"It's so fundamental right now. We can't operate in two separate silos; they have to be interwoven," Nichols says.
To that end, Kaleida set up a clinical documentation improvement group that is part of the revenue cycle. Nichols says the organization is currently making an "enormous investment" in that team.
"We have roughly doubled the amount of staff to 20 from 11 in one year," she says. "The CDI program is currently our number one project. It touches every component of what we do as a healthcare provider. There is a financial return to better documentation, but it is also just fundamental to the care we provide."
Impact of HIX is unclear
One of the biggest question marks surrounding the revenue cycle at the moment is the potential effect of the Patient Protection and Affordable Care Act and the health insurance exchanges.
"The impact on charity care and bad debt is a bit murky," Nichols says. "It's not very clear when we model it out that the exchanges will reduce charity care because folks are still responsible for paying premiums and deductibles. It's unclear if the exchanges are truthfully going to reduce bad debt, so we've chosen not to make that assumption" in the modeling.