A Critical Access Hospital at a Crossroads
As Iowa’s second-largest Critical Access Hospital (CAH), Mahaska Health is essential in delivering care to the state’s Southeastern region. Yet despite strong internal leadership and a history of process improvements, persistent revenue cycle challenges prevented Mahaska from operating at its full financial potential—especially around claim denials.
Having partnered with Stroudwater Associates in 2018 for a system-wide turnaround, Mahaska leadership knew where to turn. That initial engagement identified nearly $1 million in potential revenue cycle improvements, with the majority rooted in denials management. In 2024, Mahaska invited Stroudwater back—this time for refinement.
“We had made a lot of changes over the last five years,” said Kindal Donnelly, Executive Director of Revenue Cycle. “But we knew we could do more. Stroudwater didn’t just point out problems—they gave us the roadmap to get better and made sure we supported throughout the whole process.”
A Holistic Revenue Cycle Assessment
When Stroudwater returned, consultants Amy Graham, MBA, CRHCP and Ryan Breneman, DBA, brought a peer-level approach that resonated with Mahaska’s team. They spoke the same language—revenue cycle, not finance—and worked collaboratively with Mahaska leadership to identify both strategic opportunities and practical fixes.
At the heart of the engagement were three major initiatives: improving denials management, enhancing front-end collections, and creating a sustainable KPI-driven performance culture.
Tackling Denials Through Strategy and Simplification
Donnelly and Stroudwater immediately identified denials management as the top priority. The volume of claim denials, particularly Medicare-related ones, held Mahaska back. To address this, the team focused on the following:
- Workqueue Simplification: Mahaska’s Epic system had created a sprawling set of workqueues—automated task lists for billers—leading to workflow bottlenecks and staff overload. Stroudwater recommended simplifying and streamlining these queues. By eliminating redundancy and reducing complexity, Mahaska improved staff productivity (raising benchmarks from 50% to 60%) and ensured faster follow-up on high-priority claims.
- Medicare Denials Vendor: Stroudwater also recommended bringing in a third-party vendor to focus on Medicare denials, helping Mahaska uncover actionable denial trends. This decision allowed Mahaska to reclaim time, improve outcomes, and focus internal staff on higher-value activities.
Building a Front-End Process with Precision
Stroudwater’s recommendations were not just about the back end. One of Mahaska’s most significant improvements came from proactively reshaping its front-end collections strategy.
- The registration team began working toward a $150,000 monthly point-of-service collection goal, focusing on copays, balances, and high-dollar services.
- To hit that target, they built out proactive workflows: for example, if a patient is scheduled for an expensive service like an MRI, the team handles prior authorization in advance, then reaches out via phone, email, and mail to collect payment ahead of the visit.
- Stroudwater also helped introduce an internal incentive program that rewarded registrars who met 50% of their individual monthly goals, helping boost collections by over $21,000 within two months.
These strategies shifted Mahaska’s collections model from reactive to predictive, positioning the front-end team as a key driver of financial performance.
From Gut Feeling to Data-Driven Leadership
Before 2024, Mahaska relied on Epic’s built-in dashboards, which offered limited and highly variable insights depending on the user. Stroudwater helped the team build a custom KPI dashboard tailored to Mahaska’s strategic goals and team structure.
With Amy and Ryan’s guidance, Mahaska implemented the following performance indicators:
- Net Days in AR
- Cash Collection as % of Net Revenue
- Bad Debt as % of Net Revenue
- Clean Claim Rate
- Claim Denial Rate
- Point-of-Service Collections Rate
- % of Claims Paid Within 30 Days
- Payer-Specific Denial Rate
These metrics are now tracked in weekly leadership meetings, turning the revenue cycle from a reactive department into a forward-looking strategic function. “It gave us what we were missing,” said Donnelly. “We weren’t data-driven before—but now we are. We have what we need to keep improving.”
A Partner That Meets You Where You Are
Stroudwater’s approach left a lasting impression on Mahaska’s team, not only in outcomes but in how those outcomes were achieved.
“Stroudwater had a great balance of support and straight talk. They recognized the hard work we’d already done but weren’t afraid to challenge us when something could be better. Because of their deep revenue cycle background, it felt like gaining a peer—not just a consultant. That made their feedback easier to trust and even more impactful.”
With that blend of empathy and precision, Mahaska Health has emerged stronger than ever—more confident, more data-driven, and ready to continue its journey toward operational excellence.
“Stroudwater’s insight and expertise have been invaluable. Their hands-on approach helped us refine our revenue cycle processes and implement strategies that will sustain our financial stability for years to come.”
— Kindal Donnelly, Executive Director of Revenue Cycle, Mahaska Health
Learn more about Stroudwater’s approach to revenue cycle optimization.
