Case Analysis of Sutton Health

Topics: Health care, Health care provider, Medicine Pages: 8 (2541 words) Published: March 25, 2013

Case Analysis of Sutter Health

CASE ANALYSIS OF SUTTER HEALTH 2 Sutter Health is a non-profit network that is made up by community-based health care providers based in Northern California. This network introduced an interface that was aimed at enhancing revenue collection of the facilities from the self-pay patient. This network identified that traditional payment processing system had limitations that hindered the effective collecting of revenue. What with the recession, healthcare organizations have seen an increase in the inability to collect debt from the self-pay, the uninsured and underinsured patients. This has caused a lot of struggle when it comes to the organizations to meet the operational margins and the profits. I find there are a number of reasons for the new increase in patient’s debts, the most common are, poor accounting practices, lack of patient information and correct demographics. There is new governance that is designed to provide more coordinated care to said patients (Gleeson,2010). There are five geographic regions that reflects the health care access to the customers of Northern California. Each of the five regions will have governance structure and it will oversee many of the Sutter affiliated medical facilities and also the hospitals. “In its effort to increase point of service collections and improve the overall revenue cycle Sutter health took steps to measure performance using a handful of specific primary benchmarks, empowering PFS staff to assume responsibility for every individual account they handle, ensure each registration is analyzed using a rules engine to identify problems before patients leave the registration desk and ensure PFS staff receive appropriate comprehensive training to excel under the new system” (Souza, McCarty, 2007).

Obtaining the correct patient information plays a large part on non-collectable debt because patients are not able to be reached. These limitations were associated with limited access to accurate information by the account representatives, ineffective performance measures and fragmented centers of the service provision. The Sutter Health program developed a system that was comprised of solutions that were geared towards overcoming these limitations. I will be CASE ANALYSIS OF SUTTER HEALTH 3 discussing the new system that was created by Sutter Health. The key problems and issues, is that the United States healthcare system is characterized by huge upkeep from collecting revenue from patients. This situation is brought about by a health care insurance system which entails high deductible pay health plans and as well as higher co-payments plan. (Souza, McCarty, 2007). This situation has been made worse through the large proportion of the population not having healthcare coverage. The traditional health care system has had a hard time meeting their target revenue collection. This is due to several problems that attached along with the traditional payment system. Unlike when dealing with the payments through insurance claims but also dealing with the up-front payments that are required by the hospital for payment of services before the patient could even receive the service (Souza, Mccarty, 2007). So this means that the patient services staff (PFS) has to have complete and accurate information about above said client. This presented a problem for the traditional payment system where much of the customer payment system was processed in the back end. This system also required that the PFS staff ask for money from...
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