Research Paper on Sutter Health: Non-Profit Healthcare Providers in CA Serving 100+ Communities

Introduction

Sutter health is a non-profitable leading network of healthcare providers who are based within the communities of California. They have the capacity of providing healthcare services for over 100 communities, especially those that are located in the Northern part of California. The California Sutter Health Hospitals are entangled in a network that is comprised of over two hospitals of acute care in dozen. They also have facilities of medical research, organizations of physicians, services of home health, health network occupations, hospice, as well as care centres that offer long-term services. The paper, therefore, talks about a whole case study whose intention is to identify the issues and main problems of the California Sutter Health Hospitals, provide the background information about it, the healthcare's facts of relevance, the remedies employed towards solving its challenges, as well as the achieved results. The paper also intends to point out, explain and discuss healthcare's accounting information applied in its problem definition and solutions.

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Summary of the Critical Problems and Issues Facing the California Sutter Health Hospitals

The California Sutter Health Hospital has a question about what type of decision they should embark on and adopt to raise its upfront collections from those patients who are regarded as self-pay. The Sutter Healthcare, therefore, has issues in the deducing of a very crucial strategy for margin optimization in the season of high deductible health plans, as well as during higher copayments, even to the self-pay patients. The Sutter Hospital has also the problem of identifying effective techniques of increasing its collections of point-of-service and improvement of the entire revenue cycle.

The Patient Financial Services staff has difficulty in accessing the information based on the exact time concerning the operational and the key financial indicators like, for instance, the collections of cash and the A/R days. The staff and managers consequently had to organize for benchmarks, do the tracking of progress, or embark on making crucial decisions of business towards the end of every month. The systems of accounting in the Sutter Hospitals does not permit the managers to separate and carry out the analysis of the selected data, or the generation of the demanded reports to necessary detail levels. A programmer who is specially trained is relied on for the development of these reports, a fact that often leads to expensive delays, realizing and remedying the problems.

The staff of the central business office suffers from the absence of real-time information as well. The representatives of accounts, therefore, cannot carry out monitoring of their progress and even do the effective prioritization, since they only have access to the list of the outstanding reports. The hospital, at times, faces the problems associated with the ways of minimizing patients' claim denial, and that is a front-end collecting problem. Included as a problem is that a patient's guarantor being 17 years old and below, the patient's health status being invalid for the services offered by the Sutter, a widowed patient registering a relative as the spouse, wife or husband, the compensation of the workers being filed with a code of occurrence apart from 04 when the liability or the compensation category lacks information related to accidents when the insurance plan of Medicare is missing yet the patient's age is 65 years and above, format errors in the patient's address, duplication of numbers in a patient's medical record, the missing of policy ID number or insurance claim, and the missing of the questionnaire of the Medicare secondary payer. Yet, the patient's Medicare plan code is in any plan.

Marking the background of Sutter's problems, about 47 million citizens in America are not insured, yet nearly all of them can afford to pay their hospital healthcare. Over 80 percent of uninsured individuals are from employed families; therefore many of them have access to resources that can facilitate the payment of some if not all of their health care if they could be urged by someone to do so. The patient financial service staff needs a full, accurate as well as a piece of timely information and the necessary skills coupled with the confidence of applying them whenever required. The Sutter's staff are, however, not used to the culture of asking for money from the patients. There is, therefore, an essential need to transfer this role from the collectors and the central office of the business, which is the back end, to the front-end staff, which should be managed with a lot of deep thought and in a well-organized fashion. That move, therefore, ensures that the needs of the patient financial staff are accounted for.

Sutter Health Hospital is among the largest and most reliable health care service providers in Northern California, has a commitment geared towards providing its patient financial service staff both on the back and front ends the equipment they need to boost the patient collections, which is the bottom line of the system. Since the Sutter began, the collectors, representatives of the patients account, and members of the office of the central business of its Sierra region, the system of health is striving its way into the staff of registration, with an ultimate target of transferring many of the roles of the back-end to the front end, from the time it began in 2006. Thus it makes the collection of the point of service to be the norm.

