4 questions with Dignity Health SVP of finance, revenue cycle

San Francisco-based Dignity Health's strategic investments in revenue cycle and IT development during the past five years have positioned the system to be more nimble in risk-based markets.

Tim Panks, senior vice president of finance and revenue cycle at Dignity Health, spoke with Becker's Hospital Review about the health system's journey to optimize its revenue cycle and clinical documentation processes.

Mr. Panks previously served as vice president and CFO for Dignity Health's north state service area, where he was recognized for his achievements in the disciplines of finance, strategy and revenue cycle management.

Responses have been lightly edited for style and length.

Question: What is the strategic relationship between Optum360 and Dignity Health?

Tim Panks: Dignity Health is a minority owner of Optum360. In 2013, Dignity Health and Optum Insight came together to create Optum360. Our goal was to provide revenue cycle services to Dignity Health as well as other healthcare providers looking to maximize the efficiency and accuracy of their own revenue cycle. At Dignity Health, Optum360 is our revenue cycle department. We moved all our revenue cycle employees and services into Optum360, and they cover everything from revenue cycle strategy to account closure.

The arrangement is provided through a management services agreement that defines the scope of services and what we pay for those services. We also have a number of service level agreements that stipulate performance goals we use to hold Optum360 accountable. We have a change-order process as well, so as we grow and add new departments we can modify the MSA to cover those new revenue cycle tasks.

My revenue cycle team at Dignity Health is responsible for the application of the MSA. We work very closely with the Optum360 team on a day-to-day basis to monitor and improve our processes. One of the things we do every year is re-establish our SLAs, and we have tied many of our measurements and goals to Healthcare Financial Management Association MAP numbers, so that we are moving toward the 75th percentile or greater for all of our ratios and indicators in Dignity Health’s revenue cycle.

Our MSA also covers the implementation of a technology road map, whereby Optum360 is working to install its software tools at each Dignity Health hospital. These include computer assisted coding and computerized clinical documentation improvement tools, which play a large role in helping Dignity Health capture accurate information from our clinicians and caregivers in our patients' medical records.

Having an accurate medical record and having the ability to look into big data and find everything that we need to know about a particular patient or a group of patients is what diversifies us and gets us ready for changing payment models. The existence of Optum360 and the work we are doing together  is certainly a big piece of that preparation.

Q: What are some key components to Dignity Health’s CDI program that drive successful and meaningful change?

TP: A comprehensive clinical documentation program requires a lot more than just the revenue cycle. It requires all the players working together in the medical record to be on the same page. As far as the key components for us, we have been working very closely with all of our providers and physicians. All of our hospital leaders know that documentation is very important to Dignity Health both from a quality and patient safety point of view. We have a physician-led Optum360 CDI team and all of our CDI staff at each of our hospitals report up to that individual.

The Optum360 technology and implementations certainly go a long way to help free up those individual staff members at the hospital to spend more time with the physicians, and less time going through medical records to define what's missing or what type of query needs to be asked. They can work with the physicians elbow-to-elbow in real-time, which is one of the key components to CDI for us.

Q: As a revenue cycle leader, how have you approached the IT side of RCM strategy?

TP: For us, more than ever before, having access to the information  and having the ability to pull meaningful, relational data is paramount, not only for our patients and physicians, but for our revenue cycle as well. We're in the process of finalizing electronic health roll-out at each of our hospitals and the IT road map with Optum360, which includes the CAC and CDI.

Through all of that work, we have created an enterprise data warehouse that we can use to better serve our patients from a population health management role,  that will play into future revenue cycle  and positioning for different payment methods. That's where we are going, and thankfully to our work during that past few years, we are prepared.

As a revenue cycle leader it's more important today to be in touch with our IT teams and our revenue cycle departments to stay aware of best in class changes for IT. For us, switching to an end-to-end revenue cycle service is advantageous because Optum360 can update and implement new tools faster than we could as a healthcare system. Dignity Health's resources are devoted to our patient care and therefore not available to our revenue cycle.  The coordination between IT, Optum360 and clinical teams is what makes us nimble and more capable to take on the changes for our delivery system.

Q: What are you most excited about or looking forward to in your position as SVP during the next year?

TP: In the next year, it's about all of these different projects and components coming together in our revenue cycle. I'm excited to complete our revenue cycle technology roadmap installations and complete our EHR implementations. We'll basically be done with those by the end or our fiscal year 2017. That will allow us to have the most accurate medical record documentation for all the services Dignity Health’s physicians and caregivers provide. Bringing these major projects to a close has positioned Dignity for the future, and that's what I'm most excited about.


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