United States

Growing surgical hospital revs up revenue cycle strategy


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Siouxland Surgery Center, located in Dakota Dunes, South Dakota, is a 40-bed surgical hospital, which began as the region's first free-standing surgery center specializing in same-day surgery. Established in 1994, physician founders set out to build an institution to meet the growing health care needs of the community. Over the years the center has seen incredible growth in cases and employees, facility and services, the advancement of technological capabilities, and the education and expertise of their staff. They are recognized as a leader across the country in quality and patient satisfaction.

Currently, the center's facilities include a 100,000-square-foot licensed hospital with more than 210 physicians and over 200 employees. The hospital has grown from six operating suites to 14 over the years.

Some of the organization's key achievements include being awarded the Press Ganey Summit Award for Patient Satisfaction and the Bernard A. Kershner Innovations in Quality Improvement Award. The Siouxland Surgery Center has also been named No.1 in the state of South Dakota for major orthopedic surgery, one of the top 100 hospitals in the nation by WomenCertified, and is ranked among the top 10 percent in the nation for spinal surgery.

Challenges and approach

While growth, success and quality of care have been the mainstay for the organization, Siouxland Surgery Center has also experienced its challenges. With its phenomenal, fast-paced growth, revenue cycle challenges were also revealed. Combined with the pressure of new regulatory compliance changes, impending coding transition, the overall shift to a more patient-centric care and outcomes-based health care structure, the existing revenue cycle processes required improvement to support the center's future growth and commitment to optimal patient care.

Tapping into their existing professional relationship with RSM (the firm had been their auditor for a number of years), the center's leadership reached out to RSM's financial advisory services team for help. This was especially timely as the center required trouble-shooting and implementation help in launching their new electronic health record (EHR) initiative, a critical strategy that had been delayed after failed attempts.

The RSM team performed a rapid assessment to understand the center's EHR efforts, along with current revenue flow systems. After thorough discussions with leadership and staff, along with careful analysis of existing processes, the team provided recommendations to address some of the troubled areas impacting the center's revenue, including key performance indicator summaries comparing current performance against industry standards and recommendations for training and forecasting improvements.


The strategic modifications have advanced the center's revenue cycle efforts into a more efficient and sophisticated strategy. As one RSM consultant indicated, the upgrades have taken the center from “rocks and stones to rocket ships” when describing the evolution from paper-based revenue cycle to EHR.

Siouxland Surgery Center CEO, Greg Miner, said working with RSM was critical to their success as an organization. “The team brings such a vast array of services. They know us and the health care industry. It was important to us to work with someone who could step in, support our existing resources and be available at any given time in that advisory role.”

Final solutions provided the following outcomes for the center:

  • Successful EHR launch and implementation
  • Revenue cycle operational process improvements impacting key performance indicators, cash acceleration, cash flow, accounts receivable and business office enhancements
  • Standardized work flows and automated key functions and controls
  • Process improvements across the organization
  • Change and behavioral management improvement through ongoing staff training
  • Critical knowledge transfer to revenue cycle management and bench support

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