Browse by Topic
Learn more about the healthcare finance industry's leading professional association. Find out why our members rely on HFMA as their go-to source for insight and information.
Members have many options for helping them advance their careers. Conferences, seminars, eLearning, certification, and more -- our education and events will keep you motivated.
Stay up-to-date in a rapidly changing industry in Fort Lauderdale (Nov.16-18) and Chicago (Dec. 12-14). Register early and save.
Learn how to increase receivables, reduce denials and work more efficiently with HFMA’s new Certified Revenue Cycle Representative certification program.
Find out how to achieve recognition as an Adopter of best practices to earn your patients’ trust when it comes to financial matters.
Our newsletters offer targeted articles with
technical how-to details and thought-provoking insights from healthcare finance
leaders and industry experts.
The Helen Yerger/L. Vann Seawell Best Article
Award recognizes articles for outstanding editorial achievement in hfm
Information about leading vendors helps your buying decisions.
Forum members can network during live webinars or access a library of past webinars on topics such as ICD-10 implementation, CMS audits, bundled payment, charity care, KPIs, and more.
An ever-expanding collection of spreadsheets, policies, job descriptions, checklists, and more that you can adopt and adapt.
Forum members can submit vexing questions to a panel of experts using our Ask the Expert service.
Your source for employment solutions.
Find new employment opportunities or
reach out to qualified candidates.
Distinguish yourself as a leader among your peers and advance your career by earning certification in our healthcare finance programs.
Get an objective third-party evaluation of products and services used in the healthcare finance workplace.
MAP App is a web-based application that helps organizations improve revenue cycle performance based on industry-standard metrics called MAP Keys.
Find suppliers and products in this comprehensive vendor directory for healthcare finance professionals.
Guidance for understanding and communicating about the price of health care.
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 Jason Bramwell
Photo courtesy of Harborview Medical Center, Seattle.
As part of a yearlong fellowship, Harborview Medical Center patient safety officer Ross Ehrmantraut, RN, had to design a project that would advance patient safety and quality improvement in his organization.
At that time, the Seattle-based hospital's medicine/geriatric unit had a worrisome patient fall rate: more than six falls per 1,000 patient days, versus a hospitalwide average of just under five falls per 1,000 patient days. Even more alarming: During 2008, 21.5 percent of the unit's patients who fell suffered serious harm, such as a fracture, head injury, or even death.
Ehrmantraut had his fellowship project: to build a multidisciplinary team approach to preventing falls in the medicine/geriatric unit. The project's goal was to reduce patient falls on the unit by 20 percent in six months. Recognizing that not all falls can be prevented, the project team also focused on decreasing harm in patients who fell.
When the pilot project concluded in December 2010, the multidisciplinary team had exceeded its goal, reducing falls on the unit by 35 percent-and none of the falls resulted in serious harm. Six months later, patient falls on the unit decreased by another 21 percent.
"In 2011, our rate of patients who fell with serious harm dropped to 16.5 percent," says Ehrmantraut. "We were guarded about our results early on, thinking it could be a fluke. But it's not a fluke-it's a sustained improvement."
The majority of patient falls are preventable-and expensive. According to the Centers for Disease Control and Prevention, the average hospitalization cost for a fall injury is $17,500. Hospitals are no longer reimbursed by Medicare for certain hospital-acquired conditions-such as patient falls-that could have been reasonably prevented.
To determine how to prevent falls among medicine/geriatric unit patients, Ehrmantraut and four other team members-a nurse manager from the medicine/geriatric unit, a clinical nurse specialist, a physician, and a pharmacist-began reviewing the causes of falls, such as going to the bathroom without assistance.
"Our medicine/geriatric floor has patients who suffer from drug and alcohol addiction, and some falls were related to delirium or confusion associated with withdrawal," says Ehrmantraut. "Also, during physical therapy, for example, if a patient starts to fall and the physical therapist helps them to the floor, we count that."
The team also realized that physicians and pharmacists had little to no involvement in fall prevention. "It's always been the nurses' and patient care assistants' job to deal with fall prevention and risk assessment," says Ehrmantraut. "The physicians seldom put any energy into it. Pharmacists were involved in fall prevention on a limited basis-or not at all. In fact, pharmacists and physicians were unaware that the nurses conducted a daily fall risk assessment at 8 a.m. every morning."
The physician on the project team-a geriatrician who had previously been involved in fall prevention-was instrumental in changing this dynamic and getting physicians and pharmacists more involved in assessing and addressing fall risks, says Ehrmantraut.
Ehrmantraut credits the following strategies for reducing patient falls on the medicine/geriatric unit.
