Kim Markey began as executive director of revenue cycle at Huntington Hospital (HH) in November 2012. Located in Pasadena, California, HH was a 625-bed non-profit regional medical center that was named among the top-performing hospitals in 2012 by U.S. News & World Report. To further HH's focus on high-quality, patient-centered care, Jim Noble, executive VP-COO/CFO, was looking for a change in direction, particularly in the Business Services Office. Accounts Receivable (AR), a key billing metric, could be lower and Noble hired Markey with the mandate to improve performance. Markey's long-term vision involved re-examining the revenue cycle and the hospital's processes to ensure that HH would become a stronger performer. She needed to get her metrics under control as a first step before transforming the departments she oversaw—Admitting, Business Services, Data Services, Medical Records, and Revenue Integrity—into truly patient-focused business centers. The next step would be removing barriers for patients and evolving the mindset of her departments so that HH would become known as "an organization that is going to work with you to help you understand what's going on."This case begins by detailing the environment that Markey found in the Business Services Office when she began. Because morale was low and an atmosphere of tension permeated, Markey was thoughtful and deliberate about her approach and actions as executive director. Huntington Hospital was also deep into preparations for a major software conversion, and from past experience, Markey knew that the implementation would negatively impact AR days. She needed to get the existing processes cleaned up and AR days as efficient as possible to minimize the increase that she knew was coming. To do so, she brought in two consultants. This case leaves off with a description of the initial work that the consultants did with the Medicare team and their assessment of roadblocks to moving forward. Students are asked to develop a proposal for what Markey and the consultants should do. Also see, OB91B: Huntington Hospital (B): Empowering Staff.
