April, 2017:

How to Make an Impact in the First 100 Days as a New CIO

Starting as a new healthcare CIO, you quickly need to get beyond the optimistic view of your new information technology domain gleaned during your interview process. Wise CIOs take a page from corporate and national leaders and arrive on day one with a plan for how to reach day 100 with a deep awareness of the IT organization you manage, a solid plan with broad acceptance to achieve the corporate strategic goals, and some quick wins already delivered to your stakeholders.

Why 100 Days?

Three months is generally regarded as a reasonable “honeymoon” period for a senior executive to absorb their new organizational environment and be ready to deliver results. The additional ten days provides a measure of extra time to secure buy-in from your stakeholders and communicate your plans broadly to the organization.

How Should You Organize This 100-day Orientation to the New Job?

  1. Devote time and attention to determine the strengths, weaknesses, opportunities and threats of your IT organization. Document current state and incorporate the subjective impressions of your employees and your superiors.
  2. There will be urgent and highly visible issues that require action within a critically short timeline. Determine what you can postpone for deeper analysis and identify actions that can quickly resolve users’ pain points in less than 100 days.
  3. Build your initial IT strategic plan to address the gaps between the current state of IT and a desired future state vision driven by the needs and strategic goals of your organization. Develop alternative approaches to achieve this vision including clear costs and benefits, communicated effectively to the management team.

First 30 Days: Face-to-Face Engagement is the Key Activity in This Timeframe

  • Meet with key members of (non-IT) management. Start with senior executives and medical staff leadership. Ensure that you understand their role in the organization, how they interact with IT, what some of their recent requests have been to IT and how these have been resolved. How can IT help them achieve their strategic vision? What would they consider their most urgent or repetitive IT needs? Prepare questions that are tuned to the individual’s role but also listen to what they want to share. Find out which people in their line of report you should follow-up with.
  • Meet with IT staff, beginning with managers and supervisors. In addition to your regular management and section meetings, meet one-on-one. Seek out issues they wrestle with, whether it involves systems, processes, or people. Review recent performance evaluations, specifically if any behavior or skill gaps are not being properly documented.
  • Become familiar with the organization’s strategic and tactical plans currently in place. Evaluate plans that exist in terms of concurrence with overall organizational goals.

60 Days: Assess Your Systems and Infrastructure Environment While Continuing to Fill in Information About Staff and Shareholder Needs

  • Perform or engage a complete technology assessment
    • Network infrastructure, databases, workstations, data center capacity, etc
  • Evaluate service delivery levels
    • Help desk performance, systems reliability, implementation history, service level agreement review, etc
  • Review budgets (planned vs. actual performance)
  • Develop fast action plans for the urgent, simple issues and begin implementation

90 Days: Transition From SWOT Assessment to Tactical Plan Development

  • Test your perceptions of enterprise SWOT findings with other senior managers
  • Draw up a desired state of IT to meet the enterprise’s current and anticipated needs
  • Prepare a comprehensive gap analysis between the desired state and the current IT assessment
  • Prepare alternatives to address the gaps utilizing peer group, department staff, and expert input. Develop implementation detail around these alternatives
  • Review a draft of the gap summary and tactical plans with senior management including budget costs, KPIs, and benefits expected
  • Review execution of the fast action projects (be sure they are on-track for completion and user goals are being met)

Final 10 Days: Polishing the IT Strategic Plan and Communication

  • Develop an executive summary, describe the evaluation and planning process
  • Define an IT architecture blueprint with guiding principles for future decisions
  • Present tactical alternatives with narrative of the pros/cons of each item in terms of cost, time, and impact on business strategy
  • Describe implementation requirements, including the timeline to accomplish the alternative recommendations
  • Propose realignment of staff to accomplish tasks and define when these changes would need to occur
  • Detail changes to service levels and service delivery


Congratulations! You have arrived at day 100 with your research completed and the tools in hand to be successful in your first year as a new CIO. Now it is time to execute on the IT strategic plan, deploy and motivate IT staff to meet your goals, and monitor progress on meeting your users’ needs.

