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Children’s National Hospital successfully implements clinically driven revenue cycle during COVID-19 pandemic

by Childrens National Hospital

Published on 3/29/2022

While dealing with low patient volumes and a hybrid workforce, Children’s National Hospital implemented a clinically driven revenue cycle and simultaneously managed its legacy accounts receivable (A/R) system.

And one leader at the Cerner ITWorks client says she “could not be happier with the financial outcomes of the transition.”

“It was a heavy lift, and we're not finished yet,” said Mary Daymont, RN, vice president of revenue cycle and care management. “But I’m grateful for Cerner and the support we've received.”

The original implementation was planned for early June 2020, but when the COVID-19 pandemic hit, staff had to rethink everything. In October 2020, Children’s National staff went virtual, but they trained in person.

“We felt it was important to be in the classroom and provide learners with near-real-time support,” said Mary Daymont. “We negotiated more training rooms that would allow for social distancing and opened more training sessions. None of that would have been possible without the support of the Cerner team.”

Despite a global pandemic and concurrent revenue cycle implementation, Children’s National has posted more than $1 billion in cash.1

“We are a clinical care organization, which is like a body,” Daymont said. “However, what drives the body is the heart, and it has to be pumping blood through the body. The revenue cycle system is the heart that pumps the cash flow through the body, so the body can thrive and develop. In addition, you need the brain, or analytics, to make sound decisions about what the body is going to do next.”

Analytics systems are driven off financial systems and require a collaboration of revenue cycle departments and functions. Healthcare and clinical care providers are key to running the entire system more effectively.

“The beauty of the Cerner clinically driven revenue cycle is that it unites the body, heart and brain together, so we can work side by side to continue to grow and develop our business,” Daymont said.

Children’s National maintained its posted cash per month, stabilizing within two months of implementation. “I always say cash is king in any healthcare organization,” Daymont said. “That cash flow, particularly during a pandemic, which adversely impacted pediatric hospitals, was really welcome news to the organization.”

Two of the most significant implementation successes involved coding turnaround time and clean claim rate (CCR). Tech denials stayed stable.

In general, hovering around one day for coding is good for Cerner clients, and Children’s National is at less than a day.2  “We're over a year now post go-live, and our coding turnaround time actually improved,” Daymont said. “The implementation of 3M with the new system was very helpful, and both pro and tech clean claim rate increased.”

The technical CCR had more room for improvement because of the different billing rules Children’s National has across three state Medicaid plans.

The pre-go-live CCR of Children’s National on the technical side was 33%, compared to a post-go-live CCR of 99%.3  The organization also improved on the CCR pro side from 85% to 95%.4

Average daily revenue (ADR) went from roughly $7.23 million to $8.6 million5 , and discharged not final billed (DNFB) days remain stable around 15 days.6

“The Kansas City team has been invaluable, because that's where the brains for the system are coming from,” said Daymont. “Our Bear Institute team has been side-by-side with us in the trenches every step of the way, and we're thankful for their collaboration.”

1 Comparing Posted Cash from October 2020 - close of February 2022.

2 Comparing greater than a day in June FY 2020 to a day in June FY 2021; based on HFMA recommendation of less than 1.5 A/R days

3 Comparing June FY 2020 to June FY 2021

4 Comparing June FY 2020 to June FY 2021

5 Comparing ADR in FY 2020 (June 2019-June 2020) to ADR for FY 2021 (FY June 2020-June 2021)

6 Comparing June FY 2020 to June FY 2021

7 The formal name of the Cerner ITWorks relationship at Children’s National Hospital is the Bear Institute.

Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.