Presenting intensive reviews to staff. Ehrmantraut says the biggest factor to reducing patient falls on the medicine/geriatric unit was involving staff in solutions through monthly intensive reviews. Staff had previously received a monthly report that summarized how many falls occurred during the previous month and how many had resulted in harm. Now, Ehrmantraut gives a more detailed PowerPoint presentation to the unit's day and night shifts. The presentation breaks down falls by patient, location, fall risk score, and other details. During the monthly meeting, Ehrmantraut encourages staff to discuss ways to prevent those patients from falling again.
"I was surprised by how much staff love this," he says. "During a meeting, I'd say, 'Here are the five patients who fell in your unit last month. Here's Mr. Smith's fall risk assessment score, his fall history, and where he fell. What can we do to prevent this from happening again?' I put a name to the number, and that's been powerful."
Access Sample Intensive Review
Developing a new fall prevention tool. Harborview nurses assess a patient's likelihood of falling by using the Morse Fall Scale. Nurses assign a score to six variables-the higher the risk, the higher the score.
However, the tool is sometimes inaccurate in predicting a patient's fall risk, says Ehrmantraut. "I review patients' risk assessment scores across their hospital stays, and oftentimes, I'd see a patient was given a 'no risk' score the same day she fell," he says.
This prompted the team to develop its own fall prevention discussion tool, which encourages nurses and physicians to assess a number of fall factors that are not included on the Morse Fall Scale, including the following:
Access Sample Fall Prevention Discussion Tool
"For example, a nurse and physician may agree that a patient has a high fall risk due to his medication and would check with the team's pharmacist to determine if the medication needs to be re-evaluated," says Ehrmantraut. "During morning rounds, the pharmacist might say that the patient was started on a new antihypertensive drug two days ago, and that he would be a high fall risk. When possible, medications are adjusted to decrease the fall risk."
Using yellow to identify fall-risk patients. The hospital adopted the industry standard of using yellow to identify patients who are fall risks. Those patients are recognized by yellow armbands, yellow blankets on their beds, and yellow slippers. "Our staff knows to call a nurse immediately to assist patients who are walking by themselves in a hallway wearing yellow slippers," says Ehrmantraut.
Implementing hourly rounding. A nurse or a patient care assistant is required to stop in a patient's room each hour to check on the patient and identify any needs the patient may have, such as assistance to the bathroom.
Pleased with the results on the medicine/geriatric unit, Harborview leaders asked the multidisciplinary team to help spread the fall prevention strategies to other units, which has resulted in widespread success. For example, the psychiatric unit-which had the second-highest fall rate-realized a 33 percent drop in patient falls in the past six months after implementing intensive reviews and the fall prevention tools. Also, the number of repeat fallers at Harborview has dropped 50 percent in the past six months.
This past May, the National Patient Safety Foundation, in conjunction with the National Association of Public Hospitals and Health Systems, awarded Harborview the 2011 Patient Safety Initiative at America's Public Hospitals Leadership Award for its work in preventing and reducing patient falls.
"It was big news around here. Our CEO, our medical director, and our CNO were very excited. Our front-line staff, including physicians and pharmacists, were ecstatic-they were the ones who did the work," says Ehrmantraut. "It turned into a mission for the medicine/geriatric unit to prevent falls, and it's now turned into a mission for most of the hospital's units. We used to have the attitude, 'Well, falls happen.' That has changed."
Jason Bramwell is associate editor of newsletters and Forums, HFMA (email@example.com).
Interviewed for this article:
Ross Ehrmantraut, RN, is patient safety officer, Harborview Medical Center, Seattle (firstname.lastname@example.org).
Publication Date: Monday, February 20, 2012
In this Business Profile, Shawn Yates, director of healthcare product management at Ontario Systems, discusses the growing challenge of managing self-pay accounts and provides insight on how providers can successfully collect patient payments.
In this business profile, Cathy Smith, leader of the revenue transformation consulting practice at The Claro Group discusses how the organization helps hospitals and medical groups reimagine their revenue cycle.
In this business profile, Deloitte & Touche LLP executives Anne Phelps, principal and U.S. healthcare regulatory leader, and Daniel Esquibel, senior manager, explain ways health systems, health plans, and physician practices can prepare for MACRA.
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
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.
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.
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.
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.
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.
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.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
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.
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
HFMA offers online, email, and print opportunities to help you recruit the most talented healthcare finance professionals. Place your classified ads today.
Drive down costs while improving quality in a reform environment.
Receive expert insights and how-to action to achieve and maintain peak revenue cycle performance.
Access expert insights on financial forecasting/planning, strategic partnerships, capital allocation, and more.
Copyright 2016, Healthcare Financial Management Association.
Join HFMA today and enjoy: