In search of efficiency opportunities and in recognition of the vast difference in cost to collect between healthcare and other industries, Duke University Health System set out to develop labor standards for the revenue cycle functions in line with the approach taken by the clinical field many years ago. Whereas clinical labor standards and benchmarks were a widely available and generally accepted management tool, revenue cycle cost statistics were mired in differences in definition and data capture. As the number of revenue cycle performance statistics and the claims of efficiency opportunities from bolt-on technologies and revenue cycle management companies grew, correlated cost statistics lagged resulting in vague business case assessments.

Duke addressed this issue through the use of management engineers and the development of time study labor standards for its revenue cycle functions. Duke has been able to use these labor standards across the following applications:
- Revenue cycle budgeting
- Allocation modeling across the multiple providers serviced
- Foundation for six sigma and lean office process redesign prioritization
- Payer collaboration and efficiency initiatives
- Technology, outsourcing and process redesign ROI justification

By improving the decision-making across the applications noted above, Duke has been able to both drive down its cost to collect as well as improve its revenue cycle performance. Additionally, Duke is better able to model the impact of industry, regulatory and/or political reform/trends aimed at the need for provider efficiencies and revenue cyle activities.