Signs, signals, and steps for consolidating Acute, Outpatient, and Ambulatory revenue cycles to create one Enterprise-wide Revenue Cycle 

Today we spoke with Sandra Jacobs, Founder, and CEO of Jacobus Consulting about recognizing when it’s time to consolidate acute, outpatient, and ambulatory revenue cycles to create one enterprise-wide patient-centric revenue cycle. She walks us through the evaluation process and lays out an easy-to-follow blueprint that will benefit patients, providers, and the business office. Enjoy!



[0:00] Introduction

[1:11] Signs and signals that it’s time to consolidate 

[7:56] Evaluating if an enterprise revenue cycle is a good option for your organization

[11:48] Opportunities created by revenue cycle consolidation

[15:07] Sandra’s roadmap for getting started

[20:02] Potential roadblocks to consolidating your acute, outpatient, and ambulatory revenue cycles

[24:11] Conclusion

GUEST: Sandra Jacobs


“Traditional models of delivering health care have really changed. The revenue cycle needs to change right along with them.”

Sandra is a recognized leader in revenue cycle transformation, the shift to digital and personalized health, and is passionate about aligning healthcare information technology with people and processes.


Signs and signals that it’s time to consolidate [1:11]

First of all, traditional models of delivering health care have really changed. The revenue cycle needs to change right along with them. There are changes in revenue sources, reimbursement, etc., so the industry and organizations have to find ways to be more efficient and more effective at collecting every single dollar that is available for the services they provide. At the same time, the cost to collect must be reduced. 

Many organizations that joined together to join Integrated Delivery Networks are not realizing the benefits and cost reductions they hoped to see. The revenue cycle is a good place to look and see if they’ve gained anything. Are there multiple business offices scattered across the network, and if so, is that efficient from a cost perspective?

Additionally, it is important to recognize and evaluate what is going on for the patient in the revenue cycle. Are they having to call multiple numbers for appointments and billing questions? Do they give the same demographic information over and over again? The patient should see all of the organization’s services as one.

Economies of scale mean that organizations who are collapsing and consolidating their revenue cycles operations have the opportunity to reduce the cost to collect. Capital costs and operating costs can also be reduced dramatically if organizations take a really good look at the revenue cycle across the enterprise. 

Technology is an important factor to consider when consolidating revenue cycles. There is a lot to look forward to in terms of innovation however, there is a lot that can be done now to improve an organization’s situation. Disparate systems across multiple entities within an organization drive costs up, cause difficulties for patients, and make tasks more difficult for employees. There’s a really big opportunity for revenue cycle leaders to think strategically about how to gain efficiencies, visibility, standardization, and take a customer focus through their technology. 

Lastly, the care of populations across an organization’s continuum and over time is a huge driver for an organization to consider consolidating revenue cycles. Consolidation provides the opportunity for stronger operations, stronger foundation, and flexibility to adapt to rapid industry changes.  

Evaluating if an enterprise revenue cycle is a good option for your organization [7:56]

The first place to start in evaluating if consolidating your acute, outpatient, and ambulatory revenue cycles is right for your organization is to look at the organization’s current state. If an organizations’ patients have to provide the same information at multiple care stops, call multiple numbers to make appointments across the organization, and if they’re getting multiple bills from different entities within the same organization, then it’s probably a good idea to consolidate revenue cycle operations.

If organizations have combined into an Integrated Delivery Network and revenue cycle costs haven’t been reduced, consolidating revenue cycles is probably a good option.

Additionally, if your organization is getting a lot of requests for information when it comes to managing populations, and it requires using multiple systems and spreadsheets to provide this information, consolidation is most likely a good solution.

If an organization doesn’t trust their data or there is a lack of visibility to key performance indications because there are disparate systems, revenue cycle consolidation will likely help solve these issues.

When an executive team has a strong vision for how the revenue cycle is included in the continuum and quality of care, consolidation is a perfect way to help support this vision.

Opportunities created by revenue cycle consolidation [11:48]

According to recent research, consolidating and creating an enterprise-wide revenue cycle reduces an organization’s (including physicians) cost to collect by, at a very minimum, 15%. This may come from reducing or re-deploying staff, reduced office space needs, or the reduced cost for denials. Additionally, consolidating revenue cycles will allow for better visibility to key performance indications, faster reimbursement, and faster denials management.

Sandra’s roadmap for getting started [15:07]

  1. Establish the vision
  2. Strategic planning: define/identify the entities & offices, who, what structure, etc.
  3. Cultural integration
  4. Set goals
  5. Set Objectives
  6. Set technology roadmap after decision making
  7. Action planning: step-by-step for all involved, policy changes, training
  8. Consolidate KPI reporting for continuous monitoring
  9. Roll out and cut over planning

Potential roadblocks [20:02]

From experience, step one of establishing a vision can be the biggest roadblock. Generally, leadership at all levels of the revenue cycle needs to be involved in this step and it’s difficult to bring that many people together to establish the vision. 

The next stumbling block we typically see is in the strategic planning phase. Organizations don’t always have the right person within the revenue cycle to lead consolidation efforts.

Another really important factor is culture. If an organization fails to focus on culture, the project’s vision will not be realized. Establish the common values that can be built upon.


Resources: If you’re interested in learning more about Enterprise Revenue Cycle, Jacobus has a number of resources available: