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.
Strategize for success with the nation's top performers at HFMA's Revenue Cycle Conference (MAP Event) from Sept. 25-27 in Phoenix, Arizona. Save $150 off the full conference rate when you register by July 29.
Learn about timely healthcare industry topics and earn CPEs with HFMA live and on-demand webinars. View the latest schedule.
Stay up-to-date in a rapidly changing industry in San Diego (August 10-12). Register early and save.
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.
In 2011, faced with steadily increasing costs, Trinity Regional Health System, Rock Island, Ill., began investigating opportunities to reduce pharmacy spend and optimize reimbursement. A comprehensive assessment of pharmacy operations uncovered a cost savings opportunity of $1.5 million to $2 million. The overall goal was to use less expensive medications and lower the quantities of medications used, where possible.
This is a sample article from HFMA's Healthcare Cost Containment, a subscription newsletter that shares provider-tested tactics for strategic cost control.
Learn more and subscribe
To accomplish these goals, Trinity leveraged data derived from benchmarking analyses to encourage physicians to avoid inefficient drug utilization practices, such as prescribing high-cost medications.
By using lower cost-drugs and making changes in drug administration and dosage practices, Trinity was able to save $1.9 million in 2012, or 14 percent of its pharmacy budget. Today, the health system is developing additional pharmacy improvement initiatives to reduce costs by another $1.2 million in 2013.
Trinity Regional, a four-hospital system that is a part of West Des Moines-based Iowa Health System, historically experienced annual increases of 3 percent in its pharmacy department. However, changes in patient mix and acuity levels in high-cost areas, such as oncology, were expected to increase costs by 6 percent in 2012.
A third-party assessment of the pharmacy department, including a review of inventory, organizational structure, and processes, identified opportunities for savings by improving medication utilization practices across clinical departments. The analysis benchmarked drug expenditures per adjusted inpatient day for each clinical area at Trinity against the same expenditures at a peer group of hospitals. Analyses of areas such as cardiology and oncology, in particular, revealed significant opportunities for savings.
A medication utilization team was tasked with pinpointing the cause of the higher-than-average costs in the clinical areas and identifying ways to reduce costs. The team included two pharmacists as well as representatives from finance and revenue cycle, who tracked and measured the results of initiatives and addressed questions regarding reimbursement.
The medication utilization team also worked with clinical administrators, such as the chief medical and nursing officers, to designate physician champions or key stakeholders who could use their influence with their colleagues to win support for implementing cost-saving strategies.
The utilization team found that an expensive drug used for oncology patients, costing $2,665 per dose, could be replaced with a less expensive, but clinically equivalent drug that cost just $249 per dose. Trinity’s chief medical officer recommended a particular oncologist as the champion on this initiative and, along with the utilization team, discussed with the physician the benefits of switching to the less expensive medication. The discussion was supported with third-party benchmarking data showing positive clinical experience with the lower-cost medication.
Persuaded by the data, the oncologist helped to develop protocols for using the less-expensive medication. As a result, utilization of the more expensive chemotherapy drug dropped 21 percent, for a savings of $160,000.
Other initiatives focused on drug administration and dosage. One standard industry practice that Trinity used for administering a particular antibiotic involved infusing the patient for an hour every six hours. Studies have shown that if the regimen and infusion process is changed to support administering the medication over a four-hour period every eight hours, less of the product is used, and patient outcomes are improved. The utilization team brought proposed changes to its pharmacy and therapeutics committee for approval and then worked to educate Trinity nurses on the benefits of and steps involved in changing the infusion process, such as changing the type of bags that held the medication. The new infusion process reduced use of the antibiotic by 25 percent, for savings of $198,000.
In addition to changing from a regular to an extended infusion of the antibiotic, Trinity switched to mixing the antibiotic with a solution onsite at the pharmacy, rather than buying the premixed medication in frozen form, a more expensive process that increased costs by 50 percent.
Over the course of a year, the Trinity team implemented 58 medication utilization initiatives, beginning in November 2011. Trinity saved $600,000 in the first six months of 2012; total real savings reached $1.9 million by the end of the year, with annualized savings adding up to $2.26 million.
Once cost savings opportunities and solutions were identified, focus shifted to working with physicians whose support was critical in achieving cost savings. Any barriers presented by physicians could impede success.
Data obtained from benchmarking analyses and published medical studies were presented in different ways. Physicians who were considered to be open to new ideas were approached first and armed with data they could then take to their wider group of colleagues for discussion. The chief medical officer was instrumental in identifying both physician champions and those who could be less receptive to change. The physician chosen to champion oncology initiatives, for example, had completed a training program for physician leaders offered through Trinity.
Because Trinity has incentive programs in place with medical groups, either through co-management or management agreements, an environment of cooperation already existed between physicians and Trinity. Consequently, physicians were open to understanding the need for cost reductions; however, their real interest rested in the clinical efficacy of the proposed changes in medication utilization.
The chief medical officer, Paul McLoone, MD, and the associate chief medical officer, Ahmed Okba, MD, reviewed and vetted research used to support proposed changes and took part in clinical discussions with physician groups. For example, the utilization team’s project leader met with clinical department heads first to explain proposed changes in the formulary and prescribing patterns.
