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Ten years ago, leaders at the CHRISTUS St. John Hospital would have appreciated a crystal ball that allowed them a peak into their future success. At the time, the then 150-bed hospital in Nassau Bay, Texas, was hemorrhaging millions of dollars due to denials, timely filing issues, and other revenue cycle problems.
The hospital had just invested in a new hospital information system that hosted patient accounting, case management, and other major functions. Leaders had hoped to maximize gains, not increase losses.
Fortunately, this particular crisis ended up inspiring positive change-from the top of the organization. "Our hospital CEO Tom Permetti became very engaged in the situation," says Cassandra Hogans, patient financial services director for CHRISTUS Health. "Tom has created a safe environment for us all to work together and share information. He has eliminated finger pointing and encouraged us to break down silos between departments."
Corporate leaders at CHRISTUS Health have also provided instrumental guidance. For instance, corporate CFO Jay Herron encouraged staff to improve processes and reduce waste by introducing industry-based improvement tools, including Lean Manufacturing and the Toyota Production System. Kaycee Orman, corporate executive director of revenue cycle, also continually reinforces the need for collaboration and process improvement.
All the focus and effort around St. John's revenue cycle has paid off. St. John Hospital is now performing well on financial measures:
Best of all: "All the clinical directors are involved in the billing process and understand our commercial contracts," says St. John CFO David Witt
Patients have also benefitted, especially from efforts to streamline registration and billing and improve customer service. "Our patient satisfaction results are stronger with the improved processes," says Hogan. For example, the admitting department continually scores in the high 90th percentile ranking on Press Ganey patient satisfaction surveys.
One of the most visible changes of the cultural change at St. Johns is what's missing: "In typical business offices, you'll find stacks of papers and mail shoved away in corners, in drawers, and in overhead bins. It's a treasure hunt to find anything," says Hogans.
Not so at St. Johns. All revenue cycle functions are now paperless. All staff and managers can find out exactly what is happening in the revenue cycle by checking what Hogan calls their "visual workstation." "We document progress throughout the day on our management boards," says Hogans. "As a manager, I can see where each of my billing teams is in terms of productivity, etc."
St. John managers and staff also have access to various performance reports and tools that help them identify and address trends and problems. For instance, revenue cycle service staff and leadership receive a daily report on 15 critical indicators, including gross revenues, daily cash, and outstanding balances. Currently, the report is put together manually. Data is pulled from various sources across the hospital, and input into a spreadsheet. But the extra work is worth it, says Hogan. "Data is essential in terms of understanding where we are and where we want to go."
When staff at St. John see a problem or opportunity for improvement, they now have the tools they need to resolve it. "Our staff now use Lean Manufacturing concepts established by Toyota to design and improve processes," says Hogans. "Each team has daily briefings, during which the team talks to whatever issues, opportunities, and problems they encounter during the day. Then, the team takes on the resolution of those issues, assigning various tasks to different team members."
Some of the improvement efforts have focused on making the patient's financial experience simpler and more satisfactory. One example: St. John staff have streamlined the registration process for patients. "We have turned registration into a full-service encounter," says Sandy Green, patient access director. "We now verify benefits during the registration, confirm the patient's responsibility, and explain to the patient in an easy-to-understand manner what his or her obligation will be. So, by the end of the registration, everything that needed to be handled from a registration and billing perspective has all been done in one setting."
Key to this change: Providing registration staff with extensive training and education. "In the old days, the registration process was full of hand offs," says Green. "One person did this, one person did that. Now, all our staff are competent to address everything with regard to registration, including understanding all the managed care contracts we have."
In addition to seeing an increase in patient satisfaction, St. Johns has also witnessed an uptick in upfront payments. "At one point of time, there was belief that patients didn't want to be educated about their bills or have responsibility for payment upfront," says Hogans. "Our results show otherwise. Patients want to be educated and are willing to pay if they have an understanding of their obligations."
Transparency and process improvement goes hand in hand with collaboration at St. Johns. One of the most telling examples: Clinical directors are working with finance to help meet payment limitations and requirements under managed care contracts-without sacrificing quality care.
"Anita Fluharty, regional managed care manager, has done a great job of laying out our managed care contracts in a way that clinical directors can understand," says Witt. "We also get together with clinical directors every four months to review these contracts."
Witt and his staff explain how managed care contracts affect payment for services and supplies in their areas. For instance, they may explain to the orthopedic services director which implants are covered under which managed care contracts so the director can work with physicians to identify the most appropriate implants for patients.
"It's about ownership of your department's charges and breaking down the silos to show that we're all in this together," says Witt. "This is not just the OR show or the billing department show. Everyone at St. John's needs to understand that this is a process that we are all involved in."
Publication Date: Monday, September 21, 2009
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Dale Hockel, senior vice president of operations, and Jim Fanelli, CFO, TriMedx, share strategies for elevating clinical engineering through innovative management programs.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
Scott Schmidt, vice president, Cerner RevWorks, LLC, shares insights on best practices for maximizing a revenue cycle management partnership.
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