Overview: Orthopedic Institute of Pennsylvania (OIP)
Residents of central Pennsylvania know where to go when they tear an ACL during a game or need relief from back pain. After more than 50 years treating generations of families, Orthopedic Institute of Pennsylvania has achieved brand recognition as a leader in orthopedic injury and specialty care. OIP providers see more than 500 patients a day at six walk-in clinics and five surgical locations, one of which is their own ambulatory surgery center (ASC). Still, as the last remaining independent orthopedic group in the Greater Harrisburg area, OIP faces the same reimbursement headwinds that are impacting practices all over the country. To recover more revenue, they sought out specialty-specific RCM expertise to home in on denials, billing errors, aging AR, and other challenges that were resulting in lost revenue.
Process Improvement to Drive Revenue
OIP partnered with Ventra Health in October 2024, immediately putting into play Ventra’s high-performance revenue cycle optimization processes. With cash flow as the ultimate KPI, the team addressed several pain points across the full revenue cycle and was able to accelerate cashflow and improve the financial health, a few key areas of improved financial performance include:
- Optimized clean claims submission to prevent clerical and coding errors from delaying payments.
- Intelligent denials management powered by data and insights, proactively resolved authorization issues and other problems that could be mitigated to avoid frequent insurance denials.
- Accelerated claim follow-up to boost cash velocity and improve days in AR.
- Strategic approach to AR clean-up to dramatically improve aging AR.
“Cash is king in revenue cycle. An additional $4 million, that’s a big deal to our company.”
— Jay Shoen, CFO of Orthopedic Institute of Pennsylvania
Comparing the first five months of this year to OIP’s 2024 revenue, OIP’s cash per business day is up nearly $21,000.
“Cash is king in revenue cycle. Multiplied by 250 business days in the course of a year, that’s an additional $4 million,” says Jay Shoen, CFO of Orthopedic Institute of Pennsylvania. “That’s a big deal to our company.”
Year-to-date collections are up 8% for OIP’s Orthopedic Division and 14% for the Physical Therapy Division. Average days in AR for the Orthopedic Division has decreased by 5.2 days.
“OIP revenue cycle performance metrics are top tier, excelling in most KPIs. Ventra and OIP are collaborating closely to elevate the few outliers and continue to drive outstanding results,” notes Dyana Garcia, Senior Vice President, Client Success for Ventra Health.
Good Bones: A Foundation of Orthopedic RCM Expertise
Shoen credits Ventra’s specialty-specific expertise for the dramatic early results. Orthopedic practices deliver an extraordinarily diverse range of services including surgery, in-office consultation and treatment, radiology, physical therapy, podiatry, DME (durable medical equipment such as braces and crutches), and pain management.
Orthopedic RCM, then, requires an incredibly nuanced mastery of subspecialized billing rules and procedures. Critical billing and patient data need to be collected upfront from surgical facilities. Coders must be fluent on the guidelines for thousands of CPT codes. Data analysts must monitor a broader set of performance metrics to spot issues that could impact revenue. And the team needs industry experts who are watching for and responding to regulatory changes.
“Ventra’s expertise was evident from the beginning,” Shoen says. “Their ability to identify revenue opportunities and put every resource toward correcting issues instilled confidence early on.”
“Ventra’s ability to identify revenue opportunities and put every resource toward correcting issues instilled confidence early on.”
— Jay Shoen, CFO of Orthopedic Institute of Pennsylvania
It is a perfect complement to OIP’s experienced in-house team, which includes a key leader who has been with OIP for 50 years and others who have been there for more than 20 years. Shoen’s extensive healthcare finance resume includes serving as Revenue Cycle Director for Penn State Health, where he was responsible annually for $2 billion in cash collections.
“My team has high standards, and navigating change can be difficult,” Shoen notes. “For Ventra to win them over, that speaks volumes. Trust is the key. There’s a level of trust, confidence and partnership with Ventra.”
“My team has high standards, and navigating change can be difficult. For Ventra to win them over, that speaks volumes. Trust is the key. There’s a level of trust, confidence and partnership with Ventra.”
— Jay Shoen, CFO of Orthopedic Institute of Pennsylvania
Collaborative Partnership Delivers Results
Ventra’s white-glove approach to client service focuses on being both responsive and proactive. Working together, OIP and Ventra continue to fine-tune processes and optimize the revenue cycle. Led by Sydni Cortese, Client Success Manager at Ventra, the team meets weekly to report on key metrics, review progress on pending projects, and jump on new issues as they arise.
“We’re discovering opportunities for improvement and increased revenue every day,” Shoen notes.
A recent on-site visit to OIP solidified relationships and built an even stronger bond between the two teams. Plans are underway to expand partnership, pursue system enhancements within OIP’s Electronic Medical Record (EMR) and increase automation capabilities to drive efficiency.
“I’m looking forward to what the future brings,” Shoen says. “So far, it’s been good.”
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