When healthcare C-suite leaders consistently communicate and evaluate how process improvements are saving lives and improving patient care, those mission-driven employees will become deeply engaged in developing ways to deliver higher-quality care at a lower cost.
For example, at Trinity Medical Center, Birmingham, Ala., president and CEO Keith Granger regularly meets with quality leaders and hospital administrators to tackle quality and cost challenges. Those quality meetings have paid off. Since 2012, Trinity Medical Center has ranked in the top one percentile for Centers for Medicare and Medicaid Services (CMS) process of care measures.
Interested in replicating Granger’s results? Here are the steps he takes to run successful quality meetings:
Meet with stakeholders on a monthly basis. At Trinity Medical Center, Granger runs the monthly 60- to 90-minute quality meetings. The group consists of 20 to 25 individuals, including quality managers and five to seven administrative leaders. Other departments are invited depending on the issues under review. For example, Granger may invite leaders from nursing (e.g., nurse manager/unit director of the operating room, intensive care unit, medical/surgical unit, or the recovery room), pharmacy, materials management, and the lab, as well as staff nurses who can share their hands-on experiences at patients’ bedsides.
While there is no formal agenda, attendees receive information packets that consist of performance results for each of the CMS process of care measures, variations in these processes, and trend charts. Trinity Medical Center closely monitors acute myocardial infarction, congestive heart failure, pneumonia, inpatient and outpatient surgical care projects, ED measures, and venous thromboembolism. After variances and near misses are reviewed, follow-up goals and assignments are identified to prepare for the next scheduled meeting.
Focus the discussion. The group arrives at the meeting ready to solve problems. Although the hospital delivers positive outcomes 99.6 percent of the time, the meeting attendees use a root-cause approach to focus on its few outlier cases and any variances in quality metrics. “What if that one failure was your grandmother, sister, mother, or daughter? The goal must be zero!” Granger says.
Set a tone of high expectations and personal accountability. Granger sets the expectation that incidents will be reviewed by the individuals involved. Although physicians generally don’t attend the meetings because of time conflicts with private practice hours, their input is obtained prior to or after the meeting. The attendees bring a written recap to the meeting and explain what happened, how it happened, and what the organization can learn from it so it never occurs again. “Instead of the leader going to the employee and talking while the employee nods, we reverse that. The employee does the talking so we can understand what he or she understands and has absorbed,” notes Granger.
Anticipate more efficient meetings over time. If the team is doing its job effectively, there should be fewer clinical variances to examine. At Trinity Medical Center, the initial meetings used to last as long as three hours. However, as performance improved and the number of variances and outliers requiring review decreased, the meetings now frequently take just 30 minutes.
Also, as staff have become more focused on improving care, preparation time for analyzing the data before and during the meetings is becoming more efficient. “We often use the remaining time to talk about how process improvements could be applied to other areas, like our readmissions process, mortality review, or how we handle preoperative patients,” Granger says.
Embrace a “no excuses” culture. At the meeting, Granger and his group dissects the monthly variance report line by line in each core measure or outcomes area. For example, when an antibiotic wasn’t delivered on time to meet the core measure standard, the nurse for that patient explained that the medication was not administered because she needed to focus her attention on the patient’s blood loss.
“I stopped the meeting and suggested that if the root cause was blood loss, perhaps we should pull the lab reports to see how we performed with respect to that so we could find out when the blood was ordered and if it was really an impediment to the antibiotic administration,” Granger says.
“What we learned is that we not only missed the goal with respect to the antibiotic but also with respect to administering the blood order. In fact, we pulled 25 patient records to assess our effectiveness on taking orders off the chart at time of admission and implementing initial orders to understand the root of the problem. We really dig to look at documentation and evaluate care,” says Granger.
Provide training. To perform regular reviews of performance on CMS quality measures, staff must understand the agency’s rules. Granger’s team began by studying CMS rules and guidelines and then training staff on the requirements. They also learned from other high performers in the industry and by examining their own performance.
Structure the process. Granger credits the success of the quality meetings to the team’s monthly review process. Once the team understood CMS’s requirements, they developed the quality meeting structure to share their expertise, knowledge, and results. By examining variances in performance on CMS measures every month on real patients and situations, they are able to identify solutions so problems don’t reoccur.
Find the time. “Leaders will often say they don’t have time to run quality meetings,” says Granger. “Yet, we find time to review financials and budgets. We find time to review strategic plans. We must find time to ensure the same excellence in clinical outcomes for our patients and the reputation of our organizations.”
The collaborative process behind Trinity Medical Center’s quality meetings has created an open atmosphere that encourages hospital leaders and staff to recommend solutions, rather than make excuses. Through bottom-up discussions led by team members closest to the problem, hospital leaders can determine the root causes of near misses and outlier cases and take steps to resolve problems that hinder quality
Dan Collard is a senior leader, coach, and national speaker for Studer Group, Gulf Breeze, Fla.
ClearBalance: Boosting Patient Payment through Consumer-Friendly Loan Programs
Deloitte Consulting LLP: Employing Innovative Solutions to Optimize Revenue Cycle Performance
Grant Thornton LLP: Maintaining and Improving Collections During an EMR Implementation
KeyBank: Offering Expertise in Tax-Exempt Financing to Give Health Systems Flexible Options for Growth
Xtend Healthcare: Enabling Efficient Business Office Workflow
SSI: Bringing Patient Access to the Next Level
Deloitte: Helping Organizations Elevate the Healthcare Consumer Experience
TriMedx: Elevating and Streamlining Clinical Engineering
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
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.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
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.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
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.
The Future of Online Patient Billing Portals
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.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
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.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
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.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
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.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
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.
Revenue Cycle Payment Clarity
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.
Streamlining the Patient Billing Process
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.
Wallace Thomson Hospital Automates to Maximize Limited Resources
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.
7 Steps for Building and Funding Sustainability Projects
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.
Key Capital Considerations for Mergers and Acquisitions
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.
Key Capital Considerations for Mergers and Acquisitions
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.
Trend Watch: Providers adapt as value-based care moves from hype to reality
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 case study
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.
Reforming with a New 50-Bed Acute Care Facility
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.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
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.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
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.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
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.
Providers Focus Too Much On Revenue Cycle Management
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.
Lucille Packard Children’s Hospital Stanford Case Study
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.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
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.
ZOLL and Emergency Mobile Health Care Case Study
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.
Maximizing Medicare Reimbursements White Paper
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.
Denials Deconstructed: Getting Your Claims Paid
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.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.