Many of the hospitals that earned a 2011 MAP Award for High Performance in Revenue Cycle found success by putting their focus on the patient experience.
Although the 2011 MAP Award winners addressed a wide range of revenue cycle challenges, Suzanne Lestina, HFMA’s director of revenue cycle MAP, found three common themes in their success stories.
- Collaboration as a cultural value: “More than ever before, I am seeing a shared understanding among departments and organizational levels, as well as a shared accountability for achieving outcomes,” she says.
- Root cause analysis: “I’m seeing people implement process improvement, but they are also doing a root cause analysis to identify the source of the problem and fix it at a deeper level,” says Lestina.
- A focus on patient satisfaction: “The focus on patient satisfaction is phenomenal,” she says. “It’s obvious that there is buy-in from the CEO all the way through the organization."
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Collaboration as a Cultural Value
Lestina says revenue cycle leaders are increasingly building accountability into employment agreements, performance evaluations, and pay.
“There is a deep collaboration where goals and performance appraisals and bonuses are tied to revenue cycle metrics,” she adds. “This isn’t a ‘rah-rah-rah, we’re all in this together’ thing. This is skin in the game that makes collaboration and accountability essential.”
For example, at Princeton Baptist Medical Center in Birmingham, Ala., all employees are required to sign the Baptist Health System Patient Promise as a condition of employment. In signing this agreement, employees commit to delivering an exceptional patient care experience, which helps ensure that patients go on to recommend the hospital to others.
Another example: When Baptist Hospital of Miami relied on registrars to make out-of-pocket estimates for diagnostic services, leaders realized that accuracy and consistency in the estimates was lacking.
The hospital’s corporate pricing office led an effort to develop an “out-of-pocket calculator” for the registrars based on the payer contract terms needed for accurate calculations. The out-of-pocket calculator also integrates chargemaster information provided by the revenue pricing and integrity department. The IT department programmed the calculator, and the patient access department helped determine the formatting and tested the tool’s performance and accuracy.
The result: The calculator allows registrars to produce accurate information on copays, deductibles, and coinsurance while maintaining the confidentiality of the contract terms.
Root Cause Analysis
While reviewing applications for the MAP Award, Lestina found that health system leaders are unwilling to “Band-Aid” a problem when a diagnosis and intervention is needed. “They are leveraging root cause analysis by using data and facts to eliminate finger-pointing,” says Lestina.
Root cause analysis involves determining what happened and why—and identifying a potential action plan for preventing future problems.
For example, when cash realization for CHRISTUS St. Catherine Hospital’s Blue Cross team was below acceptable levels, a root cause analysis revealed that the patient’s share of the bill was not being collected at the point of service (POS). The Blue Cross patient financial services team worked to support the patient access team to improve POS collections. In addition, the contract manager for Blue Cross was brought into the discussion so this issue could be addressed in future negotiations with the insurer.
A Focus on Patient Satisfaction
Savvy revenue cycle leaders are creating their own survey tools to understand how patients feel about the nonclinical aspects of their hospital experience.
“The patient satisfaction surveys that are out there currently do not drill down to reveal where within the revenue cycle the process may have failed the patient and created a negative experience,” says Lestina. “Creating an internal survey—or even scripting so that staff members ask patients about their experience at the end of an interaction—allows you to get feedback from the patient in a more timely and more detailed way.”
At Texas Health Presbyterian Hospital in Plano, every patient who calls the patient access intake center or the billing office receives a question: “How would you rate the level of service I provided today?”
Patients are asked to rate the service on a scale of 1 to 5. Results are recorded for every call and tabulated weekly and monthly by a customer representative. Patients who give less than satisfactory scores receive a follow-up call from a manager. The reasons for low scores are discussed in department meetings, and two trainers help staff members improve not only the technical knowledge of their jobs, but also customer service.
“This effort—to survey patients at the time of preregistration and after calling the billing office—sends a message to the patients that, at the bookends of their hospital experience, we truly care about providing great service,” wrote Texas Health Presbyterian in its MAP Award application. “We’re not just concerned with the hospital/clinical experience, but also with the entire experience, including the revenue cycle.”
Baptist Hospital of Miami uses patient satisfaction surveys as a management tool by emailing results to all hospital leaders each week—and failure to open the email prompts a message report to the CEO.
After beefing up patient satisfaction training and working with relevant clinical areas to improve coordination, the hospital registration areas improved their Press Ganey survey results the past two years—emergency department registration went from single-digit percentiles to consistently achieving the 90th percentile, with significant improvement in other registration areas, as well.
Other patient-friendly practices from MAP Award winners include:
Improving patient pre-encounter process. Using input from its Patient Family Advisory Executive Council, Spectrum Health in Grand Rapids, Mich., is piloting a redesigned pre-encounter process in its radiology areas to provide streamlined communication and preparation.
Patients now receive just one pre-encounter call after scheduling a CT scan or other test. Before, the same patient might have received disparate calls from a few different people/offices, including the physician’s office, Spectrum Health scheduling, and the service line.
The health system improved 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.
Physician offices are given the option to serve as intermediary between the patient and Spectrum Health scheduling or hand off that responsibility to the health system to handle scheduling, preregistration, and other pre-encounter tasks.
Using a “one call” philosophy, Spectrum Health assigns a staff member—a scheduling/registration person for nonclinically complex patients or a member of the nursing team for a patient with more complex needs—to contact the patient, providing verification, scheduling, preregistration, out-of-pocket cost estimate, and any other preparation services.
“We think of it as holding their hands,” wrote Spectrum Health in its MAP Award application. “If we can demystify the revenue cycle process and allow patients to focus on their health—as opposed to worrying about what their condition will do to their financial position—we believe we are creating an exceptional experience, and maybe even contributing to better outcomes.”
Learn more about the 2011 Map Award winners.