What was key in gaining buy-in was how data were presented—with recommendations open to give-and-take discussions that centered on how a medication change would affect the way physicians practice.
Physicians readily adopted initiatives that were well-supported by data and made sense clinically; they also sometimes offered their own suggestions for improvement beyond the recommendations of the utilization team. For example, after learning that an expensive blood-thinning agent was being used even in cases where a less expensive agent was clinically appropriate, cardiologists developed guidelines for medication use in the cardiac catheterization lab, specifically noting when the more expensive agents should be used. This initiative led to savings of $120,000.
Since implementing these cost reduction initiatives, Trinity has embarked on additional pharmacy improvement projects focusing on such areas as utilization, contracting, and reimbursement. Initiatives include the following.
Patient assistance program. Trinity is developing a structured program, staffed by an FTE, for having medications given to qualifying indigent patients replenished by the manufacturer at no cost. Using software that will help to identify eligible patients, the patient assistance advocate will work with various departments, such as finance and case management, and clinicians to complete the application required for patients to be accepted into the program.
Contracting discounts with manufacturers. In addition to discounts provided through the group purchasing organization, Trinity would receive discounts for complying with additional terms that manufacturers may offer, such as pre-buying products (purchasing products in bulk based on previous purchasing history volumes, which enables the health system to buy the products at a discount while avoiding annual price increases).
Fast-tracking chemotherapy agents. Trinity is developing a subcommittee of pharmacy and therapeutics representatives to address physician requests for chemotherapy agents that are new on the market. The subcommittee will assess reimbursement of the new agents, help to educate pharmacy and nursing staff, and give patients a better indication of their costs for the new agents.
Repackaging. Trinity may be able to reduce expenses of select medications, such as oral solids, by buying in bulk and working with a licensed repackager to have the medications packaged in unit doses, rather than buying prepackaged unit doses from the manufacturer at a premium price.
Such initiatives are projected to save Trinity an additional $1.2 million in 2013, based on annualized figures. This savings is on top of the sustained savings from the initial medication utilization project.
The sum of multiple initiatives in pharmacy can have a substantial impact on the bottom line. However, managing so many opportunities requires a coordinated effort that begins with getting key stakeholders on board.
In Trinity’s initiative, finance and revenue cycle have also played key roles in sustaining results. Each month, the finance department provided the medication utilization team with savings reports on each initiative so the team could track progress and quickly address backward trends. For example, if a report showed that a high-cost drug that had been replaced had been repurchased, the utilization team could investigate the reason for the purchase and take steps to ensure compliance with the new utilization protocols.
Although the pharmacy presents ample and continuing opportunities for savings, the amount of pharmacy savings that a given hospital or health system can achieve will vary. Scanning for high-cost drugs and treatments that can be replaced with lower-cost alternatives is always a work in progress, but is worth the effort.
Cinda Bates, PharmD, MBA, is medication utilization management specialist, Trinity Regional Health System, Rock Island, Ill. ( firstname.lastname@example.org).
Barton S. Richards is a managing director, The Claro Group, Chicago, and a member of HFMA’s First Illinois Chapter ( email@example.com).
The following lessons learned through Trinity’s work in reducing pharmacy expenses could benefit other hospitals and health systems in containing pharmacy costs.
Employ change management. Getting stakeholders to accept change—the cultural aspect of any improvement initiative—is often the most challenging aspect of any initiative. Foster understanding of proposed changes by introducing information in small, palatable pieces. Address basic questions first: What is the project? Why are we doing it? What are the advantages? How will it affect me? How will it affect patients? Give stakeholders the vehicle—such as through give-and-take discussions—to voice concerns, ask questions, and offer input.
Prepare the data. Each medical staff has a different dynamic. Do not use a cookie cutter approach to presenting data; rather, determine the type of clinical and cost data that will be most compelling to physicians. Recognize that physicians will act on well-presented and coherent data. The more work that goes into building the support for change, the smoother the buy-in process will be and the greater the chance for success.
Dedicate resources. Form a multidisciplinary team of clinical and financial leaders who can address quality, outcomes, and cost issues and collaborate on solutions. Use a pharmacist in a full-time role who can address concerns of clinical stakeholders and lead the project across clinical and administrative departments.
Related article: How Trinity Regional Worked with Suppliers to Reduce Pharmacy Costs
Publication Date: Monday, February 11, 2013
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.
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.
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.
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.
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.
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.
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
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.
In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
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.
In this business profile, sponsored by SSI, Jay Colfer, vice president of sales and marketing, shares how patient access solutions are reversing the trend toward increased bad debt resulting from the rise in high-deductible consumer health plans.
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.
In this business profile of Deloitte Consulting, Matthew Hitch and David Betts explore the potential benefits of elevating the customer experience and outline strategies to change service delivery.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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's print, email, online, and mobile opportunities provide you maximum reach and impact. We will work with you to build a plan that meets your needs. Contact a sales rep.
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.
Stay informed about new directions in healthcare finance. Share tools and strategies for improving performance. Be an active participant in your profession. Together, we’ll reshape the business and practice of healthcare. Join us.
Copyright 2016, Healthcare Financial Management Association.
Join HFMA today and enjoy: