Policy Proposal for Improved Revenue Cycle Management

As the Director of Operations at Druid City Hospital, I have conducted a thorough review of our leadership structure to identify an effective process for proposing policy changes. It is essential to navigate this structure skillfully to advocate for change within the healthcare industry. Additionally, I have analyzed our organization and identified a policy that could be created or amended to enhance organizational governance, operations, and compliance with federal or state regulations. This executive summary outlines the proposed policy change, its potential benefits for the organization, the necessary changes for implementation, and an advocacy plan utilizing the approval processes within the organization.

Policy Change Overview

To address the challenges faced in revenue cycle management, I propose implementing an integrated electronic health record (EHR) system that incorporates revenue cycle management functionalities (Centers for Medicare & Medicaid Services 2021). Currently, our hospital relies on separate systems for medical records, billing, and coding, which leads to inefficiencies, delays, and increased risks of errors in the revenue cycle. By adopting an integrated EHR system, we can establish a seamless flow of patient information, automate billing processes, and enhance compliance with regulatory requirements. This policy change aligns with the industry-wide trend of digitization and has the potential to improve the organization in several key areas. The use of electronic systems to store and manage patient health information has been in practice for several decades. However, the adoption and implementation of EHR systems have gained significant momentum in recent years due to advancements in technology and the increasing focus on digitizing healthcare processes.

Cost Analysis of the Viability of the Policy Change

Conducting a comprehensive cost-benefit analysis is crucial to determine the financial viability of the proposed policy change. Firstly, the acquisition of an integrated EHR system may entail upfront expenses, including licensing fees, hardware procurement, software installation, and configuration. The magnitude of these costs will depend on the chosen vendor and the extent of the system implementation. Adequate budget allocation for these acquisition-related expenses is necessary. Secondly, comprehensive training programs must be implemented to ensure staff proficiency in using the new EHR system. Lastly, it is important to consider the potential impact on productivity and revenue generation during the transition period. Temporary disruptions, system downtime, and staff learning curves can lead to a decrease in productivity and revenue. By justifying the costs associated with the policy change through a thorough analysis, the organization can make informed decisions regarding budget allocation and ensure a successful implementation process. The average purchase and implementation cost of an EHR is $32,606 per FTE physician, and maintenance costs are another $1,500 per physician per month. The money in the capital budget for this change is estimated at roughly $162,000 to implement an EHR. The organization may develop community partnerships by working with community organizations, regional governmental organizations, and other stakeholders to maximize resources, split costs, and create cutting-edge strategies to meet healthcare needs.

An Analysis of How the Policy Change Would Improve the Organization

Evaluating vendors typically occurs during the procurement process, after the organization has identified the need for an EHR system and is ready to explore potential solutions. The vendor evaluation process involves assessing different vendors based on their offerings, capabilities, and compatibility with the organization’s requirements. Implementing an integrated EHR system would bring about significant improvements within the organization. First, it would enhance efficiency by eliminating manual data entry, reducing duplication of efforts, and streamlining workflows across departments. These changes would result in faster claim processing, reduced denial rates, and improved cash flow (American Hospital Association, 2021). Second, the policy change would improve accuracy and compliance by leveraging automated coding and billing functionalities within the EHR system. This would reduce the risk of compliance issues and audits, leading to higher reimbursement rates and a stronger compliance posture. Third, the integrated EHR system would provide robust data analytics capabilities, enabling better insights into revenue cycle performance. With this data, the organization could identify trends, implement targeted process improvements, and make data-driven decisions to optimize financial outcomes. Finally, the policy change would positively impact the patient experience. By streamlining the revenue cycle process, billing would be quicker and more accurate, reducing the financial burden on patients. Simplified billing statements, transparent cost estimates, and convenient payment options would enhance patient satisfaction and loyalty. The department to which the cost of implementing an EHR system would be allocated includes the Information Technology (IT) department, finance department, operations department, and executive leadership. Engaging relevant stakeholders from these departments early on is essential to ensure proper budgeting, resource allocation, and cost tracking throughout the EHR implementation process. This collaboration will help ensure transparency, accountability, and alignment with the organization’s strategic objectives.

The Needed Organizational Changes for Implementation

Successful implementation of the proposed policy change would require several organizational changes (Cullum, 2021). Firstly, we would conduct a comprehensive needs assessment to identify our specific requirements and evaluate suitable EHR vendors with robust revenue cycle management capabilities. Secondly, a comprehensive training program would be developed to ensure staff proficiency in utilizing the integrated EHR system. This program would encompass training on coding, documentation, and utilization of revenue cycle management functionalities. Thirdly, we would analyze current revenue cycle workflows and redesign them to align with the integrated EHR system. This may involve restructuring roles and responsibilities, eliminating redundant tasks, and implementing standardized processes. Finally, a change management plan would be implemented to address resistance to change, communicate the new system’s benefits, and engage staff at all levels throughout the implementation process.

Policy Advocacy and Approval Process

To advocate for the policy change and navigate the approval process within Druid City Hospital, a strategic plan would be implemented. Firstly, a comprehensive proposal outlining the need for the policy change, its benefits, and the associated implementation plan would be developed. This proposal would include a cost-benefit analysis, projected outcomes, and an estimated timeline. Secondly, key stakeholders, including senior executives, department heads, and relevant committees, would be engaged in discussions to gain support for the policy change. The proposal would be presented, highlighting the alignment with organizational goals and the potential positive impact on financial performance. Compelling data, case studies, and benchmarking information from reputable sources would be utilized to reinforce the rationale behind the policy change. Thirdly, a collaborative approach to decision-making would be fostered by soliciting feedback from stakeholders and incorporating their perspectives into the final proposal. This collaborative approach would enhance buy-in and support for the policy change. A pilot implementation phase would be proposed to showcase the benefits in a controlled environment, and data and testimonials from the pilot phase would be collected to further strengthen the case for full-scale implementation. Finally, a monitoring and evaluation plan would be developed to assess the effectiveness of the policy change post-implementation, with regular communication of outcomes to stakeholders.

Conclusion

The proposed policy change of implementing an integrated EHR system with revenue cycle management functionalities holds the potential to significantly enhance organizational governance, operations, and compliance at Druid City Hospital. The improvements in efficiency, accuracy, data analytics, and patient experience would contribute to sustainable financial success. By effectively advocating for the policy change and utilizing the approval processes within the organization, we can successfully implement this change and reap its benefits.

References

American Hospital Association. (2021). Revenue Cycle Management: A Vital Part of Health Care. Retrieved from https://www.aha.org/system/files/media/file/2021/06/revenue-cycle-management.pdf

Centers for Medicare & Medicaid Services. (2021). EHR Incentive Programs: FAQs. Retrieved from https://www.cms.gov/Regulations-and Guidance/Legislation/EHRIncentivePrograms/FAQs

Cullum, A. (2021). International GAAP 2021: Generally Accepted Accounting Practice under International Financial Reporting Standards. Ernst & Young.

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Question