Sutter decreases the Accounts Receivable days within the first three months of the project's implementation. The move is achieved in the region from the numbers of 65 to 69 for nine hospitals, with a consideration that each of the days is equivalent to $13 million. The project implies that the system of health manages to collect $78 million besides. To boost the cycle of the overall revenue and raise the collections of the point-of-service, Sutter Health Hospital embarked on embracing some of the following solutions. Ensuring that the appropriate and the necessary comprehensive training is provided to the patient financial service staff so that they can display excellence in the system that is new, adopting the use of primary benchmarking which are specifically handful, point out the problems before the patients leave the platforms of registration as well as empowering the patient financial service staff to emulate the assumption of responsibility for each account handled. Sutter identifies many problems, in the encounter of its revenue management cycle analysis, before the implementation of the new system program.

In eradicating the situation, it stresses on primary benchmarks in a handful fashion like, over 90, 180 and 360 per cent of A/R days, collections of cash, A/R days of primary payer, billed A/R days, unbilled A/R days as well as minimum accounts of credit balance and capitation, which refers to the gross A/R days. The strategy employed by Sutter for maximizing collections and minimizing A/R days is geared towards the individual empowerment of the patient financial service staff members to have the assumption of roles for every account they handle. Consequently, each individual in the CBO has their own business in completion with a dashboard that is customized to trace progress in meeting team as well as individual targets. Sutter has provided the patient financial service staff with a set of the necessary tools so that they can manage their s with a lot of ease.

These tools guide the members of staff not just how they prosper, but how and in areas they could guarantee an improvement, identify what accounts, which when handled successfully, will generate the maximum effect on their aims of cash collections and A/R days as well. Managers possess their dashboard of tools and receivables, which enables them to implements a component of the denials management in the previous summer. The cycle gets into its completion at the end of the year when the registration staff gets online. This happens when all segments with access to the entire data that is needed to yield legitimate claims.

The point of access can produce half of the necessary elements of billing on a UB-92/04. The consequent outcome is that there is a most excellent opportunity of minimizing denials of claims, at this cycle of revenue. Sutter's new procedure calls for the analysis of each registration by the engine rules before the patient completes the registration. It facilitates the maximization of performance at such a critical time. The editing of the front-end claims helps the patient financial service staff to see the areas that call for remedy steps or the necessity of training continuity in a quicker manner.

Similarly, the interfaces of a computer permit the flagging of accounts that needs a special operation in the system. The clerk of admission receives a prompt that may be inclusive of a description of the exact measure that should be taken. A simple warning to the registrar to gather the quantity of pre-registration has out of experience made a difference. Sutter is therefore set to test a tool of tracing the amount of money each staff personnel receives, with the hope of linking the tool to the approximation and systems of contract management, to enable the evaluation of the registrars as well on the collected targets that have been established, and rates of contract in terms of percentages. Sutter has designed a system that is intended to provide the necessary support to the patient financial service staff in existence and the registration staff, with no necessity of hiring a new staff that is more educated formally or to raise wages beyond the existing average of $10 to $20 per hour. However, the system requires a team that is trained comprehensively well.

The Accounting Practices Employed in Definition and Solution of Collection Sutter’s Problems

The Sutter adopts the use of a simple aged trial balance analysis into showing the ageing and the status of personally assigned stewardship of a patient representative. The report intends to be of assistance to the representatives in their efforts which are geared towards ensuring improved performance. The Sutter also implements the use of simple executive summary in the explanation of the front-end collecting concept. It displays various points in the revenue cycle and their equal opportunities towards the minimization of the denial claims. An analysis report that shows patient financial service staff managers and the staff performance status, based on the targets which are defined in terms of hospital objectives, are as well used by Sutter to elaborate on the concept of comprehensive training.

Alternative Solutions

The Sutter Hospital should fragment back-end and front-end the management of the revenue cycle. By dividing the back-end and front-end revenue cycles of control, the upfront solutions to the self-pay patients in the hospital will be found. The reason being is that, there will be an easier delegation of duties in the sense that, the back end revenue cycle management would have the responsibilities of managing claims, managing denial, collect the patient's burden of finance and deal with the medical billing. On the other hand, the staff from the front-end collects the patients' information, insurance eligibility and coverage confirmation as well as the registration of the new patients.

Sutter Hospital should also consider using data to trace and perform the revenue cycle benchmark. The hospital management should aim at implementing the cycle of healthcare revenue which is data-driven. The data would show the leaders of the revenue cycle, the Sutter's financial health as well as whether the staff are adequately executing their essential r...