How to avoid a revenue dip after switching EHRs, according to 1 former health system IT director

New health system EHR implementations are constantly occurring, but that switch could come at a heavy price without a detailed plan in place. 

Becker's sat down with revenue cycle and IT expert Cynthia Casatelli to discuss how to mitigate a possible revenue dip after switching EHRs and how facilities can prepare for upcoming EHR changes. 

Ms. Casatelli is the former director of administrative systems and IT director at Patterson, N.J.-based St. Joseph's Health and was director of revenue cycle and IT at Hackensack (N.J.) University Medical Center for 17 years.

Question: How common is it for hospitals to see a dip in revenue after installing a new EHR system? 

Cynthia Casatelli: It's very common to have a dip in your revenue during an EHR implementation because you're going to have users that are new to the system and don't know how to navigate it, how to post their charges or where their documentation should be entered. That will cause issues with productivity, charge masters and claims creation.

Q: What is your best advice for mitigating a post-EHR switch revenue dip?

CC: Properly plan for the implementation. You need to get a plan together and involve the right people from the very beginning of the project. If you do not include your operational teams in the planning and the implementation, your revenue dip is going to be worse. 

A system EHR implementation isn't just about installing software and hardware because it changes the culture, workflows and processes. Many systems start out with IT and how they are going to get the contract, which people involved, the project plan written, and a timeline — that's all too late. You need your operations teams involved at the very beginning of a project. Don’t include just executive or director level personnel. Take it down a few steps and engage with subject matter level experts. In my opinion, organizations that do this don't have as big of a revenue dip.

Q: Cerner customers will see major system upgrades to their financial back-end platform in 2024. Can you explain this change and how hospitals should be preparing?

CC: Cerner is moving the scheduling and registration components within the EHR to the front end of the Millennium application with the clinical teams. They are putting the financial side into another application called RevElate.

All Cerner hospitals will have to prepare. Start planning as soon as you know that your hospital is entering contract and timeline discussions with Oracle Cerner. Do not wait for the contract to be signed. That strong project plan should include who your project teams are, your resource availability, and communications about what is coming. Start talking to your operations teams, put the information together, and define your current workflows, policies, and procedures. You should also think about your risks and success measures. If you start all of this ahead of time with strong leadership to help, you'll be ahead of the game.

Q: Where do you see AI headed next within revenue cycle IT systems and the revenue cycle process?

CC: A lot of people see AI advancements from the clinical perspective, but when I look at it from a revenue cycle perspective, there are many ways to leverage AI to help make your teams more productive. You can use AI to perform data analysis and identify trends and issues, one of those areas being in claims denial management. If you can identify potential denials upfront using AI and before the claim is produced, it will help to mitigate denials and prevent root cause errors. You can also use it to identify patients that might qualify for financial assistance, or with price transparency compliance and all the challenges with getting that data online. 

Hospitals should be embracing AI. It's new and I'm sure it scares a lot of people. I don't see it reducing jobs, I see it helping people be more efficient with mundane tasks so they can focus on other things. I would think smaller hospitals may adopt it because it's going to help them with workforce shortages — I don't see why anyone wouldn't be using it in the revenue cycle process. 

Q: How should IT leaders be communicating with the rest of the hospital C-suite today?

CC: Communicating with the C-suite is always a challenge. I believe that the C-suite and the IT team should have regular meetings, whether it be biweekly or once a month. Regular meetings will keep everyone informed about strategies and what's coming. Keep meetings straightforward and right to the point. Constantly communicate because technology is part of everyday life and it makes the world go round.

Q: What were some of the biggest challenges you faced when implementing new systems and ensuring user satisfaction with new technology platforms?

CC: It's about having operational teams and subject matter experts at the table. You need to get the leaders to give you the resources and empower teams to have them be part of the implementation. If they continue to do their day-to-day jobs, system challenges are going to hit the roof because these experts are essential to setting up proper workflows and processes.

This has always been one of the biggest challenges — giving a team freedom to support an EHR implementation beyond their day-to-day jobs. It's all about resources and having leaders empower their teams to be at the EHR implementation table.

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