The Challenge

CSV completed an Epic EMR conversion thirteen months prior to the Pinnacle engagement where they modeled the design after a separate, larger hospital, within the healthcare system.  As opposed to the 2-year design and 3-6-month stabilization that typically accompanies an EMR implementation, CSV received limited hands on training to learn the inherited EMR system.  As a result, account flow within the system was not clearly understood, resulting in broken workflows, inaccurate or incomplete reporting, and a general lack of transparency and accountability.  This led to an increase in AR and unbilled days and an overall reduction in cash.  Early struggles resulted in a failure to embrace the new technology and an increased need for change management.


Pinnacle leveraged their extensive Epic background to quickly identify populations of AR that had become stagnant and were not moving forward within the account life cycle. Pinnacle created reports and queries to identify at-risk account populations while also implementing dashboard metrics to track and trend vital metrics.

Key activities included:

  • Implemented standing weekly meetings with all areas of billing ownership to drive communication, collaboration, and training
  • Provided education surrounding metric management and root cause analysis to drive long term metric success
  • Developed CFB thresholds by owning area and day of week to drive accountability and performance
  • Designed and implemented workqueue scoring to improve account prioritization
  • Created or refined system actions to drive automated account routing resulting in a more efficient exception-based workflow
  • Developed activity scoring to drive reporting
  • Designed, built, and implemented 35 Watch List metrics to identify and trend targeted high risk account populations
  • Reconciled underpayment logic to align with staff capacity
  • Designed, built, and implemented customized metrics to track inventory and aging by vendor
  • Implemented monthly placement reconciliation processes to drive account flow
  • Provided workflow education to drive reporting functionality
  • Identified and addressed black hole account populations erroneously assigned to the vendor agency
  • Implemented improved automation logic to drive account flow
  • Created situation response guidelines to drive staff workflows and reporting
  • Developed and implemented custom status codes to drive workflow and reporting
  • Created custom dashboard metrics to track progress against goals
  • Implemented standing high dollar/risk meeting to drive department collaboration
  • Established standing underpayment meetings with managed care, contract vendor, and internal resources to identify root cause and reduce inflow
  • Implemented a high dollar review process to address at-risk account populations critical to the hospital’s financial performance
  • Created functional area specific productivity reporting within Epic
  • Developed training documentation to maintain and manage reporting metrics
  • Developed a combined HB/PB productivity tracking tool to monitor individual and unit performance

Common themes across all initiatives included:

  • Established education surrounding Epic functionality and workflows to ensure end user understanding and long-term metric management
  • Leveraged system automation to move towards an exception-based workflow
  • Improved communication across departments to establish a collaborative, problem solving culture
  • Developed reporting and custom metrics to improve transparency and accountability


CSV achieved improvements in many key metrics over a five-month period from October 2019 through February 2020. most notably:

  • 5.2 day reduction (9%) in AR days with minimal write-off based initiatives
  • 4.5 day reduction (60%) in Candidate For Bill
  • 3.0 day reduction (24%) in insurance AR aged 91+
  • 0.5 day reduction in accounts failing to qualify for Epic workqueues

About this Client Partner

Christus St. Vincent Regional Medical Center

Located in Santa Fe, NM, CHRISTUS St. Vincent (CSV) is a 200-bed hospital operating under a partnership with CHRISTUS Health and SVHsupport. Each year, more than 13,000 patients are admitted, and more than 200,000 outpatient hospital encounters (including physician practices) occur at CSV.

 “I’ve appreciated your willingness to poke holes and dive into our metrics.  I know the team appreciates your willingness to partner with them and educate around what’s available in Epic and how it functions.  Without that insight, we would still be flying blind.”

Reuben Murray

Chief Financial Officer,
CHRISTUS St. Vincent Health System

 “From a system revenue cycle perspective, you are very value added. My challenge is to get you into as many areas as possible. As we look toward building the perfect Epic for our future facilities, I see you playing a larger role.”

Ryan Thompson

Senior Vice President of Revenue Cycle,
Senior Vice President of Revenue Cycle