January, 2016:

Leaving No Stones Unturned- Post Live Revenue Challenges & Tools to Help

Culbert was recently engaged to assess an existing GE Centricity Business system, struggling with some post live revenue cycle challenges.  An analysis of both system and operational workflows was conducted in order to identify opportunities for improvement.  The customer’s Centricity Business system had been installed over a year previous to our engagement and tremendous growth in the past year had left the client with a system design that no longer accommodated the organization. New CBO leadership teams were also struggling to learn the system and recognize its potential. Culbert consultants employed several assessment tools to help the customer understand what was hiding under the rocks!


  • Errors or omissions at the front-desk of a medical office can have a significant impact on the overall accounts receivable. Observation of front-desk operations often reveals workflow disparities within a practice and across the enterprise. Documented policies and SOPs (Standardized Operating Procedures) are essential to maintaining consistency with operations and provide practice managers with mechanisms to enforce protocols and audit performance. System training must be reinforced with enterprise-wide guidelines with expectations for work assignments. Training manuals should be workflow-based and provide direction for completing tasks and remedial training needs should be addressed promptly.


  • Staff and management interviews should be very informal in nature as they are simply information gathering exercises. Interviews are the components of an assessment that can tie up loose ends. Even when an issue is discovered by reviewing the application build or by analyzing reports, it is the interviews with staff and management that usually provide the reasoning behind the current design – and provide clues for how the design can and should be changed to accommodate current and future needs.


  • Thorough analysis of system reports and application designs will pinpoint functional areas and workflows that require remediation. Evaluation of the system’s core dictionaries is crucial to understanding current obstacles to optimal functionality and potential limitations to implementing necessary system changes. As the saying goes, the best-laid plans of mice and men oft go astray… In this case, the original dictionary designs could not accommodate the current conditions and required updates.


  • System solutions require a close partnership between CBO management teams and the IT department responsible for supporting the revenue cycle systems. The CBO and IT teams should meet regularly and use an “Open Tickets Review” spreadsheet as a working document that can provide a concise listing of open tickets – including assignees, status updates, and next steps – that will facilitate consensus and escalation of issues with the IT support team.
  • Oftentimes, customers already understand that there is a need to bring internal teams together to work through outstanding issues, but an external source can serve as the impetus of change. If not already in place, a Revenue Cycle Governance Board should be established with clear accountability and decision-making authority for key revenue-cycle functions.


Preparation of several tools and documents can assist with maintaining project organization, complying with timelines and milestones, and completing deliverables.

  • Project Timeline
  • A high-level bar graph representing the overall schedule of the project will set expectations and allow the customer to arrange for appropriate resources.
  • Project Plan
  • A Project Plan should contain the specific tasks to be completed for each phase of the engagement and include assignees and due dates.
  • Client Data Request List
    • Information about the client’s organization, the current design of their PM system, and copies of existing policies and procedures will be needed to proceed with an investigation and model specific Project Plan tasks.
  • Project Snapshots / Executive Status Summaries
  • The customer’s leadership team will request periodic snapshots of the current status of the project. This update can be a bulleted list of project milestones in stoplight format (green/yellow/red) that also highlights any issues posing risks to the timeline.
  • Assessment Report
    • The final assessment report should be prepared in a professional format suitable for presentation to a customer’s executive committee and contain sections that identify the original purpose of the project, all findings, and recommendations.

Best Practices in Patient Access 2016- Webinar Thursday Feb 4th 12:30-1:30 EST

Improving your organizations’ access to physicians and other healthcare extenders has never been so important. Healthcare reform and other market dynamics have created an environment where patient engagement and the effective use of technology are critical components of an organization’s patient access strategy. Culbert Healthcare Solutions invites you to join Culbert Practice Leaders, Randy Jones, DHA, FACHE, FACMPE and Johanna Epstein, MBA for a FREE WEBINAR on Thursday, February 4th at 12:30 pm Eastern for an insightful look into Best Practices in Patient Access. This one hour online webinar will discuss and demonstrate the following:

  • The health care landscape and the drivers of change around patient access and population health
  • A review of recent best practices from industry leaders as published or presented over the past two years
  • An example of a strategic roadmap for patient access

Date: Thursday, February 4, 2016 Time: 12:30 – 1:30 EST


7 HIT Trends to Watch in 2016

Clinical systems consolidation: With enterprise systems focused on R&D for specialties, patient engagement and connectivity, the wave of MU development may slow.  Ophthalmology, cardiology and bloodbank are a few examples where add-on sales may grow and niche vendors may look to be acquired.  Cerner and Athena keep their eyes peeled for good catches, while Epic (as usual) stays in-house.  Organizations will be hard pressed to justify too many 3rd party solutions when enterprise licenses support stable core applications.  Providers may be less satisfied at first, though the lifecycle of maturity will repeat in these niche areas as happened with core systems.


Connecting health systems: MSO, extension programs and connect models have been around for some time – both in regional deployment as well as across the country with additional hosting solutions. With each agreement, however, business models need to be developed to account for every aspect of the new relationship.  Payment for specific application modules, training, SLA development, access to system design, membership on governance, and many more decisions are crucial to alignment.  We should not be surprised to see major EHR vendors developing better tools to support and manage the extension of core systems – from dashboards that isolate specific practice performance and cost, to design and build access that limits scope to content, fee schedules, and relevant system impacts.  ‘Extender’ and ‘extendees’ are differently incentivized to form partnerships, though making an extension program financially viable requires staff optimization on both sides to reduce operating costs.  We will likely hear many more contrasting stories of what enabled success in this newer market.


Change Management attention:  Getting live was – the easy part?  Many leaders will agree, 2-3 years post-live.  Implementing upgrades, decision support, automated coding and finance reporting – these require disciplined staff, change control, content management and closer collaboration without the EHR staff on hand.  Most organizations may self-report a C grade for governance and management of implementation of new features.  Refill automation, patient estimate generation, automated change impact assessments, and more are all part of the new wave of change control.  EHR vendors know this is hard, and they may provide more staff and more attention to helping organizations reach maturity with tools.  They want to see organizations get to the post live staffing goals just as much as you do.  Some may even be incentivized by it.


Patients and the EHR: Patients are accessing their charts more than clinicians. Epic speaks of this trend often, and as patient portals mature, others surely will see the same trend.  Patients are savvy users and expect the same ease of use that they have with banking, consumer applications, shopping and more.  They want online scheduling, payment options, health coaches, reminders, and easy communication.  We’ll likely see continued investment in web integration and patient solutions that focus on more than just engagement, but complementary features to the EHR.  Developing call centers that support social media outreach and knowledgeable staff that know how to best connect WITH you will influence the market and patient satisfaction.


Connected health – delay takeoff?:  Connected health is an exciting space with lots of funding – from Samsung’s connected devices and platforms to the MIT media lab’s patient monitors.  Consumer interest is high, though integration, standards and focus is not clear.  Chronic disease management applications are gaining traction and partnerships as they have a clear ROI.  Look for Medtronic, Samsung and Apple’s partnerships to give some better signs of success.  Startups like Oscar in NYC will also overlap with this space as they provide personalized insurance solutions across the US.  EHR vendors will open more doors as they see the consumer demand.  Epic exampled their interest with a FHIR development week to close 2015.


Security is higher on the list: Data breaches are here to stay, and stakeholders will scrutinize user access, authentication and standards to stay protected. Not much will change here, or quickly perhaps.  It may take catastrophic events to spur industry change – investing dollars to change infrastructure with no immediate ROI is always a battle.  Audit shops and risk management may have to illustrate competitive risk to win changes here.  EHR vendors may provide advice, but they typically stay away from dictating policy.


Big data is hard: Oracle, Microsoft and big vendors provide platforms, though integration, reporting knowledge, data definitions and data management are not their domain.  There just aren’t enough data scientists with EHR experience to make a big dent just yet.  Pharma and insurance companies will have the firepower to play with EHR data, as will academics, as will some shared population risk modelers.  Look to see vendors help, though different platforms make this a pricey problem for each organization.  Perhaps anonymized patient data will go up for sale more often, creating a playground for outsiders.  Price schedules should be, though aren’t transparent.  Real time intervention costs and outcomes should be available as well.  Don’t bet your house on 2016 breakthroughs just yet.


Director Epic Practice

Director Epic Practice




Culbert Healthcare Solutions adds new Director of Consulting Services-Jerri Ivey

Culbert Healthcare Solutions continues to expand and adds Jerri Ivey as a Director while entering their 10th year in business.

Jerri Ivey has been in the health care field for 30 years. Over 20 years of her experience was managing medical practices. For the past 9 years Jerri has been in the electronic health record industry serving as a consultant moving into leadership roles throughout the years. Jerri has been successful in taking her many years’ experience in ambulatory clinics and applying it to the implementation of an EHR. As a previous EHR Project Manager for a multi-specialty group, Jerri understands the importance of needing strong resources, managing the project closely, and ensuring success. Her strengths include being an innovative leader, managing/mentoring teams, and providing quality services.






How Patient Happiness Effects Physician Fulfillment

Culbert’s Johanna Epstein discusses Patient Happiness & Physician Fulfillment

MIR_3944-Johanna Epsteinlink here

Tips to Keep Patients Happy During Physician Transition

Medical Practice Insider:

3 Tips to Keep Patients Happy During Physician Transition

Donald Callahan – Director of operations at the Robert Wood Johnson Physician Enterprise; Randall Shulkin – Executive Consultant with Culbert Healthcare Solutions

link here