Richard L. Clarke, DHA, FHFMAPresident and CEO, HFMA
Courage in Leadership, the theme of HFMA Chairman Joe Fifer, involves having the courage to speak up when things are going wrong, and the courage to do the right thing for the right reasons.
Lisa Goldstein, Moody’s team manager for healthcare ratings, writes in the forthcoming September issue of hfm magazine that “Successful leaders demonstrate a willingness to make and execute difficult decisions.” She notes that successful management teams establish strong credibility as demonstrated by their track record of achievement. In other words, they “walk the talk.”
Revenue cycle is an area where courage in leadership is needed. Issues such as pricing, billing and collection techniques for the uninsured, and accounting for community benefits require that leaders make the right decisions for the right reasons--not because of the threat of litigation or regulation.
Take pricing. List prices for medical services are almost impossible to defend without a long explanation about cost shifting, payer contracting, governmental rules, and so on. And these issues are real and complex. But many believe these explanations are merely ways to mask the true cost of these services. Reporters, consumer advocates, and legislators all decry this system of pricing--one that we appear to defend. Courage in leadership, however, would lead us to walk the talk by changing the method by which prices are set. And some provider organizations are doing just that. They are renegotiating payer contracts, developing pricing rationales based on cost or average payments, and working to eliminate regulatory barriers to rational prices at the state and national levels. It is not easy, and for the most part, it’s not currently required. But it is the right thing to do.
Similarly, developing, implementing, and publicly disclosing charity care and collection policies is an example of courage in leadership related to the revenue cycle. Recently, I listened to a consumer advocate who stated that while most hospitals may have rewritten their charity care policies, most do not publicly describe or display them. From the hospital perspective, there is a risk that some individuals will take advantage of the situation by providing incorrect information to meet criteria, or dropping health coverage to gain the benefit of our policies. But that concern should not drive the methods by which we implement and disclose these policies. Responding to the real issues faced by uninsured and underinsured persons of limited means is the key concern. Fully implementing and disclosing these policies is another way we demonstrate courage in leadership.
And what about accounting for community benefits for tax-exempt organizations? Some organizations attempt to justify their tax exemption by identifying everything that might be considered of value to the community. But walking the talk requires us to first proactively identify community needs, then to plan to meet them within the financial capability of the organization. It is a forward-looking approach to making a difference, not a backward-looking justification for exemption. And it’s done because it is the right thing to do.
HFMA has the tools to help. The key is having the courage to use these tools.
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