Executive Consultant-Culbert Healthcare Solutions


Why FSC Consolidation?

A front desk representative stares at the pick-list of Financial Status Categories (FSCs), trying desperately to match one of the myriad choices to a patient’s Aetna HMO plan. Should she choose “Aetna HMO,” “Aetna HMO/POS CAP,” “Aetna HMO/POS Non Cap,” “Aetna Medicare HMO,” or “Aetna Medicare HMO/POS?”  What is the difference between them?  What does all this even mean?  With so many choices, in all probability, she’ll choose the wrong one.

As a result, incorrect edits will be applied, the claim will be routed incorrectly and will be denied. Unnecessary man-hours will be spent correcting the error and resubmitting the claim.  But again, the problem of too many FSCs available remains.  More denials, more man-hours wasted.  Eventually, the patient is billed.  More time is spent in customer care calls before the charges are finally resolved, if they are resolved.  In a worst-case scenario, the patient refuses to pay for services which are covered by their insurance and the invoice goes into collection.  Nasty reviews on social media and bad word-of-mouth could be the least of the trials faced by a good practice that only wants to be able to focus on quality patient care.

All because the organization has too many FSCs.

The most common reply to an entity being informed they have too many FSCs is “So what?” How could having too many financial classes possibly hurt an organization?  The answer is “a great deal.”

The impact of too many FSCs include:

  • Confusion about which FSC to select for registration
  • Increased time needed to register a patient
  • Claims routed to the incorrect payer ID or address
  • Increased rejections or denials creating additional work for A/R staff impacting, productivity, days in A/R, and revenue/cash flow
  • Reduced customer satisfaction due to incorrect billing
  • Increased customer service calls
  • Possible compliance issues, as certain plans have specific regulations associated with them
  • Fines or lawsuits because of an audit or customer complaint
  • Inaccurate reporting reflecting insurance activity

Luckily, it is not difficult to resolve all these issues and reduce FSCs to a manageable number. Common scenarios indicating the need to consolidate are the sheer number of FSCs, poor claims submission resulting in high numbers of rejections/denials and high days in A/R rates.

Once a need for consolidation has been determined, all that is needed is to plan the future state of the organization’s FSC structure and then implement.

Part of setting the future state is determining which FSCs are obsolete. Useful tools for this decision are examining which FSCs have the most A/R, billing rules such as claim forms, state regulations, and payer rules/billing requirements.  Revenue activity, claim production, and payer rules all have direct bearing on determining if a FSC is obsolete or a living, useful component of an organization’s revenue cycle.

Once FSC requirements are determined and broad FSC groups are laid out, individual FSCs can be analyzed and consolidated into a surviving FSC. It is also possible to eliminate FSCs which are completely obsolete and can simply be deactivated.

The overall goal is to have a minimal number of FSCs in the future state. A simple optimization resulting in big payoffs across the full revenue cycle.



Consulting -Life Balance

Have you ever tried to be a road warrior and maintain mental, emotional, spiritual and physical health at home? Typically, it’s challenging because you usually give all you have at the client site and rarely have anything left to give once you arrive home. So, what can be done to maintain a healthy ‘you’ while meeting the needs of family/friends, your firm and the client? Many people try to get their ‘me’ time in on the weekends while at home, but there is only so much you can do with 48 hours (for some 72). Saturdays seem to fly by and Sunday greets you with the bittersweet awareness that you wanted to sleep in, however, you forgot to pack last night. Hopefully these tips will support help you to achieve some resemblance of consulting/life balance.

 Take a look at some helpful suggestions below:

  • Bring home with you on the road! For as much as we live in an age of technology, we sometimes forget to actually ‘use’ the technology in our hands to stay connected with family and friends. A scheduled 10 to 15 minute video call can do wonders for you and those who love you. It will keep you up-to-date with what is going on in their lives and maintains that much needed connection. This can greatly support your emotional and mental health. If you have a spiritual practice, you don’t have to wait for the week to end. Practice what makes sense during your work week, whether that’s reading, meditation, music, etc.

