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Hawaiian CFO digs deep to mine revenue

Technology plays a big role in Hilo Medical Center's efforts to manage costs and extract more revenue

Money Atwal, who is both CFO and CIO at Hilo Medical Center in Hilo, Hawaii, is digging deeper into hospital operations to extract more revenue in the face of lower provider reimbursements and declining resources. The rural nature of Hawaii Island adds to the challenge.

One major undertaking has been to continuously improve the medical center’s coding, documentation and charge capture systems to obtain the most efficient and correct patient care delivery information that will result in a net increase in revenue despite lower payments. Technology has been an important tool.

Atwal, who came from The Queen’s Medical Center in Honolulu, spoke recently with Healthcare Finance News at his office at Hilo Medical Center, which serves largely rural residents of the eastern side of the Big Island. With two remote critical access hospitals associated with Hilo Medical Center, it has a combined 142 beds under its system and expanding outpatient clinics.

Q. How does improving the charge capture system translate to more revenue?

Atwal: For example, when a physician puts an order into our electronic medical records system, it then triggers a set of required elements that a clinician, whether it is a nurse or provider, is required to answer. So when a patient’s IV bag is replaced, in order to get reimbursement for that charge, you have to document the start time and end time. We want it to be accurate to bill for it. That change accounted for almost a $1.8 million increase on an annual basis across the board over the past year and a half. In the paper world, nurses would have to record a time element while taking care of other procedures. But in this system, you can’t proceed without putting in an end time. 

Q. How else are you improving revenue outlook amid lower payments?

Atwal: There are several aspects of this. We’ve had maybe 1 to 2 percent increase in our admits and 4 to 5 percent in our ER volume. But if you look at our net revenue, it has increased. Our ER visits volume is continuing to grow in part because of the lack of primary care in the community. We have made a concerted effort to increase the throughput into the ER. Our wait time used to be recorded in the hours. Now, it’s down to 22 to 25 minutes. The word is out that the ER is very efficient for utilizing our services. And it is an entry point to our operations.

Q. What other tactics is Hilo Medical Center implementing?

Atwal: We are also looking at cost reductions like any other place. We’ve been going through a cost reduction since January and anticipating cuts from the legislature. (Hilo Medical Center faces a $9 million budget shortfall in the just-started fiscal year as a result of the Hawaii legislature appropriating $102 million for the Hawaii Health Systems Corp. compared to its $150 million request.) We’re trying without impacting the core staffing to shift our temporary staffing and resources to a profit center or higher profit-generating center. When the state decreases funding unexpectedly, then we have to leverage all our tools – maximizing revenue, become more efficient or cost reductions.

To expand access to the rural population, we have opened nine outpatient clinics plus a pain clinic. We also have a residency program that is just starting up to increase primary care, with four residents this year and four more each year to a maximum of 12.

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