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Stable revenue cycle helps rural hospital avoid closure trend, expand services

by Clara Barton Hospital and Clinics

Published on 1/14/2021

Rural health systems across the U.S. face unique struggles as they fight for survival. Facilities are closing, leaving vulnerable patients without convenient access to necessary care. When the COVID-19 pandemic hit, health systems faced even more strain. By December 2020, 17 rural hospitals nationwide closed, totaling 176 rural closures since 2005.1

While eight rural Kansas hospitals shuttered from 2010-2020,1 one hospital in a town of 2,500 residents expanded its services and facilities. Leaders at Clara Barton Hospital & Clinics in Hoisington, Kansas, recognized the role of revenue cycle stability in the critical access hospital’s continued vitality.

In 2016, hospital leaders implemented Cerner’s electronic health record (EHR) and Cerner Revenue Cycle Management.

“Converting to a new EHR was not something I wanted to do on my own,” said Jim Blackwell, CEO. “Finding a strategic partner, someone who believed in us became the priority. A platform that served the physician clinics as efficiently as the hospital setting was key for us to celebrate our fiscal independence.”

After implementing the revenue cycle solution, the health system found itself on stable footing.

“Once we went live in August 2016, we were dropping outpatient claims shortly thereafter,” said Mary Bennett, director of patient accounts.

In the past four years since implementation, Clara Barton’s monthly A/R balance and days steadily improved, with A/R days falling from 48 to 39.2

“The revenue cycle tool offers a lot of power that allows the billing person to be more efficient,” said Bennett. “They can look at the claims, charges, registration, the EHR and the diagnosis code. They have all these tools at their fingertips. From a high-level view, I can look at each biller’s worklist to see who’s most efficient at their claim processing.”

Growth and expansion

The strong revenue cycle helped hospital leaders expand services and facilities, including a new clinic in nearby Great Bend, Kansas.

“While we are a small organization, we have a strong regional referral network,” said Blackwell. “Our growth over the years has positioned us for another brick-and-mortar expansion that will help accommodate our patients' needs for years to come. Both in our Hoisington community, as well as our neighboring town of Great Bend.”

The organization also built a new imaging suite in Hoisington to permanently house MRI services that previously occupied a mobile truck. The hospital is also purchasing a robotic surgical system, something Blackwell says is an anomaly for critical access hospitals.

“For me to be able to make the bond, the principal and interest payments, we need an EHR that’s helping me turn cash so I can make that obligation,” he said. “If you don’t have an EHR that helps you fiscally, you’re finished.”

Weathering COVID-19

COVID-19 hit rural health systems hard. With elective operations canceled, routine appointments postponed and the rush to purchase personal protective equipment, health system leaders worried about their bottom line and whether they could continue providing care.

While Clara Barton hospital leaders felt the impact, they feel they handled the financial crisis better than others.

“I did not sweat as much as some of these other facilities,” said Blackwell. “We built a very efficient and successful revenue cycle. We’ve been able to stockpile reserves and weather different storms.”

Blackwell’s team hopes that work will be easier, thanks to continued support from their Cerner counterparts.

“During the pandemic, Cerner was amazing to watch,” added Rebecca Moore, project manager. “They did things that directly and indirectly affected our revenue cycle, and they completely anticipated our needs as a client — needs we didn’t even know we had.”

With strong support, Blackwell believes Clara Barton will continue to break the trend of many other rural hospitals and see more growth and expansion.

“We want to be an organization that continually moves forward using this product in a way that’s superior for hospitals our size. I want to do this for years to come.”

Data for this story was pulled utilizing Cerner Lights On Network®.

1 “175 Rural Hospital Closures: January 2005 – Present (133 since 2010),” The Cecil G. Sheps Center for Health Services Research, accessed November 10, 2020.

2 Comparing from November 30, 2016 to November 30, 2020.

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.