HHSC Kauai Region implements a clinically driven revenue cycle for strong growth

Learn how one health system implemented a clinically driven revenue cycle to deliver a healthier bottom line.


That’s the beauty of having a CDRC. It allows a hospital to operate more efficiently and effectively and really have the system work for you—instead of the other way around.

Christine AsatoRegional Chief Financial Officer, HHSC Kauai Region

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Over the past several years, many health systems have run into pain points that lead to underperforming metrics, insufficient workflows, and undefined roles. But Hawaii Health Systems Corporation (HHSC) – Kauai Region began tackling these issues in 2019 by implementing CommunityWorks and a clinically driven revenue cycle (CDRC).

Before implementation, staff were constrained by manual tasks such as charge capture, coding, and documentation.

This focus on process and training, along with the engagement of an operational revenue cycle architect, helped HHSC Kauai Region increase its average daily revenue by 7%.1

Staffers were not only able to track performances through a clinical lens, but also follow patient journeys within their facilities. This helped HHSC Kauai Region in the effort to reduce time spent on manual charge captures.

Accounts receivable (A/R) greater than 90 days decreased by 12.6%[2], while payments increased by 61.7%[3] and clean claim rate (CCR) jumped from an overall 51% to approximately 87%.[4]

Gross A/R days also dropped by 8.8%.5

“It is important for us to understand our puzzle piece and how our pieces connect to each other and the bigger picture,” Asato says. “Patient financial services is responsible for getting the claim out the door and the payment in our bank; registration is responsible for getting accurate demographic information from the patient; coding is responsible for assigning codes based on the documentation provided in the chart; and our clinicians and providers are responsible for making sure all services performed are documented in the chart in a complete and timely manner. When all these moving pieces are working as designed, the CDRC becomes the glue that holds us all together.”

This glue is a major reason why HHSC Kauai Region continued to see additional growth since launching the new system.

“After moving to Cerner, our revenue increased6 while our volume during this same period decreased due to COVID-19,” Asato says.7 “There are two main reasons for the increase in our revenue: 1) better charge capture from our electronic health record, and 2) an increase in swing bed utilization.”


1 Comparing the average daily revenue percent increase from December 1, 2021 to January 31, 2022.

2 Comparing the A/R balance greater than 90 days from December 31, 2021 to January 31, 2022.

3 Comparing payments in dollars from December 31, 2021 to January 31, 2022.

4 Comparing the CCR of 87% (December 2021) to the average CCR of 51% (July 2019 to the end of December 2019).

5 Gross A/R days decreased by 8.5 days (December 1, 2021 to January 31, 2022) which was an overall improvement of 8.8%.

6 Comparing the average daily revenue percent increase from December 1, 2021 to January 31, 2022.

7 This is an industry trend — reflected by Becker's Hospital review industry report comparing patient volume decline by state 2nd quarter 2020 vs. 2nd quarter 2019.

Published:August 30, 2022

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