Delivering High Performance

Although organizations pursue a variety of strategies to attain revenue cycle excellence, results of the research are clear: High performance doesn't just happen. Those hospitals and health systems that are making good on efforts to realize patient-focused and value-driving revenue cycle processes have done so by instilling organizational commitment to their goals.

Efforts must reach beyond the business office. Revenue cycle performance is affected by those across the organization, with success dependent on support from health information management, physicians, nurses, and IT, to name only a few. As such, key actions will be needed from both the C-suite and revenue cycle leadership to attain the widespread support vital for achieving high performance.

Exhibit: Roles in a High-Performance Revenue Cycle

Roles in Driving Value

C-suite executives as well as revenue cycle leadership will need to take active roles in ensuring organizational dedication to improvement in the revenue cycle. The significance of revenue cycle to achieving the organization's mission needs to be communicated throughout the organization.


At the organization's executive level, it is important that leaders focus on instilling an elevation of the revenue cycle at both strategic and operational levels:

  • Set high expectations for revenue cycle positions.
  • Devote organizational resources to improved training and compensation.
  • Develop and participate in intraorganizational teams around revenue cycle.
  • Use patient experience as the cornerstone for setting revenue cycle strategy.
  • Appreciate community dynamics when prioritizing technology spending.
  • Encourage improved monitoring of revenue cycle processes through use of nontraditional metrics.
  • Develop and enforce systems of accountability around monitoring and reporting practices.
  • Support organizational alignment around clear, correct, and patient-friendly messaging.
  • Establish clear and transparent financial assistance policies and procedures.
  • Demonstrate value for the revenue cycle through significant commitment of time and resources.
  • Establish systems to reward high revenue cycle performance.

The importance of executive buy-in to revenue cycle improvement can't be emphasized enough. The role senior leadership plays in pursuing the above actions is fundamental for organizations to truly be effective in executing any operational change.

Revenue Cycle Leadership

At the revenue cycle leadership level, focus should be on ways to extend these concepts into everyday practice. As such, revenue cycle leaders will play key roles in not only developing and implementing tactics to support high performance but energizing the organization around these tactics as well.

To set high expectations for revenue cycle positions:

  • Hire only the most appropriate staff
  • Create detailed job descriptions that outline optimal staff qualifications and skill requirements for revenue cycle positions, and work with executive leadership and human resources so these descriptions align for a natural career path progression from one position to the next
  • Develop and provide formal and informal continuing education, with ongoing training targeted for revenue cycle problem areas
  • Seek improved compensation structures as well as other efforts that drive employee satisfaction, such as bonuses for achieving performance goals or work arrangement flexibility

To encourage patient-focused revenue cycle process improvement throughout the organization:

  • Apply teams of both revenue cycle staff and nonrevenue cycle staff around key process challenges
  • Support inclusion of patient focus groups or advisory councils, ongoing and at the outset of any significant revenue cycle improvement initiative
  • Prioritize process improvements based on what will have greatest impact on patients (Chances are, your top to-do list will include education surrounding out-of-pocket financial obligation and access to financial assistance.)
  • Consider use of established improvement methodologies to assist in defining and streamlining processes

To support value-driving technology investment:

  • Ensure solid processes are in place prior to seeking fixes through automation
  • In addition to financial factors, weigh impact on patient base when making a business case for technology investments

To encourage improved supervision of revenue cycle processes:

  • Strive for performance monitoring and reporting that is frequent and actionable
  • Seek opportunities to provide feedback as close to performance occurrence as possible
  • Explore metrics that others are using and how they are using them to discover new ways to learn more about your organization's revenue cycle performance

To establish communications that are clear, correct, concise, and patient friendly:

  • Streamline the number and repetitive nature of interactions required of patients
  • Ensure written billing statements, applications for financial assistance/charity care, and other financial communications explain what the patient can expect and where to obtain additional help (Use easily understood language, make it available in multiple formats, and provide the communication in other languages if needed.)
  • Supply scripting to staff and similar language on web sites and printed materials so patients receive consistent, appropriate messaging from the time of appointment scheduling through payment processes

To instill a culture of value for the revenue cycle:

  • Create a shared understanding of the importance of the revenue cycle by finding opportunities to demonstrate the impact of revenue cycle functions on patient satisfaction (Educate staff about the many ways their actions can influence the patient's experience.)
  • Demand revenue cycle performance excellence and celebrate when high achievers are able to obtain it (Whether expressed through formal incentive programs or simple notes of gratitude, recognition of success fosters a sense of enthusiasm and motivation for performance improvement.)

Positioning for the Future

Despite how daunting these actions may seem at first glance, particularly given the current environment, it's important to know that challenge alone should not become an excuse for lack of action. As the research has shown, high performers don't always have the latest technology in place or belong to organizations with the most financially desirable characteristics.

What these organizations do possess, however, is a spirit of perseverance. Regardless of the particular revenue cycle strategy pursued, an organization's dedication to successful execution makes the difference.

High performers aren't just good at setting goals. Organizations able to realize their goals possess both the competencies to recognize opportunities and enthusiasm to put these goals into action. Simply put: Attitude makes the difference. Those organizations that stay the course on performing well in those areas that are most important for delivering value to their organizations and the patients and communities that they serve will be best positioned for future success.

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