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Academic hospital achieves best-practice revenue cycle, $97M benefit

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Grant Thornton LLP’s work drove $97 million in revenue improvements at SUNY’s Upstate University Hospital in its revenue cycle transformation while implementing Epic. In addition, Upstate was named a Top Quartile performer in Epic-generated metrics and an Epic Revenue Cycle Most Valuable Performer.

“We needed a consultant that could quickly survey our organization and processes, develop a plan of attack and help us execute. Grant Thornton did just that, and more. Their team of highly competent, professional and diligent consultants far exceeded my expectations for the engagement. Hiring Grant Thornton was the best investment I've made during my tenure at SUNY Upstate! Stuart M. Wright, CFO, SUNY University Hospital THE SITUATION The State University of New York (SUNY) Upstate Medical University operates two hospitals in Syracuse and is the only academic medical center in central New York.

With more than 9,000 employees, one of the two hospitals — Upstate — is the region’s largest employer. Upstate had implemented Epic as its comprehensive electronic health record (EHR) system.

THE CHALLENGES Upstate’s revenue cycle process and financial performance were not optimal, with lagging cash collections and a rapidly aging accounts receivable system.

Management sought to appropriately restructure the central business office, while optimizing processes concurrent with an Epic build and implementation. Upstate did not have an in-house team to lead the necessary improvements.

WHAT THE TEAM DID To gain support for revenue cycle improvements during Epic implementation, Upstate turned to Grant Thornton. The Grant Thornton professionals had demonstrated deep revenue cycle experience, patient accounting system and IT knowledge, and a collaborative approach to implementing change.

Upstate and Grant Thornton formed an integrated team to build and implement a best-of-practice revenue cycle with Epic. The team:

  • Restructured the business office to staff to volume and increase individual accountability and productivity
  • Deployed Grant Thornton staff with client leadership in key revenue cycle areas
  • Collaboratively re-engineered processes to aid in achievement of best practices and successful system transition
  • Developed pre- and post-Epic cutover risk mitigation strategies
          - Charge routing and testing
             - Legacy system integration
             - Patient-, account- and claim-level work queue development and implementation
             - Transition from Epic Ambulatory to Epic Enterprise

  • Supported design and build to incorporate leading practice workflow to maximize revenue realization and positively affecting operations and financial performance

OUTCOMES A new revenue cycle structure, streamlined processes and better-than-expected cash flow were the results of the collaboration between Upstate staff and Grant Thornton professionals. The optimized revenue cycle processes were implemented with cash baselines recovering in less than one-half the average time. Grant Thornton’s significant contributions include these benefits to Upstate:

  • A financial benefit of $97 million was realized during the first two years of the implementation, due to reduced denials, increased charging, an accelerated billed A/R resolution, and reduced bad debt transfers and discharged-not-final-billed periods.
  • More than $32 million in additional one-time cash was generated prior to the go-live of the EHR and patient accounting system.
  • More than $30 million in co-validated revenue is recurring annually.
  • The traditional cash decline encountered by most providers during implementation wasn’t experienced.
  • A historical cash baseline was obtained in eight weeks, far exceeding the standard performance of 20 weeks.

Contacts Lane Jackson
Partner, Health Care Advisory Services
T +1 704 632 3510

Matt Oliver
Senior Manager
Health Care Advisory Services
T +1 404 475 0088