Troy Spring never planned for a career in revenue cycle. “No one really does that,” he points out, laughing. However, his experience and career path ultimately brought him to his current role as vice president of revenue cycle at SCL Health.
After working in managed care early in his career, Spring joined his father’s consulting company, which included a subsidiary third-party administrator for healthcare providers who were taking risk from third parties. The company managed capitation risk payments from insurers and HMOs, adjudicated claims, paid providers, and prepared all associated financial analysis and reporting—what Spring describes as “a mirror image of the revenue cycle.” The business narrowly survived the dot-com bubble, but it was unable to overcome the investor anxiety that followed 9/11. Given these challenges, Spring and his father both chose to pursue other career opportunities.
Then, on a friend’s recommendation, Spring applied to and took a job at Duke University Health System. “My first job was in data analytics on the revenue cycle, which gave me real insight into the complete cycle, from patient access all the way through to self-pay billing and collections,” Spring says. He soon moved into a director position and did what he calls “a tour of duty in revenue cycle.” He also earned a master’s in healthcare administration from the University of North Carolina.
After receiving his master’s, Spring was ready for the next step, and accepted a role as the vice president of revenue cycle with SCL Health, an organization originally founded by the Sisters of Charity of Leavenworth, which started serving the community 1864. Today, SCL Health is a $2.6 billion, eight-hospital health system located in the Broomfield, Colorado.
Spring’s role at SCL Health is to ensure that the organization is collecting outstanding payments as quickly and efficiently as possible. On the surface, the role of the function is operational; however, the services it provides and the impact of its work goes well beyond operations and directly impacts SCL Health patients.
“The bigger picture for us centers around the patient experience—trying to help the patient navigate through the complexities of billing,” he says. “There’s a big focus on pricing transparency, patient-friendly billing, and trying to make sense of the complexities of the billing world. As an industry, we are still navigating revenue cycle challenges, but consistently improving and becoming a leader in these areas is a top priority for us.”
SCL Health is a member of the Healthcare Financial Management Association, which annually recognizes high-performing revenue cycle operations through its Measure, Apply, Perform award (MAP). The efforts the award is named after, or the MAP Initiative, is a comprehensive strategy designed to help organizations measure and strengthen their performance by applying evidence-based improvement strategies to their revenue cycle. SCL Health has set a goal of earning the award by 2025, which requires meeting industry standard revenue cycle benchmarks, implementing patient-centered recommendations and best practices, and achieving outstanding patient satisfaction scores.
“The bigger picture for us centers around the patient experience—trying to help the patient navigate through the complexities of billing.”
“We are deliberately tracking metrics across our department and comparing our performance to industry data,” Spring shares. “The numbers show that we are a well-performing department; however, the process has highlighted areas of opportunity and it is our goal to continue to improve.”
One area where SCL Health has already made substantial progress is in reducing its candidate for bill (CFB) days, or the time it takes to bill an account. “Getting a bill out the door seems pretty straightforward, but it’s actually a complicated process,” Spring says. Revenue cycle managers have to make sure that medical documentation supports the billing, that it is coded properly, that all charges are captured, and that regulations are being followed. Then, bills go through multiple rounds of billing edits. Under Spring’s leadership, SCL Health has reduced CFB days from nearly nine to approximately three.
Spring credits the change to two things. “We had really good, strong analytics and reporting, and we have a multidisciplinary team that meets biweekly to review inventories and to make sure that we’re hitting established targets,” he says. “We have discussion on how we can improve or reduce our unbilled accounts to the levels we need to be able to get cash more quickly.” The team includes staff from Health Information Management, coding, billing, patient access, care sites, care management, revenue integrity, and other units.
As a nonprofit with a mission to improve the health of people and communities, especially people who are poor and vulnerable, SCL Health provides myriad programs to help patients access and pay for care. A team of financial counselors, among Spring’s seven hundred-fifty staff members, help patients enroll in Medicaid. SCL Health’s financial assistance policy helps uninsured and underinsured patients access and pay for the care they need. The system also provides charity care and employs certified staff members to help patients navigate the Affordable Care Act.
While processes and numbers are often a large part of revenue cycle work, Spring is a strong believer that the work is all about people and relationships. “I love the people part of my work,” he says. “Helping to foster a vision for our team and following through on that vision in our day-to-day work will ultimately help us better serve the individuals relying on SCL Health for top-quality care and the best experience.”