The Customer Profile
CommonSpirit Health is the largest Catholic health system and the second-largest nonprofit hospital chain in the United States. Built on the legacy of healing and caregiving, CommonSpirit Health is committed to drawing on the power of innovation to build healthy communities and advocate for the poor and vulnerable. The health system spans 21 states across communities of all sizes with more than 700 points of care and approximately 150,000 employees and 6,000 providers.
The Goal
Enhancing Revenue Integrity Practices
The continuing growth of regulatory compliance demands in the healthcare industry— and the heightened risk that accompanies it—is placing an enormous strain on auditing resources in most organizations. Like many large health systems operating in today’s lean climate, the CommonSpirit Health revenue integrity department continuously seeks the most efficient and effective ways to elevate compliance practices and optimize revenue capture.
A Hayes client since 2016, CommonSpirit Health had long appreciated the advantages of MDaudit Professional (MDAP), a server-based solution that streamlined auditing processes through automation and analytics. When Hayes launched the cloud-based version of its flagship MDaudit solution in 2017, the organization identified an opportunity to elevate revenue integrity practices by transitioning to the newer cloud-based, risk intelligent auditing solution that would enable staff to automate workflows, continuously monitor risk and detect anomalies in a single platform with enterprise-wide views.
We knew MDaudit Enterprise (MDAE) would offer a new level of efficiency and accessibility across our entire organization. The ease of creating audits was much improved, and the introduction of more advanced functionality would lay the foundation for us to further refine our processes and move into risk-based auditing practices—part of our future roadmap.
We’re getting more done. We’re doing more with the same number of staff. A couple of our larger markets have been able to implement a hybrid model that encompasses both risk-based and scheduled audits, which is where we want to be as an entire organization. Their productivity has increased to the point that they can start moving towards risk-based models.
We are a large, complex organization, and it would be nearly impossible to roll out new technology without some hiccups. When we moved to Enterprise, we had a set of expectations, and the Hayes implementation team ensured we overcame challenges and realized the new vision for our auditing practice that we were aiming for.
The Implementation
Transitioning from MDaudit Professional to MDaudit Enterprise
Like any technology implementation, CommonSpirit Health recognized that change management strategies would be critical to a successful rollout, especially since team members were already very satisfied with MDAP and would not immediately see a reason for the transition to the enterprise solution. Working with the Hayes implementation team, Toby noted that upfront education addressing the organization’s goals and the appeal of MDAE was identified as an important first step.
“We had to set the expectation that the enterprise solution was everything the staff enjoyed in MDAP, but so much more,” Toby noted, pointing to such areas as the new ability to incorporate remit information and draw on the power of constant, comprehensive reporting. “It was pretty easy to get buy-in after the Hayes team scheduled a demo and Q/A session with our core steering committee and demonstrated the intuitive nature of the solution along with its robust monitoring capabilities and advanced functionality.”
Throughout the roll-out, the Hayes team, in conjunction with broad representation from CommonSpirit Health facilities and markets, conducted webinars and training sessions to keep everyone in the loop. The core implementation group communicated regularly via bi-weekly scheduled meetings and impromptu phone calls during the entire course of the roll-out.
Toby recalled several minor challenges and bumps in the road that presented during the implementation period. For example, because CommonSpirit Health policies set Internet Explorer as the default browser, staff had to get used to copying the MDAE link into Google Chrome to access the solution. In addition, the steering committee had to rethink the setup of audit groups across the organization’s many regions and markets due to variances with the former MDAP.
The Results
Since the implementation of MDAE, a bird’s eye view of end-to-end audit processes reflect greater productivity, an improved user experience and minimal down time—an issue that would crop up regularly with the server platform. The cloud-based environment offered by MDAE has streamlined data access across CommonSpirit Health’s 15 different billing platforms. The previous time-consuming task of bringing data together monthly is now readily available in the MDAE system.
The revenue integrity team is also working smarter – auditing more services per provider. Toby noted that the organization’s minimum expectation is 10 services per provider during an audit, and some markets have increased that number to 20 or 30.