Speaking of bringing home with you, if you are an avid reader, bring your book(s). Do you knit, crochet, etc.? Bring it with you! Play a lot of online games? Many games can be played using your smart phone or other electronic device (not your work laptop please!). Bring whatever makes the most sense with you on the road. You can decompress while on the road – you do not have to wait until you get home.

  • Don’t lose sight of the things you enjoy. While on the road, make sure you don’t leave your passion and fun behind you (at home)! Many areas have similar activities you would engage in at home, right in their own backyard. I’ve experienced some pretty enjoyable painting, fitness, bowling, spa, and other fun activities while traveling. Working out (not in the hotel) has kept me focused and motivated on many assignments!
  • Interested in volunteering? There are many local and not too distant programs and charity locations in most towns or cities. Working long hours at the client site can sometimes be inevitable, but scheduling time for fun, relaxation, or volunteering can help in decreasing your stress level, sense of isolation, and lack of fulfillment.
  • Get chores done before the weekend. Don’t be hesitant to find a local dry cleaner, nail spa, hair salon or other self-care establishment in the town or city of your client. This can decrease the amount of time you (or your family members) have to spend on those weekend errands. You’ll have more time to do those really precious things you can’t do on the road, including absolutely nothing!

Consultant/life balance is achievable, but it requires flexibility, openness and a few moments to decide where you want to engage in your other activities. You’ll be ready to live more and give more to yourself and those around you once at home, all while meeting or exceeding the expectations of your client and firm. Everyone wins with work and life balance!

Melissa L Roberts, Culbert Consultant and Life Coach



Creating and Implementing a Revenue Cycle Management Denials Committee

A denials committee is a necessity for effective revenue cycle management for hospital and physician groups. It is a great initiative to help organizations identify trends and issues surrounding specific denials, whether they are front or back-end denials. It provides transparency and opportunities for improvements, such as reduction in denials, increased cash flow and reeducation opportunities. With the right tools and participation, this can be a very successful endeavor. There are many crucial aspects and key players necessary in order to be effective. In addition, having the necessary reporting tools and analysis to provide the data are also essential components.

Recently, a hospital with multi-specialty departments in Arizona was seeking to implement a denials committee. Once key players were determined, we had to work with the leadership in the central business office to engage the key players or their designees. Initial communication was sent to executive leadership to explain the intent of this committee and what we were trying to help them accomplish with these bi-monthly meetings. The initial meetings were informational and the meetings that followed were considered working meetings in smaller sub-groups. With multi-specialty hospitals the start-up process can be a little more difficult, but not impossible. It is essential that there is a leader from the organization that is able to identify the leadership for each department.

At the first meeting, we gave an introduction as to who we were, our goals and the end result that we were trying to attain. The initial meeting sparked interest and created a sense of eagerness to find out where the denials were coming from and why. Once there is interest and buy-in from the senior leadership, then the meetings can move forward and be effective.

After the initial meetings, training was provided on the reporting tool that was being utilized as a data tool for denials. The training was broken down into separate sessions to ensure that the users had hands-on experience with the reporting tool. It is important for users to look at reports independently and prepare for upcoming meetings. After the training, we demonstrated the denial trending and provided assistance with report review.

Once the working meetings started, specific examples of the top five denials for the client were provided, including eligibility denials and the front-end staff. Detailed audits on hundreds of accounts were performed in order to provide the details on why the denials occurred and to discuss solutions to reduce these denials. We continued to do audits on the top denials to try and reduce the denial percentage for the client, while asking team members to also investigate on their end.

This is a prime example of how to successfully establish a denials committee. Organizations should consider implementing these committees since it is proven to be effective in reducing denials and increasing cash flow. It is important for health systems to also remember to continue the meetings so that no momentum is lost and their revenue cycle can flourish.