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Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
By Suzanne Lestina
Providers are being challenged with payment changes and cuts, increases in uncompensated care, and the implementation of ICD-10 and other federally unfunded mandates. This has resulted in hospital budget cuts and cost reductions. Revenue cycle leaders will continually be challenged to do more with less.
It is clear that thriving in today's healthcare environment requires strong leadership. I have seen this firsthand among HFMA's 2011 MAP Award winners, all of which have achieved the designation of "high performance in revenue cycle." Getting to that level requires revenue cycle leaders who are not just good but great. These leaders have the necessary desire and skills to continually move their organizations to higher levels of performance.
Patient-friendly revenue cycle approaches are key to improving overall performance. While each of the 12 2011 MAP Award winners had to meet financial goals, they were also challenged to improve patient satisfaction and the patient experience. MAP Award winners had to achieve a score of 75 percent or higher for "would definitely recommend" in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
While revenue cycle leaders are unique and leadership styles vary, there are five traits that I believe move these leaders from "good to great," to borrow a term from Jim Collins.
They measure improvement. Although high-performing revenue cycle leaders' metrics score in the top quartile, they are never satisfied. They refer to their performance as good and then immediately talk about what they can do to move the metrics even higher. For example, when it comes to point-of-service cash collections, I've never heard a great revenue cycle leader say, "I'm happy where we're at." Instead, I hear things like, "We've done a good job, but we can do even better."
They compare performance. At a recent HFMA event, a revenue cycle leader shared one of his organization's performance metrics. He thought his organization's net days in accounts receivable was right around the top performers in the industry. But when I asked him, "Compared to what and whom?" the revenue cycle leader wasn't exactly sure. A good leader compares his organization's performance to other industry organizations and confirms they are doing a good job.
What elevates a revenue cycle leader from good to great is their desire to figure out where their organization's performance on metrics stands in the industry and how they compare with their organization's peers, as well as how to move those scores to a higher level.
They identify solutions-with an emphasis on patient-friendly practices. High-performing revenue cycle leaders conduct in-depth analyses of their current performance, leverage peer comparison data to set meaningful goals, and set realistic targets to move their performance scores from good to great.
In identifying potential solutions, they consider how patients will be affected and aim to implement patient-friendly practices. For example, one award-winning organization implemented an online bill payment program to increase collections. However, by streamlining the collections process, the program eliminated personal contact with patients. Because not all patients are comfortable sharing their credit card information online, the organization allowed patients to opt out of the online payment program and instead talk to a patient financial services representative to finalize bill payment.
Another award-winning organization was able to improve its scheduling process by grouping all pre-encounter services-including schedulers, preregistration and verification staff, financial counseling, and pre-arrival nursing-together to address patient needs.
A third organization was able to develop an "out-of-pocket" calculator for their registrars to produce accurate information on copays, deductibles, and coinsurance for patients.
They share best practices with peers. Great revenue cycle leaders are always looking for ways to implement best practices. They do this by asking questions, challenging status quo, engaging in conversations with their peers, and bringing that information back to their organizations to determine if there are other, better ways of improving performance.
At the 2011 MAP Event this past October in Miami, MAP Award winners shared revenue cycle best practices with their peers. There were many instances of "a-ha" moments, as stated to me by one attendee: "Suzanne, education was great. I came back with a couple of novel ideas, and that always thrills me. I'm more excited than ever about the MAP initiative and what it's doing for the revenue cycle. I met a lot of people who were inspired-just as I was-to rise to the top when, in the past, being average was OK. After the panel discussion, I had a couple of good conversations with folks about just how to make it happen, too."
They engage staff in improving patient satisfaction and financial outcomes. High-performing revenue cycle leaders invest in their human resources. Great leaders understand that their staff are one of their most valuable assets to ensuring that financial and patient satisfaction outcomes are not only achieved but sustained.
MAP Award winners have implemented several ways to track staff interaction with patients to improve patient satisfaction. For example, at one organization, patients who talk to a staff member-at the front end and at the back end of the revenue cycle-are asked to rate how their call was handled. The staff member records the patient's response on a scale of 1 to 5 (5 being the highest), and any score below 3 is used for additional training to improve the patient experience.
High-performing revenue cycle leaders take a disciplined approach to process improvement and patient satisfaction. This includes encouraging innovative ideas, engaging staff, implementing innovative patient-friendly processes, comparing performance to their peers, measuring their success, and striving to push the bar to the highest level of revenue cycle performance possible.
The many challenges facing revenue cycle leaders today-and on the horizon-can be overwhelming to a good leader, but a great leader is ready to take them on.
Suzanne Lestina is director of revenue cycle MAP, HFMA (firstname.lastname@example.org).
Learn more about HFMA's MAP initiative.
Publication Date: Friday, November 18, 2011
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Copyright 2016, Healthcare Financial Management Association.
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