver:
- Process improvement expertise. The best technology won’t serve an organization if workflows are not aligned with technology tools. LGH wanted a partner who understood process improvement in the healthcare industry and who could help them achieve measurable performance improvements.
- Technology expertise. LGH knew the organization’s lack of alignment with their new EHR was contributing to their problems. They needed a partner with deep EHR expertise to optimize their technology.
- Staffing expertise. The right technology and the right processes won’t sustain improvement unless the people that make up the organization are equipped with the right skills, employed in the right positions, and supported with training. LGH needed a partner who could help them align their human resources with their revenue goals.
- Change management expertise. Improvements only matter if they are sustainable. It was important to LGH to work with a partner with expertise in change management so they could continue to sustain improvements after the engagement.
- Strategic/Advisory expertise. LGH wanted a partner with the experience to assess and analyze their unique situation. They did not want to bring in a partner who would take a one-size-fits-all approach to their concerns.
To learn more about how your organization can realize revenue gains through a transformative engagement, get in touch with our team.