St. Louis-based BJC HealthCare completed its Epic revenue cycle integration in September, a process the system's vice president and chief revenue officer, Tracy Berry, said was a smooth one.
Ms. Berry recently spoke with Becker's about the implementation, challenges with payer relations and how she is working to build a sense of camaraderie with an increasingly remote workforce.
Note: This interview was lightly edited for length and clarity.
Question: What is the project or goal completed this year you are most proud of?
Tracy Berry: Completing our Epic revenue cycle implementations. We just finished those in September. We started this journey with two community hospitals back in June of 2021. So we transitioned them to Epic rev cycle and then we had our three academic hospitals [transition] in April and now our final hospitals in September, so it's nice to have everyone on one platform and to have those go-lives behind us.
Q: What is the benefit of rolling out the implementation over the course of three phases?
TB: For us it was really about risk mitigation. We're a $6 billion system and to implement all hospitals at one point has a lot of risk involved. So for us, we elected to do three waves and we could learn from each wave. We got better at it each time.
We started with those two community hospitals. That went well, but certainly there were lessons learned of how we could do even better next time and even better the third time. Our third implementation was incredibly smooth.
Q: What are the challenges you're facing in terms of payer relations?
TB: Our [accounts receivable] has grown since the pandemic started. Interestingly enough, our denials haven't grown. … We've really been scratching our heads over the past couple of years trying to figure out what's driving that A/R growth. We really believe a lot of it is what we would call "slow pay." So we're not necessarily getting a denial. We might be getting more requests for information, we might be going back and forth. I think payers were challenged with what we were challenged with, which was quickly sending a lot of staff home and having to readjust to having a remote workforce and perhaps having some challenges in staffing and recruitment. I don't know if the payers are dealing with the same kind of industry challenges or if it's more nefarious than that. But what we're finding — and I think many of my colleagues would say this as I'm out in the industry talking to folks — I think a lot of people are feeling this slow pay, where we're seeing our A/R grow. So we've had to be a lot more diligent in working with our payers. Pushy might be another way of stating that. We're really working with them trying to continue getting payment. It's been a real issue for us.
Q: Has it been a challenge building a sense of team camaraderie with a remote/hybrid workforce? How do you address those challenges?
TB: We created our department about 10 or 11 years ago and it was a very traditional [department], as we started consolidating and centralizing. We did a lot of work building our culture because we were a new group. We did a lot of things to build that culture, whether that's potlucks, or an annual picnic, dress-up days, silly hat day, celebrating hospital week or doing fundraisers for the United Way. There are lots of reasons you could have some fun at work. And that is certainly a lot trickier in a remote environment.
I think the good thing for us right now is we built a culture that is still there, but as we hire and replace, we're getting a lot of employees who never were part of that culture that we built those earlier years. I think it's evolving in terms of how we manage that. We've done things that many have. We really encourage people to turn their cameras on during meetings. … We try to connect in that way. We even hired a musician who did a virtual concert for us as a kind of thank-you to our employees. We had a magician once. We're continuing to look for ways to connect.
Now that the pandemic is more — I guess we're in it for the long haul, it's our new normal state — we've done some renovations in our office where we've made some very nice collaborative space. Now we're trying to turn our attention to "what is the new normal?" WWhen does it make sense to bring employees or leaders in for perhaps a training or a key meeting?" We're very particular about "when would there really be a benefit of being all together?' I can't say we have that all figured out at this point. We're developing that new normal to look for opportunities for some eye-to-eye communication but trying to make the most of our virtual and video communication.
Q: What has been the biggest benefit of consolidating the revenue cycle department?
TB: I think it's about standardization, figuring out the right way and doing it the same way … sharing expertise. If you're a standalone business office with 30 people, let's say, you can't afford the same kind of analytic support or training support that you can with a team of 2,000. I have a dedicated analytic team, a dedicated training team. We can bring in very talented leaders to manage a broader scope. I think that kind of expertise we can gain is huge, that we can then share across all the revenue cycles across BJC. I think there's a lot of opportunity for career growth. Here again, if you're a small business office with 50 or 70 or 100 people, there's not going to be the same type of career opportunities as there are with a large rev cycle like we run.
At the end of the day, it's about can you get better results. And I believe we can and we've been faced with some really big challenges, especially with the pandemic. I think about our patient access team, our registrars, they are still located at our different hospitals, but having that under a unified umbrella of leadership, we could make sure we were doing the same thing at Hospital A as Hospital B. We could share staff from places. In those really difficult times with the pandemic, we were able to make decisions, be nimble and be standardized in a way we wouldn't have been if those had been 14 different patient access teams.