Providers that employ the so-called “swivel-chair strategy” to manage their legacy accounts receivable (A/R) when navigating through a conversion or implementing a new revenue cycle management platform, risk serious disruptions in performance and, in worst cases, a significant hit on cash reserves/cash collections.

A swivel-chair strategy requires billers and collectors to work in two systems – the legacy A/R system and the new revenue cycle system at the same time, as opposed to outsourcing the legacy A/R. There are four key problems with this strategy:

1. Collectors rely on what they know. Professionals in any field are accustomed to a particular process and way of work based on training and experience. Because billers know the old system best, they are less likely to work effectively and accurately in a new system – when having to swivel between the two.
2. New system training is negatively impacted. In order to train effectively, revenue cycle staff need time to learn the new system. When billers and collectors spend their time inputting data into the legacy system, it is time they are taking away from learning the new system.
3. Split attention impacts work quality. In a swivel-chair approach, one staff person is performing two jobs. This arrangement, particularly if it lasts a long time, can impact the quality of the work, with inaccuracies likely resulting in revenue loss. 
4. Employee burnout and turnover can increase. The stress of a conversion is significant when added to staffs’ normal workload. A swivel-chair approach exacerbates the problem because it doubles the work required and compromises their ability to learn the new platform.

Additional stress is caused, in part, by the cognitive dissonance introduced when revenue cycle teams are working in two platforms. Many people find it difficult to learn the new platform, processes and procedures while still working in the old system.

As such, the consequence can be that new procedures and processes are not adhered to, and familiarity with the old process—and all its flaws—make its way into the new workflow. Typical errors include compliance failures and inaccurate claims and remedial follow-up, which can lead to denials and delayed or reduced revenue.

The risks created by the swivel-chair strategy should give providers pause during the pre-conversion planning process.  All leaders want to seamlessly introduce new systems, without operational upheaval or a disruption to cash flows or billings.

Considering a swivel-chair approach as a way to deal with legacy A/R carries significant operational and financial risk. Are you willing to risk a delay in cash flow? Or, worse, tap into vital cash reserves to account for the problems that a swivel-chair approach may introduce?

Often, the success of a revenue cycle conversion has little to do with how well the health system converts to the new system, but instead how well it manages the legacy A/R while they are converting. In order to keep cash flow at or above historic rates, most high-performing revenue cycle shops and reputable consultants recommend a legacy A/R outsourcing strategy to augment their efforts before, during and after a system conversion.

Working with a vendor partner experienced in system conversions and that is familiar with a myriad of revenue cycle platforms can alleviate these problems. The right partner enables your internal staff to train on a new platform and learn new procedures and policies, while the partner focuses their attention on your legacy A/R.

This alternative to a swivel-chair approach enables accounts to be reconciled, and cash flow to be supported, all while the new system starts generating revenue.

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